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Borulu F, Ceyhun G, Çalik ES, Jalalzai I, Usta H. Multiple Arterial Thrombosis after COVID-19: A Case Report. Vasc Specialist Int 2023; 39:34. [PMID: 37936477 PMCID: PMC10630740 DOI: 10.5758/vsi.230063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 11/09/2023] Open
Abstract
Since the beginning of severe acute respiratory syndrome Coronavirus 2 pandemic, many reports have pointed to states of incrieased hypercoagulability during the acute phase of the disease. We report a 63-year-old female who developed acute mesenteric ischemia due to celiac trunk and superior mesenteric artery thrombi together with acute lower extremity ischemia caused by saddle embolism of the iliac bifurcation and thrombosis of the left external iliac artery. These thrombi developed 20 days after discharge from an intensive care unit due to severe pneumonia and pulmonary embolism associated with COVID-19. The patient had consecutive interventions. Surgical thrombectomy for aortoiliac thrombosis was performed and the mesenteric thrombosis was treated by percutaneous endovascular intervention. We emphasize that the prothrombotic state after COVID-19 infection may persist long after the acute symptomatic phase.
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Affiliation(s)
- Ferhat Borulu
- Department of Cardiovascular Surgery, Ordu University Medical Faculty, Ordu, Turkey
| | - Gökhan Ceyhun
- Departments of Cardiology, Ataturk University Medical Faculty, Erzurum, Turkey
| | - Eyüp Serhat Çalik
- Departments of Cardiovascular Surgery, Ataturk University Medical Faculty, Erzurum, Turkey
| | - Izatullah Jalalzai
- Departments of Cardiovascular Surgery, Ataturk University Medical Faculty, Erzurum, Turkey
| | - Hakan Usta
- Departments of Cardiovascular Surgery, Ataturk University Medical Faculty, Erzurum, Turkey
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2
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Splenic Artery Infarct Requiring Surgery: A Rare Complication of COVID-19 Infection. Case Rep Surg 2022; 2022:3391405. [PMID: 36505726 PMCID: PMC9729033 DOI: 10.1155/2022/3391405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/22/2022] [Accepted: 11/11/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction. Coronavirus disease (COVID-19) from SARS-CoV-2 infection is linked to a hypercoagulable state, leading to arterial and venous thrombotic events, of which pulmonary embolism is the most frequent. However, arterial thromboembolisms may also occur as visceral infracts in unusual sites, such as the renal, splenic, and intestinal arteries. Case Report. A 46-year-old unvaccinated male with a COVID-19 infection was admitted to the COVID-19 isolation ward with symptoms of respiratory infection. He complained of epigastric pain and fever for several days; radiological imaging of the abdomen revealed complete splenic arterial occlusion due to a large infarct. He was treated with low molecular weight heparin (enoxaparin) in therapeutic doses, resulting in minimal improvement. However, the pain worsened, and eventually, a laparotomy and splenectomy were performed. He was hospitalized for another 36 days before he was discharged in good condition. A second surgery was performed to remove a noninfected encapsulated hematoma from the subdiaphragmatic space. The patient remained healthy afterward, with no relapses. Discussion. Although rare, the number of cases of visceral infarcts in COVID-19 patients has increased. Splenic artery infarct is an exceptional case of acute abdominal pain that can be treated successfully with anticoagulant medication. Splenectomy may be required to manage refractory pain after failure of conservative management.
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3
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Shokri Varniab Z, Pourabhari Langroudi A, Amouei M, Pak N, Khosravi B, Radmard AR. Abdominal Imaging Findings in Patients with COVID-19 Part 2: Solid Organs. Middle East J Dig Dis 2022; 14:373-381. [PMID: 37547497 PMCID: PMC10404099 DOI: 10.34172/mejdd.2022.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/10/2022] [Indexed: 08/08/2023] Open
Abstract
Since severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) first appeared in China in December 2019, the globe has been dealing with an ever-increasing incidence of coronavirus disease 2019 (COVID-19). In addition to respiratory disorders, 40% of patients present with gastrointestinal (GI) involvement. Abdominal pain is the most common indication for computed tomography (CT) and ultrasonography. After GI tract involvement, solid visceral organ infarction is the most prevalent abdominal abnormality in COVID-19. This review aims to gather the available data in the literature about imaging features of solid abdominal organs in patients with COVID-19. Gallbladder wall thickening and distension, cholelithiasis, hyperdense biliary sludge, acalculous cholecystitis, periportal edema, heterogeneous liver enhancement, and liver hypodensity and infarction are among hepatobiliary imaging findings in CT, particularly in patients admitted to ICU. Pancreatic involvement can develop as a result of direct SARS-CoV2 invasion with signs of acute pancreatitis in abdominal CT, such as edema and inflammation of the pancreas. Infarction was the most prevalent renal and splenic involvement in patients with COVID-19 who underwent abdominal CT presenting with areas of parenchymal hypodensity. In conclusion, although solid abdominal organs are rarely affected by COVID-19, clinicians must be familiar with the manifestations since they are associated with the disease severity and poor outcome.
