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Guevara S, Miyara SJ, Aronsohn J, Homsi JT, McCann-Molmenti A, Mumford JM, Keber B, Shore-Lesserson L, Morales L, Metz CN, Cho YM, Molmenti CLS, Loto R, Pesce MM, Zafeiropoulos S, Giannis D, Pipolo DO, Jacque F, Montorfano L, Shinozaki K, Shoaib M, Choudhary RC, Nishikimi M, Takegawa R, Endo Y, Hayashida K, Fontan FM, Becker LB, Molmenti EP. COVID-19-Associated Portal Vein Thrombosis Post-Cholecystitis. Int J Angiol 2023; 32:262-268. [PMID: 37927847 PMCID: PMC10624542 DOI: 10.1055/s-0042-1743409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
This case study describes a 45-year-old Caucasian male with a past medical history of obesity, hypertension, and non-insulin-dependent diabetes mellitus, who in the setting of coronavirus disease 2019 (COVID-19) pneumonia, developed portal vein thrombosis (PVT) presenting as an acute abdomen after hospital discharge from a cholecystitis episode. PVT is a very infrequent thromboembolic condition, classically occurring in patients with systemic conditions such as cirrhosis, malignancy, pancreatitis, diverticulitis, autoimmunity, and thrombophilia. PVT can cause serious complications, such as intestinal infarction, or even death, if not promptly treated. Due to the limited number of reports in the literature describing PVT in the COVID-19 setting, its prevalence, natural history, mechanism, and precise clinical features remain unknown. Therefore, clinical suspicion should be high for PVT, in any COVID-19 patient who presents with abdominal pain or associated signs and symptoms. To the best of our knowledge, this is the first report of COVID-19-associated PVT causing extensive thrombosis in the portal vein and its right branch, occurring in the setting of early-stage cirrhosis after a preceding episode of cholecystitis.
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Affiliation(s)
- Sara Guevara
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Department of Family Medicine, Glen Cove Hospital, Glen Cove, New York
| | - Santiago J. Miyara
- Feinstein Institutes for Medical Research, Manhasset, New York, USA
- Elmezzi Graduate School of Molecular Medicine, Manhasset, New York
| | - Judith Aronsohn
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Department of Anesthesiology, North Shore University Hospital, Manhasset, New York
| | - Joseph T. Homsi
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - James M. Mumford
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Department of Family Medicine, Glen Cove Hospital, Glen Cove, New York
| | - Barbara Keber
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Department of Family Medicine, Glen Cove Hospital, Glen Cove, New York
| | - Linda Shore-Lesserson
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Department of Anesthesiology, North Shore University Hospital, Manhasset, New York
| | - Luis Morales
- Department of Surgery, North Shore University Hospital, Manhasset, New York
| | - Christine N. Metz
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Feinstein Institutes for Medical Research, Manhasset, New York, USA
- Elmezzi Graduate School of Molecular Medicine, Manhasset, New York
| | - Young Min Cho
- Department of Internal Medicine, Northeast Georgia Medical Center, Gainesville, Georgia
| | | | - Rodrigo Loto
- Department of Radiology, Delta Sanatorium, Rosario, Santa Fe, ARG
| | - Martin M. Pesce
- Department of Radiology, Delta Sanatorium, Rosario, Santa Fe, ARG
| | - Stefanos Zafeiropoulos
- Feinstein Institutes for Medical Research, Manhasset, New York, USA
- Elmezzi Graduate School of Molecular Medicine, Manhasset, New York
| | | | - Derek O. Pipolo
- Department of Surgery, North Shore University Hospital, Manhasset, New York
| | - Francky Jacque
- Department of Surgery, North Shore University Hospital, Manhasset, New York
| | | | - Koichiro Shinozaki
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
| | - Muhammad Shoaib
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | - Rishabh C. Choudhary
- Feinstein Institutes for Medical Research, Manhasset, New York, USA
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
| | - Mitsuaki Nishikimi
- Feinstein Institutes for Medical Research, Manhasset, New York, USA
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
| | - Ryosuke Takegawa
- Feinstein Institutes for Medical Research, Manhasset, New York, USA
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
| | - Yusuke Endo
- Feinstein Institutes for Medical Research, Manhasset, New York, USA
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
| | - Kei Hayashida
- Feinstein Institutes for Medical Research, Manhasset, New York, USA
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
| | - Fermin M. Fontan
- Department of Surgery, Memorial Medical Center, Las Cruces, New Mexico
