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Fahrni G, Rocha AC, Gudmundsson L, Pozzessere C, Qanadli SD, Rotzinger DC. Impact of COVID-19 pneumonia on pulmonary vascular volume. Front Med (Lausanne) 2023; 10:1117151. [PMID: 37035332 PMCID: PMC10073514 DOI: 10.3389/fmed.2023.1117151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/24/2023] [Indexed: 04/11/2023] Open
Abstract
Background Pulmonary manifestations of COVID-19 pneumonia are well known. However, COVID-19 is also associated with a range of vascular manifestations such as embolism, congestion, and perfusion changes. Regarding congestion, research from different groups has suggested arteriovenous anastomosis dysregulation as a contributing factor. In this study, we aim to better describe the changes in vascular volume in affected lung zones and to relate them to pathophysiological hypotheses. Methods We performed automatic vascular volume extraction in 10 chest CTs of patients, including 2 female and 8 male with a mean age of 63.5 ± 9.3 years, diagnosed with COVID-19 pneumonia. We compared the proportion of vascular volumes between manually segmented regions of lung parenchyma with and without signs of pneumonia. Results The proportion of vascular volume was significantly higher in COVID (CVasc) compared to non-COVID (NCVasc) areas. We found a mean difference (DVasc) of 5% and a mean ratio (RVasc) of 3.7 between the two compartments (p < 0.01). Conclusion Vascular volume in COVID-19 affected lung parenchyma is augmented relative to normal lung parenchyma, indicating venous congestion and supporting the hypothesis of pre-existing intra-pulmonary arteriovenous shunts.
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Affiliation(s)
- Guillaume Fahrni
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Ana-Carolina Rocha
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Louis Gudmundsson
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Chiara Pozzessere
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Salah D. Qanadli
- Riviera Chablais Hospital and University of Lausanne, Lausanne, Switzerland
| | - David C. Rotzinger
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Acute Pulmonary Embolism in COVID-19: A Potential Connection between Venous Congestion and Thrombus Distribution. Biomedicines 2022; 10:biomedicines10061300. [PMID: 35740322 PMCID: PMC9219696 DOI: 10.3390/biomedicines10061300] [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] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/23/2022] [Accepted: 05/30/2022] [Indexed: 11/22/2022] Open
Abstract
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.
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Aissaoui H, Eskenazi A, Suteau V, Adenis A, Drak Alsibai K. Reporte de caso: Papel potencial de los corticosteroides en el tratamiento de la neumonía post-COVID-19. KOMPASS NEUMOLOGÍA 2022. [PMCID: PMC9059001 DOI: 10.1159/000521869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Houari Aissaoui
- Departamento de Medicina, Unidad de Pulmonología, Centro Hospitalario Andrée Rosemon, Cayenne, Guayana
- *Houari Aissaoui,
| | - Anaïs Eskenazi
- Departamento de Medicina, Centro Hospitalario Andrée Rosemon, Cayenne, Guayana
| | - Valentin Suteau
- Departamento de Patología, Centro Hospitalario Andrée Rosemon, Cayenne, Guayana
| | - Antoine Adenis
- Centre d'Investigation Clinique Antilles-Guyane (Inserm 1424), Centro Hospitalario Andrée Rosemon, Cayenne, Guayana
| | - Kinan Drak Alsibai
- Departamento de Patología, Centro Hospitalario Andrée Rosemon, Cayenne, Guayana
- Centro de Recursos Biológicos (CRB Amazonie), Centro Hospitalario Andrée Rosemon, Cayenne, Guayana
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Zhao Y, Wang D, Mei N, Yin B, Li X, Zheng Y, Xiao A, Yu X, Qiu X, Lu Y, Liu L. Longitudinal Radiological Findings in Patients With COVID-19 With Different Severities: From Onset to Long-Term Follow-Up After Discharge. Front Med (Lausanne) 2021; 8:711435. [PMID: 34621760 PMCID: PMC8490620 DOI: 10.3389/fmed.2021.711435] [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: 05/18/2021] [Accepted: 08/20/2021] [Indexed: 12/18/2022] Open
Abstract
Objective: This study aimed to investigate the evolution of radiological findings in the patients with coronavirus disease 2019 (COVID-19) pneumonia with different severities from onset to 1-year follow-up and identify the predictive factors for different pulmonary lesion absorption status in the patients infected with COVID-19. Methods: A retrospective study was performed on the clinical and radiological features of 175 patients with COVID-19 pneumonia hospitalized at three institutions from January 21 to March 20, 2020. All the chest CT scans during hospitalization and follow-ups after discharge were collected. The clinical and radiological features from the chest CT scans both at the peak stage and before discharge from the hospital were used to predict whether the pulmonary lesions would be fully absorbed after discharge by Cox regression. Then, these patients were stratified