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Affiliation(s)
- Zahra Shokri Varniab
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mehrnam Amouei
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Pak
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Bardia Khosravi
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Reza Radmard
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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4
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Belfiore MP, Russo GM, Gallo L, Atripaldi U, Tamburrini S, Caliendo V, Impieri L, Del Canto MT, Ciani G, Parrella P, Mangoni di Santo Stefano ML, Salvia AAH, Urraro F, Nardone V, Coppola N, Reginelli A, Cappabianca S. Secondary Complications in COVID-19 Patients: A Case Series. Tomography 2022; 8:1836-1850. [PMID: 35894019 PMCID: PMC9326591 DOI: 10.3390/tomography8040154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction. Coronavirus SARS-CoV-2, the causative agent of COVID-19, primarily causes a respiratory tract infection that is not limited to respiratory distress syndrome, but it is also implicated in other body systems. Systemic complications were reported due to an exaggerated inflammatory response, which involves severe alveolar damage in the lungs and exacerbates the hypercoagulation that leads to venous thrombosis, ischemic attack, vascular dysfunction and infarction of visceral abdominal organs. Some complications are related to anticoagulant drugs that are administrated to stabilize hypercoagulability, but increase the risk of bleeding, hematoma and hemorrhage. The aim of this study is to report the diagnostic role of CT in the early diagnosis and management of patients with severe COVID-19 complications through the most interesting cases in our experience. Material and Methods. The retrospective analysis of patients studied for COVID-19 in our institution and hospitals, which are part of the university training network, was performed. Cases. Pneumomediastinum, cortical kidney necrosis, splenic infarction, cerebral ischemic stroke, thrombosis of the lower limb and hematomas are the most major complications that are reviewed in this study. Conclusions. Since the onset of the COVID-19 pandemic, the CT imaging modality with its high sensitivity and specificity remains the preferred imaging choice to diagnose early the different complications associated with COVID-19, such as thrombosis, ischemic stroke, infarction and pneumomediastinum, and their management, which significantly improved the outcomes.
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Affiliation(s)
- Maria Paola Belfiore
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 80138 Naples, Italy; (M.P.B.); (L.G.); (U.A.); (V.C.); (L.I.); (M.T.D.C.); (G.C.); (P.P.); (A.A.H.S.); (F.U.); (V.N.); (N.C.); (A.R.); (S.C.)
| | - Gaetano Maria Russo
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 80138 Naples, Italy; (M.P.B.); (L.G.); (U.A.); (V.C.); (L.I.); (M.T.D.C.); (G.C.); (P.P.); (A.A.H.S.); (F.U.); (V.N.); (N.C.); (A.R.); (S.C.)
- Correspondence: ; Tel.: +39-3495838248
| | - Luigi Gallo
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 80138 Naples, Italy; (M.P.B.); (L.G.); (U.A.); (V.C.); (L.I.); (M.T.D.C.); (G.C.); (P.P.); (A.A.H.S.); (F.U.); (V.N.); (N.C.); (A.R.); (S.C.)
| | - Umberto Atripaldi
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 80138 Naples, Italy; (M.P.B.); (L.G.); (U.A.); (V.C.); (L.I.); (M.T.D.C.); (G.C.); (P.P.); (A.A.H.S.); (F.U.); (V.N.); (N.C.); (A.R.); (S.C.)
| | - Stefania Tamburrini
- Department of Radiology, Ospedale del Mare, Via Enrico Russo, 80147 Naples, Italy;
| | - Valentina Caliendo
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 80138 Naples, Italy; (M.P.B.); (L.G.); (U.A.); (V.C.); (L.I.); (M.T.D.C.); (G.C.); (P.P.); (A.A.H.S.); (F.U.); (V.N.); (N.C.); (A.R.); (S.C.)
| | - Luigi Impieri
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 80138 Naples, Italy; (M.P.B.); (L.G.); (U.A.); (V.C.); (L.I.); (M.T.D.C.); (G.C.); (P.P.); (A.A.H.S.); (F.U.); (V.N.); (N.C.); (A.R.); (S.C.)
| | - Maria Teresa Del Canto
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 80138 Naples, Italy; (M.P.B.); (L.G.); (U.A.); (V.C.); (L.I.); (M.T.D.C.); (G.C.); (P.P.); (A.A.H.S.); (F.U.); (V.N.); (N.C.); (A.R.); (S.C.)
