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Wang Z, Gao X, Miao H, Ma X, Ding R. Understanding COVID-19-associated coagulopathy: From PIC to SIC or DIC. JOURNAL OF INTENSIVE MEDICINE 2021; 1:35-41. [PMID: 36943814 PMCID: PMC7997848 DOI: 10.1016/j.jointm.2021.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/29/2021] [Accepted: 03/03/2021] [Indexed: 12/15/2022]
Abstract
Coagulopathy, characterized by a high D-dimer level, is a common pathological occurrence in coronavirus disease 2019 (COVID-19) and is associated with poor prognosis. Severe cases with COVID-19 is associated with a significantly higher risk of deep vein thrombosis and acute pulmonary embolism. Pulmonary intravascular coagulopathy is the characteristic coagulopathy in COVID-19. Unlike sepsis-induced coagulopathy and disseminated intravascular coagulation, which are manifestations of systemic coagulopathy, pulmonary intravascular coagulopathy is a manifestation of a local coagulation disorder in the lung. The progression from pulmonary intravascular coagulopathy to sepsis-induced coagulopathy or disseminated intravascular coagulation in the context of COVID-19 may indicate that the patient's coagulation dysfunction has progressed from local to systemic. Exploring the associated coagulation disease will aid in the understanding of the pathophysiological mechanisms underlying severe COVID-19.
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Affiliation(s)
| | | | | | | | - Renyu Ding
- Corresponding author: Renyu Ding, Department of Critical Care Medicine, The First Hospital of China Medical University, North Nanjing Street 155, Shenyang, Liaoning 110001, China.
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Chen J, Wang X, Zhang S, Lin B, Wu X, Wang Y, Wang X, Yang M, Sun J, Xie Y. Characteristics of Acute Pulmonary Embolism in Patients With COVID-19 Associated Pneumonia From the City of Wuhan. Clin Appl Thromb Hemost 2020; 26:1076029620936772. [PMID: 32726134 PMCID: PMC7391435 DOI: 10.1177/1076029620936772] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/26/2020] [Accepted: 06/02/2020] [Indexed: 01/08/2023] Open
Abstract
The aim of this study was to describe clinical, imaging, and laboratory features of acute pulmonary embolism (APE) in patients with COVID-19 associated pneumonia. Patients with COVID-19 associated pneumonia who underwent a computed tomography pulmonary artery (CTPA) scan for suspected APE were retrospectively studied. Laboratory data and CTPA images were collected. Imaging characteristics were analyzed descriptively. Laboratory data were analyzed and compared between patients with and without APE. A series of 25 COVID-19 patients who underwent CTPA between January 2020 and February 2020 were enrolled. The median D-dimer level founded in these 25 patients was 6.06 μg/mL (interquartile range [IQR] 1.90-14.31 μg/mL). Ten (40%) patients with APE had a significantly higher level of D-dimer (median, 11.07 μg/mL; IQR, 7.12-21.66 vs median, 2.44 μg/mL; IQR, 1.68-8.34, respectively, P = .003), compared with the 15 (60%) patients without APE. No significant differences in other laboratory data were found between patients with and without APE. Among the 10 patients with APE, 6 (60%) had a bilateral pulmonary embolism, while 4 had a unilateral embolism. The thrombus-prone sites were the right lower lobe (70%), the left upper lobe (60%), both upper lobe (40%) and the right middle lobe (20%). The thrombus was partially or completely absorbed after anticoagulant therapy in 3 patients who underwent a follow-up CTPA. Patients with COVID-19 associated pneumonia have a risk of developing APE during the disease. When the D-dimer level abnormally increases in patients with COVID-19 pneumonia, CTPA should be performed to detect and assess the severity of APE.