into two groups with different risks of pulmonary lesion absorption, and an optimal timepoint for the first CT follow-up was selected accordingly. Results: A total of 132 (75.4%) patients were classified into the non-severe group, and 43 (24.6%) patients were classified into the severe group, according to the WHO guidelines. The opacification in both the groups changed from ground-glass opacity (GGO) to consolidation and then from consolidation to GGO. Among the 175 participants, 135 (112 non-severe and 23 severe patients with COVID-19) underwent follow-up CT scans after discharge. Pulmonary residuals could be observed in nearly half of the patients (67/135) with the presentation of opacities and parenchymal bands. The parenchymal bands in nine discharged patients got fully absorbed during the follow-up periods. The age of patient [hazard ratio (HR) = 0.95, 95% CI, 0.95–0.99], level of lactate dehydrogenase (LDH) (HR = 0.99; 95% CI, 0.99–1.00), level of procalcitonin (HR = 8.72; 95% CI, 1.04–73.03), existence of diffuse lesions (HR = 0.28; 95% CI, 0.09–0.92), subpleural distribution of lesions (HR = 2.15; 95% CI, 1.17–3.92), morphology of residuals (linear lesion: HR = 4.58, 95% CI, 1.22–17.11; nodular lesion: HR = 33.07, 95% CI, 3.58–305.74), and pleural traction (HR = 0.41; 95% CI, 0.22–0.78) from the last scan before discharge were independent factors to predict the absorption status of COVID-19-related pulmonary abnormalities after discharge. According to a Kaplan–Meier analysis, the probability of patients of the low-risk group to have pulmonary lesions fully absorbed within 90 days reached 91.7%. Conclusion: The development of COVID-19 lesions followed the trend from GGO to consolidation and then from consolidation to GGO. The CT manifestations and clinical and laboratory variables before discharge could help predict the absorption status of pulmonary lesions after discharge. The parenchymal bands could be fully absorbed in some COVID-19 cases. In this study, a Cox regression analysis indicated that a timepoint of 3 months since onset was optimal for the radiological follow-up of discharged patients.
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Affiliation(s)
- Yajing Zhao
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Dongdong Wang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Nan Mei
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Bo Yin
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xuanxuan Li
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yingyan Zheng
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Anling Xiao
- Department of Radiology, Fuyang Second People's Hospital, Fuyang, China
| | - Xiangrong Yu
- Department of Radiology, Zhuhai People's Hospital, Zhuhai, China
| | - Xiaohui Qiu
- Department of Radiology, Bozhou People's Hospital, Bozhou, China
| | - Yiping Lu
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Li Liu
- Department of Radiology, Shanghai Cancer Center, Fudan University, Shanghai, China
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Aissaoui H, Eskenazi A, Suteau V, Adenis A, Drak Alsibai K. Case Report: Potential Role of Corticosteroids in the Management of Post-COVID-19 Pneumonia. Front Med (Lausanne) 2021; 8:686806. [PMID: 34568360 PMCID: PMC8458727 DOI: 10.3389/fmed.2021.686806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 07/26/2021] [Indexed: 12/29/2022] Open
Abstract
Certain patients who recover from severe pneumonia due to coronavirus disease 2019 (COVID-19) remain symptomatic in the post-infectious period, either clinically, radiologically, or respiratory. The post-COVID-19 period is characterized by clinical symptoms of varying duration from one subject to another and does not seem to depend on the severity of initial pneumonia. The persisting inflammatory and/or immune reactions in the post-COVID-19 period may play a role in the development of pulmonary lesions. Here, we report the case of a 61-year-old man with severe COVID-19 pneumonia, complicated by acute respiratory distress syndrome and pulmonary embolism, which required the patient's admission to the intensive care unit and high-flow oxygen therapy. The patient was hospitalized for 23 days for the management of his severe COVID-19 pneumonia. Afterwards, he was discharged home following a negative SARS-CoV-2 PCR test. The post-COVID-19 period was characterized by a complex respiratory symptomatology associating cough, resting dyspnea, and exertional dyspnea requiring oxygen therapy for several weeks. Surprisingly, the follow-up chest CT scan performed 4 weeks after discharge revealed bilateral interstitial lung lesions. After ruling out pulmonary superinfection, the patient was treated with oral corticosteroid for 3 months at a digressive dose. In our case, the use of corticosteroid therapy in the post-COVID19 phase had improved the outcome of the lung disease. These benefits are characterized by a rapid symptomatic improvement, accelerated repair of pulmonary images, rapid oxygen withdrawal, and rapid return to daily activities.