| | - Giovanni Ciani
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 80138 Naples, Italy; (M.P.B.); (L.G.); (U.A.); (V.C.); (L.I.); (M.T.D.C.); (G.C.); (P.P.); (A.A.H.S.); (F.U.); (V.N.); (N.C.); (A.R.); (S.C.)
| | - Pasquale Parrella
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 80138 Naples, Italy; (M.P.B.); (L.G.); (U.A.); (V.C.); (L.I.); (M.T.D.C.); (G.C.); (P.P.); (A.A.H.S.); (F.U.); (V.N.); (N.C.); (A.R.); (S.C.)
| | | | - Antonio Alessandro Heliot Salvia
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 80138 Naples, Italy; (M.P.B.); (L.G.); (U.A.); (V.C.); (L.I.); (M.T.D.C.); (G.C.); (P.P.); (A.A.H.S.); (F.U.); (V.N.); (N.C.); (A.R.); (S.C.)
| | - Fabrizio Urraro
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 80138 Naples, Italy; (M.P.B.); (L.G.); (U.A.); (V.C.); (L.I.); (M.T.D.C.); (G.C.); (P.P.); (A.A.H.S.); (F.U.); (V.N.); (N.C.); (A.R.); (S.C.)
| | - Valerio Nardone
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 80138 Naples, Italy; (M.P.B.); (L.G.); (U.A.); (V.C.); (L.I.); (M.T.D.C.); (G.C.); (P.P.); (A.A.H.S.); (F.U.); (V.N.); (N.C.); (A.R.); (S.C.)
| | - Nicola Coppola
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 80138 Naples, Italy; (M.P.B.); (L.G.); (U.A.); (V.C.); (L.I.); (M.T.D.C.); (G.C.); (P.P.); (A.A.H.S.); (F.U.); (V.N.); (N.C.); (A.R.); (S.C.)
| | - Alfonso Reginelli
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 80138 Naples, Italy; (M.P.B.); (L.G.); (U.A.); (V.C.); (L.I.); (M.T.D.C.); (G.C.); (P.P.); (A.A.H.S.); (F.U.); (V.N.); (N.C.); (A.R.); (S.C.)
| | - Salvatore Cappabianca
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 80138 Naples, Italy; (M.P.B.); (L.G.); (U.A.); (V.C.); (L.I.); (M.T.D.C.); (G.C.); (P.P.); (A.A.H.S.); (F.U.); (V.N.); (N.C.); (A.R.); (S.C.)
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5
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Childers J, Do TVC, Smith F, Vangara A, Ganti SS, Akella R. Incidental and Asymptomatic Splenic Infarction and Infrarenal Thrombus in a COVID-19 Patient. Cureus 2022; 14:e26555. [PMID: 35936145 PMCID: PMC9348832 DOI: 10.7759/cureus.26555] [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] [Accepted: 07/04/2022] [Indexed: 12/03/2022] Open
Abstract
The cytokine storm associated with coronavirus disease 2019 (COVID-19) triggers a hypercoagulable state leading to venous and arterial thromboembolism. Lab findings associated with this phenomenon are elevated D-dimer, fibrinogen, C-reactive protein (CRP), ferritin, and procalcitonin. We present the case of a 66-year-old male with dyslipidemia who was diagnosed with COVID-19 with worsening shortness of breath, myalgia, and loss of taste. Physical examination was remarkable for crackles with diminished lung sounds and use of his accessory muscles. Labs showed normal white blood cell count, D-dimer of 1.42 mg/L, ferritin of 961 ng/mL, lactate dehydrogenase (LDH) of 621 U/L, and CRP of 2.1 mg/dL. Chest X-ray showed atypical pneumonitis with patchy abnormalities. He required oxygen supplementation with fraction of inspired oxygen of 100% proning as tolerated. He received remdesivir, ceftriaxone, azithromycin, dexamethasone, prophylactic enoxaparin, and a unit of plasma therapy. His D-dimer had increased from 1.65 to 3.51 mg/L with worsening dyspnea. At this time, computed tomography angiogram (CTA) of the chest showed extensive ground-glass opacities and a 2.4 × 1.9 × 1.3 cm distal thoracic aortic intraluminal thrombus. He was started on a heparin drip. A follow-up CTA of the aorta showed thrombus or hypoattenuation within the splenic artery and wedge-shaped areas extending from the hilum with possible infarction and a 6 mm thrombus in the infrarenal abdominal aorta. He was transitioned to enoxaparin 1 mg/kg twice daily. He remained asymptomatic from his splenic infarction. This case adds more insight to splenic infarction associated with COVID-19 in addition to the 32 reported cases documented thus far. Management of thromboembolism includes a therapeutic dose of anticoagulation. To prevent thromboembolism, prophylactic anticoagulation is recommended for those hospitalized with COVID-19.