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Affiliation(s)
- Jianpu Chen
- COVID-19 Investigating and Research Team, Department of Radiology, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Jiang’an District, Wuhan, Hubei, China
| | - Xiang Wang
- COVID-19 Investigating and Research Team, Department of Radiology, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Jiang’an District, Wuhan, Hubei, China
| | - Shutong Zhang
- COVID-19 Investigating and Research Team, Department of Radiology, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Jiang’an District, Wuhan, Hubei, China
| | - Bin Lin
- COVID-19 Investigating and Research Team, Department of Radiology, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Jiang’an District, Wuhan, Hubei, China
| | - Xiaoqing Wu
- COVID-19 Investigating and Research Team, Department of Radiology, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Jiang’an District, Wuhan, Hubei, China
| | - Yanfang Wang
- COVID-19 Investigating and Research Team, Department of Radiology, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Jiang’an District, Wuhan, Hubei, China
| | | | - Ming Yang
- COVID-19 Investigating and Research Team, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Jiang’an District, Wuhan, Hubei, China
| | | | - Yuanliang Xie
- COVID-19 Investigating and Research Team, Department of Radiology, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Jiang’an District, Wuhan, Hubei, China
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Albadri Z, Khattab O. Non-small-cell Carcinoma Localised within the Pulmonary Artery Misdiagnosed as Pulmonary Thromboembolism. Eur J Case Rep Intern Med 2020; 6:001284. [PMID: 31890710 PMCID: PMC6886629 DOI: 10.12890/2019_001284] [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: 09/22/2019] [Accepted: 09/23/2019] [Indexed: 11/21/2022] Open
Abstract
In this case report we describe a 69-year-old male ex-smoker with non-small-cell carcinoma localised within the pulmonary artery, misdiagnosed as pulmonary thromboembolism. This case indicates that non-small-cell carcinoma can be localised within the pulmonary artery. Furthermore, it emphasises the importance of performing a positron emission tomography scan and diagnostic intraluminal biopsy in unexplained lesions in the pulmonary artery to reach the proper diagnosis at the early stages of the disease. The patient is currently undergoing concurrent chemotherapy and radiation therapy.
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Affiliation(s)
| | - Omar Khattab
- Ryhov University Hospital, Radiology Department, Jönköping, Sweden
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Nakamura Y, Shimizu T, Fukumoto Y, Sugimura K, Ito S, Fujishima F, Oikawa M, Watanabe M, Shimokawa H, Sasano H. A Case of Angiosarcoma Arising in Trunk of the Right Pulmonary Artery Clinically Simulating Pulmonary Thromboembolism. World J Oncol 2012; 3:119-123. [PMID: 29147292 PMCID: PMC5649790 DOI: 10.4021/wjon467w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2012] [Indexed: 11/03/2022] Open
Abstract
Angiosarcoma arising in the pulmonary artery is extremely rare. We herein report a case of angiosarcoma arising in the pulmonary artery trunk of 71 year-old woman. This case was clinically diagnosed as pulmonary thromboembolism but angiosarcoma of the pulmonary artery should be considered as the differential diagnosis of unusual clinical manifestations of pulmonary thromboembolism because of the extremely poor prognosis of the lesion.
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Affiliation(s)
- Yasuhiro Nakamura
- Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toru Shimizu
- Department of Cardiovascular medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshihiro Fukumoto
- Department of Cardiovascular medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Koichiro Sugimura
- Department of Cardiovascular medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shigemi Ito
- Devision of Pathology, Miyagi Cancer Center, Natori, Japan
| | - Fumiyoshi Fujishima
- Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mariko Oikawa
- Division of Oral Pathology, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Mika Watanabe
- Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hironobu Sasano
- Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
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5
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Goto T, Maeshima A, Kato R. Lung adenocarcinoma with peculiar growth to the pulmonary artery and thrombus formation: report of a case. World J Surg Oncol 2012; 10:16. [PMID: 22264353 PMCID: PMC3278376 DOI: 10.1186/1477-7819-10-16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 01/21/2012] [Indexed: 01/07/2023] Open
Abstract
Background Cases of pulmonary artery masses have only rarely been reported, and the optimal type of the diagnosis and treatment is controversial. Case Presentation An 81-year-old woman was found to have an abnormal shadow on chest X-ray film. Computed tomography showed an irregularly bordered tumor centered in the hilar region extending from segment 6 to the middle lobe of the right lung. Pulmonary angiography showed complete occlusion of the trunk at the periphery proximal to the bifurcation of the posterior ascending branch. Based on bronchoscopic biopsy of the tumor, an adenocarcinoma was diagnosed. Middle and lower lobectomy was performed. Histopathologically, the adenocarcinoma had invaded the tunica intima of the pulmonary artery and also replaced the endothelium in the same region. Although a large thrombus was found at the vessel invasion site of the adenocarcinoma in the pulmonary artery, there were no malignant findings in the thrombus itself. Conclusions This is the first reported case of radical resection of a lung cancer with invasion along the pulmonary artery wherein a benign thrombus had formed. In general, surgery would be the treatment of choice for a pulmonary artery mass.