| | - Lance B. Becker
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Feinstein Institutes for Medical Research, Manhasset, New York, USA
- Elmezzi Graduate School of Molecular Medicine, Manhasset, New York
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
| | - Ernesto P. Molmenti
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Feinstein Institutes for Medical Research, Manhasset, New York, USA
- Department of Surgery, North Shore University Hospital, Manhasset, New York
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Ghafoor S, Germann M, Jüngst C, Müllhaupt B, Reiner CS, Stocker D. Imaging features of COVID-19-associated secondary sclerosing cholangitis on magnetic resonance cholangiopancreatography: a retrospective analysis. Insights Imaging 2022; 13:128. [PMID: 35939241 PMCID: PMC9358102 DOI: 10.1186/s13244-022-01266-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/05/2022] [Indexed: 11/24/2022] Open
Abstract
Background Despite emerging reports of secondary sclerosing cholangitis (SSC) in critically ill COVID-19 patients little is known about its imaging findings. It presents as delayed progressive cholestatic liver injury with risk of progression to cirrhosis. Diagnosis cannot be made based on clinical presentation and laboratory markers alone. Magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) can aid in the diagnosis. The aim of this study was to describe MRI/MRCP imaging features of COVID-19-associated SSC. Results Seventeen patients (mean age 60.5 years, 15 male) who underwent MRI/MRCP were included. All had been admitted to intensive care unit (ICU) (median duration of ICU stay 10 weeks, range, 2–28 weeks) and developed acute respiratory distress syndrome requiring mechanical ventilation. On imaging, all patients had intrahepatic bile duct strictures and 10 (58.8%) had associated upstream dilatation. Intrahepatic bile duct beading was seen in 14 cases (82.3%). Only one patient (5.9%) had extrahepatic bile duct stricturing. Patchy arterial phase hyperenhancement and high signal on T2- and diffusion-weighted images were seen in 7 cases (53.8%) and 9 cases (52.9%), respectively. Biliary casts were seen in 2 cases (11.8%). Periportal lymphadenopathy and vascular complications were not seen. Conclusion On MRI/MRCP, COVID-19-associated SSC presents with multiple intrahepatic bile duct strictures with or without upstream dilatation and intrahepatic bile duct beading. Surrounding hepatic parenchymal changes including alterations in enhancement and T2 signal are common. The extrahepatic biliary tree was typically spared and periportal lymphadenopathy was missing in all patients. Supplementary Information The online version contains supplementary material available at 10.1186/s13244-022-01266-9.
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Affiliation(s)
- Soleen Ghafoor
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Manon Germann
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Christoph Jüngst
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Beat Müllhaupt
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Cäcilia S Reiner
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Daniel Stocker
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland. .,University of Zurich, Zurich, Switzerland.
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Akella R, Raj R, Kannan L, Jacob A. Coexisting Portal Vein Thrombosis and Aortic Thrombosis in a Patient with COVID-19: A Case Report and Literature Review. IDCases 2022; 28:e01509. [PMID: 35602469 PMCID: PMC9113953 DOI: 10.1016/j.idcr.2022.e01509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/05/2022] [Accepted: 05/16/2022] [Indexed: 11/29/2022] Open
Abstract
The Coronavirus Disease 2019 (COVID-19) pandemic has rapidly progressed, resulting in significant global morbidity and mortality. Predominantly affecting the respiratory tract, it has been found to be associated with extrapulmonary manifestations such as coagulopathies. We hereby report a case of an elderly man with no predisposing risk factors or history of hypercoagulable disorder who presented with acute onset abdominal pain and was diagnosed with portal vein thrombosis and splenic infarct two weeks following mild COVID-19. Incidentally, the patient was also noted to have aortic thrombosis. The patient was treated with therapeutic anticoagulation with complete resolution in his symptoms. Our case highlights a high risk of coagulopathy following infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
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Affiliation(s)
- Ramya Akella
- Department of Internal Medicine, Pikeville Medical Center, Pikeville, KY 41501, USA
- Correspondence to: Department of Internal Medicine, Pikeville Medical Center, 911 Bypass Road, Pikeville, KY 41501, USA.