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6
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Aissaoui O, Husam S, Mounir A, Benouna EG, Benmallem O, El Kettani C, Barrou L. Concomitant acute limb ischemia and myocardial infarction: another challenge of COVID-19's hypercoagulability. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2022; 12:149-152. [PMID: 35873181 PMCID: PMC9301031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 05/26/2022] [Indexed: 06/15/2023]
Abstract
The COVID-19, actual pandemic due to SARS COV 2 is associated with numerous thromboembolic complications. Although venous thrombosis including pulmonary embolisms have been widely described, arterial localization seems rarely reported. Acute limb ischemia and myocardial infarction are two major consequences of arterial thrombosis and their concomitant occurrence among COVID-19 patients is extremely rare. It is an evident aspect of hypercoagulability and a real challenge to physicians. We herein describe the management of a 77 years old COVID-19 patient presenting an acute lower limb ischemia with concomitant myocardial infarction. He underwent coronary angiography with subsequent stent placement then was transferred to the operating room where a thrombectomy was performed. The outcome was poor as the cardiogenic shock persisted in addition to a reperfusion syndrome with multiorgan failure.
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Affiliation(s)
- Ouissal Aissaoui
- Department of Intensive Care and Anesthesiology, Ibn Rochd University Hospital, Laboratory of Clinical Immunology, Inflammation and Allergy (LICIA), Hassan II University of CasablancaMorocco
| | - Salem Husam
- Department of Intensive Care and Anesthesiology, Ibn Rochd University Hospital, Laboratory of Clinical Immunology, Inflammation and Allergy (LICIA), Hassan II University of CasablancaMorocco
| | - Anass Mounir
- Department of Intensive Care and Anesthesiology, Ibn Rochd University Hospital, Laboratory of Clinical Immunology, Inflammation and Allergy (LICIA), Hassan II University of CasablancaMorocco
| | - El Ghali Benouna
- Department of Cardiology, Ibn Rochd University Hospital, Hassan II University of CasablancaMorocco
| | - Othmane Benmallem
- Department of Cardiology, Ibn Rochd University Hospital, Hassan II University of CasablancaMorocco
| | - Chafik El Kettani
- Department of Intensive Care and Anesthesiology, Ibn Rochd University Hospital, Laboratory of Clinical Immunology, Inflammation and Allergy (LICIA), Hassan II University of CasablancaMorocco
| | - Lahoucine Barrou
- Department of Intensive Care and Anesthesiology, Ibn Rochd University Hospital, Laboratory of Clinical Immunology, Inflammation and Allergy (LICIA), Hassan II University of CasablancaMorocco
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7
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Al Suwaidi S, Alakasheh BJ, Al-Ozaibi LS. Splenic Infarction in a COVID-19 Patient without Respiratory Symptoms. DUBAI MEDICAL JOURNAL 2022. [PMCID: PMC8805056 DOI: 10.1159/000521207] [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] [Indexed: 11/19/2022] Open
Abstract
High rates of thromboembolic events have been seen in cases of COVID-19. Here, we report a case of 23-year-old previously healthy female presented with left-sided abdominal pain associated with vomiting. The computed tomography scan showed multiple ill-defined wedge-shaped low attenuating areas of the spleen, suggesting splenic infarction. In the absence of other thromboembolic contributing factors, we believe this was a thromboembolic event in splenic circulation in relation to COVID-19 infection. Our case adds to the evidence of an arterial thrombotic event in a noncritical COVID-19 patient, emphasizing the importance of addressing thromboembolism diagnosis and management measures to avoid potentially deadly consequences.
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8
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Thrombosis leading to acute abdomen in corona virus disease- 19:A case series. Indian J Gastroenterol 2022; 41:313-318. [PMID: 35907170 PMCID: PMC9362381 DOI: 10.1007/s12664-022-01260-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/30/2022] [Indexed: 02/04/2023]
Abstract
Involvement of the gastrointestinal (GI) system in corona virus disease-19 (COVID-19) in form of diarrhea, loss of taste, nausea, and anorexia is common and associated with poor prognosis. COVID-19 is also associated with a hypercoagulable state that mainly involves the pulmonary vasculature. However, GI complications involving thrombosis are observed infrequently. We report two COVID-19 patients who had two different causes of acute abdomen. The first patient was a 49-year-old male diagnosed with an aortic thrombus along with a splenic infarct. He was diagnosed early and successfully managed with anticoagulants. The second patient was a 30-year-old male who developed pain in the abdomen and was found to have features suggestive of peritonitis. A contrast-enhanced computerized tomography (CECT) scan of the abdomen revealed dilated bowel loops. Immediate exploratory laparotomy was performed; he was found to have jejunal perforation with gangrene. Histopathological examination of the resected specimen showed inflammatory cells with edema and thrombotic vessels. However, he succumbed to sepsis and multiorgan failure. Therefore, it is important to investigate cases of acute abdomen in COVID-19 thoroughly and whenever indicated CT angiogram should be obtained.
