Acute Pulmonary Embolism in COVID-19: A Potential Connection between Venous Congestion and Thrombus Distribution.

Nevesny, Franck; Rotzinger, David C; Sauter, Alexander W; Löbelenz, Laura I; Schmuelling, Lena; Alkadhi, Hatem; Ebner, Lukas; Christe, Andreas; Platon, Alexandra; Poletti, Pierre-Alexandre; Qanadli, Salah D (2022). Acute Pulmonary Embolism in COVID-19: A Potential Connection between Venous Congestion and Thrombus Distribution. Biomedicines, 10(6) MDPI 10.3390/biomedicines10061300

[img]
Preview
Text
biomedicines-10-01300.pdf - Published Version
Available under License Creative Commons: Attribution (CC-BY).

Download (3MB) | Preview

BACKGROUND

Vascular abnormalities, including venous congestion (VC) and pulmonary embolism (PE), have been recognized as frequent COVID-19 imaging patterns and proposed as severity markers. However, the underlying pathophysiological mechanisms remain unclear. In this study, we aimed to characterize the relationship between VC, PE distribution, and alveolar opacities (AO).

METHODS

This multicenter observational registry (clinicaltrials.gov identifier NCT04824313) included 268 patients diagnosed with SARS-CoV-2 infection and subjected to contrast-enhanced CT between March and June 2020. Acute PE was diagnosed in 61 (22.8%) patients, including 17 females (27.9%), at a mean age of 61.7 ± 14.2 years. Demographic, laboratory, and outcome data were retrieved. We analyzed CT images at the segmental level regarding VC (qualitatively and quantitatively [diameter]), AO (semi-quantitatively as absent, <50%, or >50% involvement), clot location, and distribution related to VC and AO. Segments with vs. without PE were compared.

RESULTS

Out of 411 emboli, 82 (20%) were lobar or more proximal and 329 (80%) were segmental or subsegmental. Venous diameters were significantly higher in segments with AO (p = 0.031), unlike arteries (p = 0.138). At the segmental level, 77% of emboli were associated with VC. Overall, PE occurred in 28.2% of segments with AO vs. 21.8% without (p = 0.047). In the absence of VC, however, AO did not affect PE rates (p = 0.94).

CONCLUSIONS

Vascular changes predominantly affected veins, and most PEs were located in segments with VC. In the absence of VC, AOs were not associated with the PE rate. VC might result from increased flow supported by the hypothesis of pulmonary arteriovenous anastomosis dysregulation as a relevant contributing factor.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology

UniBE Contributor:

Löbelenz, Laura Isabel; Ebner, Lukas and Christe, Andreas

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2227-9059

Publisher:

MDPI

Language:

English

Submitter:

Pubmed Import

Date Deposited:

27 Jun 2022 09:28

Last Modified:

27 Jun 2022 09:28

Publisher DOI:

10.3390/biomedicines10061300

PubMed ID:

35740322

Uncontrolled Keywords:

CT CT-angiography infection lung pulmonary embolism

BORIS DOI:

10.48350/170921

URI:

https://boris.unibe.ch/id/eprint/170921

Actions (login required)

Edit item Edit item
Provide Feedback