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Affiliation(s)
- Houari Aissaoui
- Department of Medicine, Pulmonology Unit, Cayenne Hospital Center Andrée Rosemon, Cayenne, French Guiana
| | - Anaïs Eskenazi
- Department of Medicine, Cayenne Hospital Center Andrée Rosemon, Cayenne, French Guiana
| | - Valentin Suteau
- Department of Pathology, Cayenne Hospital Center Andrée Rosemon, Cayenne, French Guiana
| | - Antoine Adenis
- Centre d'Investigation Clinique Antilles-Guyane (Inserm 1424), Cayenne Hospital Center Andrée Rosemon, Cayenne, French Guiana
| | - Kinan Drak Alsibai
- Department of Pathology, Cayenne Hospital Center Andrée Rosemon, Cayenne, French Guiana.,Center of Biological Resources (CRB Amazonie), Cayenne Hospital Center Andrée Rosemon, Cayenne, French Guiana
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Qanadli SD, Sauter AW, Alkadhi H, Christe A, Poletti PA, Ebner L, Rotzinger DC. Vascular Abnormalities Detected with Chest CT in COVID-19: Spectrum, Association with Parenchymal Lesions, Cardiac Changes, and Correlation with Clinical Severity (COVID-CAVA Study). Diagnostics (Basel) 2021; 11:606. [PMID: 33805443 PMCID: PMC8066822 DOI: 10.3390/diagnostics11040606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 01/16/2023] Open
Abstract
Although vascular abnormalities are thought to affect coronavirus disease 2019 (COVID-19) patients' outcomes, they have not been thoroughly characterized in large series of unselected patients. The Swiss national registry coronavirus-associated vascular abnormalities (CAVA) is a multicentric cohort of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who underwent a clinically indicated chest computed tomography (CT) aiming to assess the prevalence, severity, distribution, and prognostic value of vascular and non-vascular-related CT findings. Clinical outcomes, stratified as outpatient treatment, inpatient without mechanical ventilation, inpatient with mechanical ventilation, or death, will be correlated with CT and biological markers. The main objective is to assess the prevalence of cardiovascular abnormalities-including pulmonary embolism (PE), cardiac morphology, and vascular congestion. Secondary objectives include the predictive value of cardiovascular abnormalities in terms of disease severity and fatal outcome and the association of lung inflammation with vascular abnormalities at the segmental level. New quantitative approaches derived from CT imaging are developed and evaluated in this study. Patients with and without vascular abnormalities will be compared, which is supposed to provide insights into the prognostic role and potential impact of such signs on treatment strategy. Results are expected to enable the development of an integrative score combining both clinical data and imaging findings to predict outcomes.
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Affiliation(s)
- Salah D. Qanadli
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland;
| | - Alexander W. Sauter
- Department of Radiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland;
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, 8006 Zurich, Switzerland;
| | - Andreas Christe
- Department of Radiology, Division City and County Hospitals, Inselgroup, Bern University Hospital, University of Bern, 3004 Bern, Switzerland;
| | - Pierre-Alexandre Poletti
- Emergency Radiology Unit, Service of Radiology Division of Clinical Epidemiology Service of Radiology, Geneva University Hospital, 1205 Geneva, Switzerland;
| | - Lukas Ebner
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland;
| | - David C. Rotzinger
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland;
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