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9
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Alvarenga Fernandes D, Batista Araújo Filho JDA, Ribeiro de Jesus A. SARS-CoV-2 and splenic infarction: a rarely described thromboembolic presentation. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2022; 114:52-53. [PMID: 33761750 DOI: 10.17235/reed.2021.7964/2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We report the case of a COVID-19 patient presenting with fever, headache and dyspnea, evolving with severe acute abdominal pain. A contrast-enhanced computed tomography (CT) scan diagnosed splenic infarction. We emphasize the importance of seeking the identification of complications of SARS-CoV-2 infection, notably thromboembolic events, with the potential to reduce the morbidity and mortality of the disease. Studies on radiological aspects involving the spleen and splenic infarctions associated with COVID-19 are rare.
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Affiliation(s)
| | | | - Amélia Ribeiro de Jesus
- Immunology Investigative Institute, UniversitHospital Universitario. Universidade Federal de Sergipe, Brasil
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10
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Prentice G, Wilson S, Coupland A, Bicknell S. Complete splenic infarction in association with COVID-19. BMJ Case Rep 2021; 14:14/12/e246274. [PMID: 34876448 PMCID: PMC8655515 DOI: 10.1136/bcr-2021-246274] [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] [Indexed: 11/04/2022] Open
Abstract
COVID-19 predominantly affects the respiratory system. As a novel disease, understanding of its management and complications continues to grow. Herein, we present a case of almost complete splenic infarction in a patient with COVID-19 pneumonia. This case highlights the need to maintain diagnostic vigilance whilst investigating secondary complications of COVID-19. It is also important to stress the high incidence of thromboembolic complications in patients with COVID-19, which may occur anywhere in the vasculature.
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Affiliation(s)
- Graham Prentice
- Respiratory Department, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Stephen Wilson
- Respiratory Department, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Alexander Coupland
- Radiology Department, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Stephen Bicknell
- Respiratory Department, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
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11
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Moradi H, Mouzannar S, Miratashi Yazdi SA. Post COVID-19 splenic infarction with limb ischemia: A case report. Ann Med Surg (Lond) 2021; 71:102935. [PMID: 34659749 PMCID: PMC8500846 DOI: 10.1016/j.amsu.2021.102935] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/07/2021] [Accepted: 10/07/2021] [Indexed: 12/20/2022] Open
Abstract
Introduction and importance: COVID-19 has been associated with thrombotic events in a variety of organs and systems, with pulmonary embolism being the most prevalent. Splenic infarction, renal infarction, and intestinal ischemia have all been documented recently as abdominal visceral infarctions. Case presentation A 59 years old female patient with a history of COVID-19 disease was admitted to our hospital due to her left upper quadrant abdominal and left flank pain. She had a history of left heel color change in few days. We perform an ultrasound and it was shown vein thrombosis. So, heparin infusion was started for her. We also performed a thoraco-abdominopelvic computed tomography (CT) with intravenous and oral contrast. Total evidence suggests a splenic system infarction. A regular clinical examination for malignancy was performed on the patient and there was no evidence of cancer. Other probable reasons were ruled out. The patient was diagnosed with splenic infarction, Due to coagulopathy caused by SARS-Cov-2 infection. Treatment with heparin was continued for 5 days and she was discharged home on day 9 with oral agents. The patient was asymptomatic when she returned. The spleen had decreased in size on the follow-up CT, and there were no clinical complications. Discussion and conclusions Spleen artery thrombosis is a rare complication of COVID-19. In this report, we described a 59 years old female with a history of COVID-19. She was discharged home and in follow-up, there was no evidence of thrombosis anymore. Due to COVID-19 pandemic, it is important to report any new cases. Splenic infarction is reported as a COVID-19 complication. Limb ischemia simultaneously with spleen infarction is very rare. It is important to notice coagulopathy and its treatment in COVID-19 patients.