| | - Rishi Raj
- Department of Internal Medicine, Department of Endocrinology, Diabetes and Metabolism, Pikeville Medical Center, Pikeville, KY 41501, USA
| | - Lakshmi Kannan
- Department of Internal Medicine, Division of Nephrology, Pikeville Medical Center, Pikeville, KY 41501, USA
| | - Aasems Jacob
- Department of Hematology and Oncology, Pikeville Medical Center, Pikeville, KY 41501, USA
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Antunes de Brito CA, de Oliveira Filho JRB, Marques DT, Lencastre MDC, de Almeida JR, Lopes EP. COVID-19 and Hepatic Artery Thrombosis: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e932531. [PMID: 34333508 PMCID: PMC8340922 DOI: 10.12659/ajcr.932531] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Patient: Female, 45-year-old Final Diagnosis: COVID-19 • hepatic artery thrombosis Symptoms: Abdominal pain • anosmia • asthenia • cough • dysgeusia • headache • myalgia • sore throat Medication: — Clinical Procedure: Anticoagulant Specialty: Gastroenterology and Hepatology • Infectious Diseases
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Affiliation(s)
- Carlos Alexandre Antunes de Brito
- Department of Internal Medicine, Center of Medical Sciences of Federal University of Pernambuco, Recife, PE, Brazil.,Department of Immunology, Autoimmune Research Institute, Recife, PE, Brazil
| | | | - Diogo Torres Marques
- Department of Radiology, Royal Portuguese Hospital of Beneficence, Recife, PE, Brazil
| | - Maria do Carmo Lencastre
- Alberto Ferreira da Costa Institute, Royal Portuguese Hospital of Beneficence, Recife, PE, Brazil
| | - José Roberto de Almeida
- Department of Internal Medicine, Center of Medical Sciences of Federal University of Pernambuco, Recife, PE, Brazil
| | - Edmundo Pessoa Lopes
- Department of Internal Medicine, Center of Medical Sciences of Federal University of Pernambuco, Recife, PE, Brazil
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Gracia-Ramos AE, Jaquez-Quintana JO, Contreras-Omaña R, Auron M. Liver dysfunction and SARS-CoV-2 infection. World J Gastroenterol 2021; 27:3951-3970. [PMID: 34326607 PMCID: PMC8311530 DOI: 10.3748/wjg.v27.i26.3951] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/09/2021] [Accepted: 06/16/2021] [Indexed: 02/06/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 infection is the cause of coronavirus disease 2019 (COVID-19), which predominantly affects the respiratory system; it also causes systemic and multi-organic disease. Liver damage is among the main extrapulmonary manifestations. COVID-19-associated liver injury is defined as any liver damage occurring during the disease course and treatment of COVID-19 in patients with or without pre-existing liver disease, and occurs in approximately one in five patients. Abnormal liver test results have been associated with a more severe course of COVID-19 and other complications, including death. Mechanisms linking COVID-19 to liver injury are diverse. Particular consideration should be made for patients with pre-existing liver disease, such as metabolic dysfunction-associated fatty liver disease, chronic liver disease due to viral or autoimmune disease, liver transplant carriers, or cirrhosis, given the risk for more severe outcomes. This manuscript summarizes the current lines of evidence on COVID-19-associated liver injury regarding pathophysiology, clinical significance, and management in both patients with or without pre-existing liver disease, to facilitate clinicians' access to updated information and patient care. Finally, we mention the ideas and recommendations to be considered for future research.
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Affiliation(s)
- Abraham Edgar Gracia-Ramos
- Department of Internal Medicine, General Hospital, National Medical Center "La Raza", Instituto Mexicano del Seguro Social, Mexico City 02990, Mexico
| | - Joel Omar Jaquez-Quintana
- Gastroenterology Service and Department of Internal Medicine, Faculty of Medicine, University Hospital "Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico
| | - Raúl Contreras-Omaña
- Centro de Estudio e Investigación en Enfermedades Hepáticas y Toxicológicas (CEIHET), Pachuca 42184, Mexico
| | - Moises Auron
- Departments of Hospital Medicine and Pediatric Hospital Medicine, Cleveland Clinic, Cleveland, OH 44195, United States
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