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Affiliation(s)
- Taichiro Goto
- Department of General Thoracic Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
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Debnath J, George R, Satija L, Bhardwaj R, Piplani S, Venkatesan S. Pulmonary metastases: a rare cause for pulmonary artery invasion and in situ pulmonary artery thrombosis-demonstration with multidetector computed tomography. Med J Armed Forces India 2012; 68:65-7. [PMID: 24669039 DOI: 10.1016/s0377-1237(11)60115-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 09/07/2011] [Indexed: 01/15/2023] Open
Affiliation(s)
| | - Ra George
- Senior Advisor (Radiology), Military Hospital, Mhow
| | - Lovleen Satija
- Senior Advisor (Radiology) Command Hospital (CC), Lucknow
| | - Reena Bhardwaj
- Senior Advisor (Pathology), Army Hospital (R&R), Delhi Cantt. - 10
| | - Sanjay Piplani
- Senior Advisor, (Medicine & Oncology), Command Hospital (AF), Bengaluru
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7
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Dornas APAV, Campos FTAF, Rezende CJ, Ribeiro CA, Amaral NF, Corrêa RDA. Intimal sarcoma of the pulmonary artery: a differential diagnosis of chronic pulmonary thromboembolism. J Bras Pneumol 2010; 35:814-8. [PMID: 19750336 DOI: 10.1590/s1806-37132009000800015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Accepted: 03/05/2009] [Indexed: 02/07/2023] Open
Abstract
Intimal sarcoma of the pulmonary artery is a rare and potentially lethal tumor, the diagnosis of which is difficult and therefore frequently delayed. The clinical signs and symptoms are nonspecific, often mimicking chronic pulmonary thromboembolism (CPTE). We report the case of a 45-year-old male under treatment for CPTE associated with pulmonary arterial hypertension and chronic cor pulmonale. There was no response to treatment with anticoagulants and sildenafil. We emphasize the difficulties in diagnosing intimal sarcoma of the pulmonary artery, the need to investigate this neoplasm in the differential diagnosis of CPTE and the systematic use of criteria for the appropriate prescription of new medications for pulmonary artery hypertension.
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Lee JE, Kim JH, Kang MK, Park HJ, Lee JH, Kim EK, Lee YK, Jeong HC. A Case of Pulmonary Arterial Thrombosis in a Patient with Tuberculous-destroyed Lung and Pulmonary Hypertension. Tuberc Respir Dis (Seoul) 2008. [DOI: 10.4046/trd.2008.64.1.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Ji Eun Lee
- Department of Internal Medicine, Pochon CHA University College of Medicine, Seongnam, Korea
| | - Jung Hyun Kim
- Department of Internal Medicine, Pochon CHA University College of Medicine, Seongnam, Korea
| | - Min Kyoung Kang
- Department of Internal Medicine, Pochon CHA University College of Medicine, Seongnam, Korea
| | - Hyun Jeong Park
- Department of Internal Medicine, Pochon CHA University College of Medicine, Seongnam, Korea
| | - Ji Hyun Lee
- Department of Internal Medicine, Pochon CHA University College of Medicine, Seongnam, Korea
| | - Eun Kyung Kim
- Department of Internal Medicine, Pochon CHA University College of Medicine, Seongnam, Korea
| | - Young Kyung Lee
- Department of Radiology, Pochon CHA University College of Medicine, Seongnam, Korea
| | - Hye Cheol Jeong
- Department of Internal Medicine, Pochon CHA University College of Medicine, Seongnam, Korea
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