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Affiliation(s)
- Hazhir Moradi
- Medical Student, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Samah Mouzannar
- Department of Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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12
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Berrichi S, Bouayed Z, Berrajaa S, Mezzeoui SE, Moujahid A, Nasri S, Bkiyar H, Skiker I, Housni B. Acute limb ischemia with concomitant splenic and renal infarcts: Thromboembolic events revealing COVID-19. Ann Med Surg (Lond) 2021; 68:102646. [PMID: 34341687 PMCID: PMC8319040 DOI: 10.1016/j.amsu.2021.102646] [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: 06/09/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 11/01/2022] Open
Abstract
Introduction Since December 2019, the coronavirus 19 (COVID-19) pandemic continues to spread worldwide and has caused millions of deaths. Although the main manifestation of the disease is acute respiratory distress syndrome, hypercoagulability resulting from hypoxemia leads to venous thromboembolism and arterial thrombosis, which have a fatal prognosis for COVID-19. Case report management We report the case of patient admitted to our unit for management of a concomitant limb ischemia, splenic and renal infarcts associated to a COVID-19 infection with favorable outcomes after thrombectomy and therapeutic doses of heparin. Conclusion Systemic procoagulant manifestations related to a COVID-19 infection is a newly described phenomenon responsible of cardiovascular and neurological disorders.
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Affiliation(s)
- Samia Berrichi
- Anesthesiology and Intensive Care Unit Department, Faculty of Medicine and Pharmacy Oujda, Mohammed VI University Hospital Center, Mohammed University 1st, Oujda, Morocco
| | - Zakaria Bouayed
- Radiology Department, Faculty of Medicine and Pharmacy Oujda, Mohammed VI University Hospital Center, Mohammed University 1st, Oujda, Morocco
| | - Sara Berrajaa
- Anesthesiology and Intensive Care Unit Department, Faculty of Medicine and Pharmacy Oujda, Mohammed VI University Hospital Center, Mohammed University 1st, Oujda, Morocco
| | - Sanae El Mezzeoui
- Anesthesiology and Intensive Care Unit Department, Faculty of Medicine and Pharmacy Oujda, Mohammed VI University Hospital Center, Mohammed University 1st, Oujda, Morocco
| | - Amal Moujahid
- Radiology Department, Faculty of Medicine and Pharmacy Oujda, Mohammed VI University Hospital Center, Mohammed University 1st, Oujda, Morocco
| | - Siham Nasri
- Radiology Department, Faculty of Medicine and Pharmacy Oujda, Mohammed VI University Hospital Center, Mohammed University 1st, Oujda, Morocco
| | - Houssam Bkiyar
- Anesthesiology and Intensive Care Unit Department, Faculty of Medicine and Pharmacy Oujda, Mohammed VI University Hospital Center, Mohammed University 1st, Oujda, Morocco
| | - Imane Skiker
- Radiology Department, Faculty of Medicine and Pharmacy Oujda, Mohammed VI University Hospital Center, Mohammed University 1st, Oujda, Morocco
| | - Brahim Housni
- Anesthesiology and Intensive Care Unit Department, Faculty of Medicine and Pharmacy Oujda, Mohammed VI University Hospital Center, Mohammed University 1st, Oujda, Morocco.,Oujda Medical Simulation Training Center, Faculty of Medicine and Pharmacy, Oujda, Morocco
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13
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Splenic infarction with aortic thrombosis in COVID-19. Am J Med Sci 2021; 362:418-423. [PMID: 34161825 PMCID: PMC8214812 DOI: 10.1016/j.amjms.2021.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 05/23/2021] [Accepted: 06/18/2021] [Indexed: 12/30/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has been associated with an increased risk of venous and arterial thrombotic disease. Although pulmonary embolism has been the most common thrombotic complication, there have been recent reports of COVID-19-associated large-vessel ischemic stroke, acute upper- and lower-limb ischemia, as well as infarctions of the abdominal viscera, including renal, splenic, and small bowel infarctions. Here, we describe a case of splenic infarction (SI) associated with aortic thrombosis, which evolved despite the prophylactic use of low-molecular-weight heparin (LMWH), in a 60-year-old female patient with COVID-19. The patient was treated clinically with a therapeutic dose of LMWH, followed by warfarin, and eventually presented a favorable outcome. We also present a review of the literature regarding SI in patients with COVID-19.
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14
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Knefati M, Ganim I, Schmidt J, Makkar A, Igtiben S, Landa E, Tarawneh A, Hicks C, Zimmerman S, Sukpraprut-Braaten S. COVID-19 With an Initial Presentation of Intraperitoneal Hemorrhage Secondary to Spontaneous Splenic Rupture. Cureus 2021; 13:e15310. [PMID: 34211811 PMCID: PMC8236337 DOI: 10.7759/cureus.15310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 01/08/2023] Open
Abstract
The WHO declared coronavirus disease 2019 (COVID-19) a global pandemic in early 2020. As the pandemic has continued to evolve over a period of several months, many cases of unusual presentations are now emerging, which pose a greater challenge for physicians in terms of quickly identifying COVID-19 patients based on initial signs and symptoms. In this report, we present one such unusual presentation in a patient with sudden intraperitoneal hemorrhage and spontaneous splenic rupture with COVID-19 as the likely etiology and contributing factor. The patient was a 75-year-old Caucasian woman who presented to the emergency department (ED) with complaints of severe left-sided abdominal pain for several days without any preceding trauma. A CT of the abdomen/pelvis revealed a large amount of fluid in the abdomen, which raised suspicion of bleeding. An exploratory laparotomy revealed splenic rupture with hemoperitoneum, and the patient subsequently underwent an emergent splenectomy. The patient's COVID-19 antigen test returned positive during the surgery and was subsequently confirmed with a polymerase chain reaction (PCR) test. COVID-19 has been found to result primarily in respiratory symptoms through its ability to invade endothelial cells via angiotensin-converting enzyme 2 affinity. It is speculated that this mechanism may cause a predisposition to micro-thromboses, which can eventually lead to manifestations such as large lymphoid organ thrombosis. Based on this case presentation and the evolving literature on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), spontaneous splenic rupture is an emergent differential diagnosis that should be considered in COVID-19 patients presenting with gastrointestinal complaints such as abdominal pain and nausea.
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Affiliation(s)
| | | | | | | | | | - Eric Landa
- Internal Medicine, Unity Health, Searcy, USA
| | - Ahmad Tarawneh
- Pulmonary and Critical Care Medicine, Unity Health, Searcy, USA
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15
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Norton EJ, Sheikh N. Splenic Infarct Due to a Patent Foramen Ovale and Paradoxical Emboli Post-COVID-19 Infection: A Case Study. Cureus 2021; 13:e14887. [PMID: 34109076 PMCID: PMC8180182 DOI: 10.7759/cureus.14887] [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] [Indexed: 11/13/2022] Open
Abstract
Hypercoagulability is now a recognized complication of COVID-19 infection. Despite this, splenic infarction remains rare and is often found incidentally, radiologically, or at autopsy. We report a case of symptomatic splenic infarction with superimposed infection, secondary to COVID-19-induced hypercoagulability in a young patient with paradoxical emboli due to an undiagnosed patent foramen ovale (PFO). This multifactorial case should prompt a level of suspicion of the patient with unexplained abdominal pain and recent COVID-19 infection.
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Affiliation(s)
- Emma J Norton
- Gastroenterology Department, West Suffolk NHS Foundation Trust, Bury St Edmunds, GBR.,Division of Anaesthesia, University of Cambridge, Cambridge, GBR
| | - Nadim Sheikh
- Gastroenterology Department, West Suffolk NHS Foundation Trust, Bury St Edmunds, GBR
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16
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Castro GRA, Collaço IA, Dal Bosco CLB, Corrêa GG, Dal Bosco GB, Corrêa GL. Splenic infarction as a complication of covid-19 in a patient without respiratory symptoms: A case report and literature review. IDCases 2021; 24:e01062. [PMID: 33777695 PMCID: PMC7980490 DOI: 10.1016/j.idcr.2021.e01062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/14/2021] [Accepted: 03/09/2021] [Indexed: 12/30/2022] Open
Abstract
Introduction Multiple studies suggest that SARS-CoV-2 infection is associated with a pro-thrombotic state and thrombotic events have been recorded in several organs and systems. We report a patient with no respiratory symptoms, presented with abdominal pain and an extensive splenic infarction after COVID-19. Case report A 67 year-old man was admitted to the emergency department with a moderate, dull, left-sided abdominal pain. The patient denied respiratory symptoms but referred contact with family members positive for COVID-19. He tested positive for COVID-19 and had increased D-dimer levels. Imaging studies revealed splenic infarcts and ground-glass opacities in bilateral pulmonary bases. He was treated with full-dose anticoagulation and was discharged home on oral Rivaroxaban. Discussion Although rare in the literature, cases of acute abdomen in COVID-19 patients associated with vascular infarctions have increased. Coagulopathy may be present even without clinical respiratory manifestations of the disease. Patients meeting disseminated intravascular coagulation criteria or with markedly elevated D-dimer may benefit from anticoagulant therapy. Conclusion Clinicians should suspect of abdominal visceral infarctions in COVID-19 patients presented with acute abdominal pain, despite the absence of respiratory symptoms.
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Affiliation(s)
- Gustavo Rodrigues Alves Castro
- Department of General Surgery, Hospital do Trabalhador, Av. Rep. Argentina, 4406 - Novo Mundo, Curitiba, Paraná, 81050-000, Brazil
| | - Iwan Augusto Collaço
- Department of General Surgery, Hospital do Trabalhador, Av. Rep. Argentina, 4406 - Novo Mundo, Curitiba, Paraná, 81050-000, Brazil
| | - Caroline L Balcewicz Dal Bosco
- Department of General Surgery, Hospital do Trabalhador, Av. Rep. Argentina, 4406 - Novo Mundo, Curitiba, Paraná, 81050-000, Brazil
| | - Gustavo Gusso Corrêa
- Department of General Surgery, Hospital do Trabalhador, Av. Rep. Argentina, 4406 - Novo Mundo, Curitiba, Paraná, 81050-000, Brazil
| | - Giovana Balcewicz Dal Bosco
- Department of General Surgery, Hospital do Trabalhador, Av. Rep. Argentina, 4406 - Novo Mundo, Curitiba, Paraná, 81050-000, Brazil
| | - Giovana Luiza Corrêa
- Department of General Surgery, Hospital do Trabalhador, Av. Rep. Argentina, 4406 - Novo Mundo, Curitiba, Paraná, 81050-000, Brazil
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17
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Mahmood SN, Dawod YT, Chan CM. Splenic Infarction in a Postpartum Patient with COVID-19. TH OPEN 2021; 5:e81-e83. [PMID: 33615124 PMCID: PMC7886598 DOI: 10.1055/s-0041-1723783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/21/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Syed Nazeer Mahmood
- Section of Pulmonary/Critical Care, Department of Medicine, MedStar Washington Hospital Center, Washington, District of Columbia, United States
| | - Yaser T Dawod
- Section of Pulmonary/Critical Care, Department of Medicine, MedStar Washington Hospital Center, Washington, District of Columbia, United States
| | - Chee Man Chan
- Section of Pulmonary/Critical Care, Department of Medicine, MedStar Washington Hospital Center, Washington, District of Columbia, United States
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18
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Dennison JJ, Carlson S, Faehling S, Phelan H, Tariq M, Mubarik A. Splenic infarction and spontaneous rectus sheath hematomas in COVID-19 patient. Radiol Case Rep 2021; 16:999-1004. [PMID: 33619439 PMCID: PMC7881734 DOI: 10.1016/j.radcr.2021.02.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/07/2021] [Indexed: 12/24/2022] Open
Abstract
Multiple studies and reports have suggested that coronavirus disease-19 (COVID-19) promotes arterial and venous thrombotic events in multiple organ systems, although the mechanism leading to a hypercoagulable state is still unknown. Few cases of splenic infarction associated with COVID-19 have been reported, of which half were found incidentally upon autopsy. This may be due to a clinically silent presentation or the symptoms being wrongfully attributed to pain caused by the effects of COVID-19. Due to the rarity of the condition and its lack of consistent symptomatology, splenic thromboembolism can be difficult to diagnose. Awareness of the condition and high clinical suspicion will help the clinician identify and manage the problem. Hemorrhage in patients with COVID-19 is uncommon in the hypercoagulable state that threatens thrombus formation in patients with COVID-19 infection. Despite prophylactic treatment with anticoagulation therapies, patients are more prone to developing clots. It is also well-known that therapeutic anticoagulation can place patients at a higher risk of bleeding. Thus, this unique population is at risk of developing both thrombotic and hemorrhagic events. We report a rare case of splenic infarction in a patient with confirmed COVID-19 infection despite prophylactic treatment with low-molecular-weight heparin which was found incidentally during workup for 2 other rare conditions: spontaneous rectus sheath hematoma and microhemorrhage or thrombus of the mesenteric vessels.
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Affiliation(s)
- Jennifer J Dennison
- Medical College of Wisconsin, 1900 Westwood Center Blvd, Unit 3100, Wausau, WI, 54401 USA
| | - Samuel Carlson
- Medical College of Wisconsin, 1900 Westwood Center Blvd, Unit 3100, Wausau, WI, 54401 USA
| | - Shannon Faehling
- Medical College of Wisconsin, 1900 Westwood Center Blvd, Unit 3100, Wausau, WI, 54401 USA
| | - Hannah Phelan
- Medical College of Wisconsin, 1900 Westwood Center Blvd, Unit 3100, Wausau, WI, 54401 USA
| | | | - Ateeq Mubarik
- Ascension Saint Michael's Hospital, Stevens Point, WI.,Clinical Assistant Professor, Medical College of Wisconsin, 1900 Westwood Center Blvd, Unit 3100, Wausau, WI 54401 USA
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