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Bansal N, Younes S, Maaieh M. Percutaneous Debulking of a Large Mobile Mitral Valve Vegetation Using the Angiovac. Cureus 2024; 16:e56537. [PMID: 38646334 PMCID: PMC11027443 DOI: 10.7759/cureus.56537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
The Angiovac aspiration system has been used successfully for the removal of intravascular material or thrombus in the right-sided heart structures, vena cava, implantable cardiac defibrillator, or other devices. For infective endocarditis, it is reserved for the patients who warrant but are not good candidates for the surgery. The evidence regarding Angiovac aspiration of the infective endocarditis of the left-sided heart valves is scarce. The risk of complications, including thrombi fragmentation leading to systemic embolization, damage to the cardiac structures and tissue, and hemodynamic instability, precludes the widespread use of this procedure, especially for the left-sided lesions. We report a case of successful removal of the mitral valve endocarditis using the Angiovac aspiration technique under the TEE guidance. A SENTINEL™ cerebral protection system was used to prevent embolus migration and a venous rather than an arterial access was used for reperfusion.
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Affiliation(s)
- Nahush Bansal
- Department of Internal Medicine, The University of Toledo, Toledo, USA
| | - Stephanie Younes
- Department of Cardiology, ProMedica Toledo Hospital, Toledo, USA
| | - Mohammed Maaieh
- Department of Cardiology, ProMedica Toledo Hospital, Toledo, USA
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2
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Jolou J, Martineau J, Müller H, Cikirikcioglu M, Huber C. Case Report: Right atrial mass arising from the Eustachian valve. Front Cardiovasc Med 2023; 10:1268918. [PMID: 38028473 PMCID: PMC10666182 DOI: 10.3389/fcvm.2023.1268918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
A mass in the right atrium (RA) is an unusual finding that warrants further investigation. We report the case of a 72-year-old male patient who underwent a Bentall operation with a biological composite graft and closure of patent foramen ovale 18 months prior to his presentation with an incidental new RA mass during follow-up echocardiography. Transesophageal echocardiography and thoracic CT angiography confirmed a right atrial mass attached to the Eustachian valve and additionally revealed a non-occlusive pulmonary embolism in the inferior lobar artery of the left lung. Despite 2 months of anticoagulation treatment, the size of the mass did not decrease. Further MRI imaging showed a central mass enhancement which raised concerns about a tumoral lesion. Following a discussion with the local Heart Team, management with surgical treatment was decided. The intraoperative findings revealed a 2.5 cm × 2.1 cm mass arising from the Eustachian valve and a non-diagnosed Chiari network in the RA. Both were resected and sent for a frozen section procedure which excluded a malignancy. The final histopathological analysis described fibrotic tissues compatible with an organized thrombus. The patient was discharged on postoperative day 7 without any complications. Although imaging studies are useful for the initial and differential diagnosis of RA masses, it is not always possible to get the final diagnosis without surgery. In case of a suspicion of a potentially malignant pathology, surgical exploration and resection are necessary.
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Affiliation(s)
- Jalal Jolou
- Department of Cardiovascular Surgery, Geneva University Hospitals, Geneva University, Geneva, Switzerland
| | - Jérôme Martineau
- Department of Cardiovascular Surgery, Geneva University Hospitals, Geneva University, Geneva, Switzerland
| | - Hajo Müller
- Department of Cardiology, Geneva University Hospitals, Geneva University, Geneva, Switzerland
| | - Mustafa Cikirikcioglu
- Department of Cardiovascular Surgery, Geneva University Hospitals, Geneva University, Geneva, Switzerland
| | - Christoph Huber
- Department of Cardiovascular Surgery, Geneva University Hospitals, Geneva University, Geneva, Switzerland
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3
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Hasegawa K, Powers EM, Yoneda ZT, Richardson TD, Stevenson WG. Intracardiac thrombi fluttering like hair in the wind at VT ablation. J Cardiovasc Electrophysiol 2023; 34:2403-2405. [PMID: 37787011 DOI: 10.1111/jce.16079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/06/2023] [Accepted: 09/13/2023] [Indexed: 10/04/2023]
Abstract
INTRODUCTION Intracardiac echocardiography (ICE) reveals mobile thrombus on implantable electronic device leads in some patients undergoing electrophysiologic procedures. METHODS ICE was performed in a patient undergoing ventricular tachycardia (VT) ablation. RESULTS ICE showed extensive mobile thrombi on the implantable cardioverter defibrillator lead. Radiofrequency catheter ablation of VT from perimitral scar was safely performed via a retrograde aortic approach. After the procedure, chronic anticoagulation was initiated. CT-angiography of the chest 2 months later showed no pulmonary emboli. CONCLUSIONS The significance of these thrombi, as related to chronic pulmonary embolization, warrants further study.
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Affiliation(s)
- Kanae Hasegawa
- Department of Medicine, Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Edward M Powers
- Department of Medicine, Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Zachary T Yoneda
- Department of Medicine, Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Travis D Richardson
- Department of Medicine, Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - William G Stevenson
- Department of Medicine, Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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4
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Lopez-Pedrera C, Oteros R, Ibáñez-Costa A, Luque-Tévar M, Muñoz-Barrera L, Barbarroja N, Chicano-Gálvez E, Marta-Enguita J, Orbe J, Velasco F, Perez-Sanchez C. The thrombus proteome in stroke reveals a key role of the innate immune system and new insights associated with its etiology, severity, and prognosis. J Thromb Haemost 2023; 21:2894-2907. [PMID: 37100394 DOI: 10.1016/j.jtha.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 03/30/2023] [Accepted: 04/13/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Nowadays little is known about the molecular profile of the occluding thrombus of patients with ischemic stroke. OBJECTIVES To analyze the proteomic profile of thrombi in patients who experienced an ischemic stroke in order to gain insights into disease pathogenesis. METHODS Thrombi from an exploratory cohort of patients who experienced a stroke were obtained by thrombectomy and analyzed by sequential window acquisition of all theoretical spectra-mass spectrometry. Unsupervised k-means clustering analysis was performed to stratify patients who experienced a stroke. The proteomic profile was associated with both the neurological function (National Institute of Health Stroke Scale [NIHSS]) and the cerebral involvement (Alberta Stroke Program Early CT Score [ASPECTS]) prior to thrombectomy and the clinical status of patients at 3 months using the modified Rankin Scale. In an independent cohort of 210 patients who experienced a stroke, the potential role of neutrophils in stroke severity was interrogated. RESULTS Proteomic analysis identified 580 proteins in thrombi, which were stratified into 4 groups: hemostasis, proteasome and neurological diseases, structural proteins, and innate immune system and neutrophils. The thrombus proteome identified 3 clusters of patients with distinctive severity, prognosis, and etiology of the stroke. A protein signature clearly distinguished atherothrombotic and cardioembolic strokes. Several proteins were significantly correlated with the severity of the stroke (NIHSS and ASPECTS). Functional proteomic analysis highlighted the prominent role of neutrophils in stroke severity. This was in line with the association of neutrophil activation markers and count with NIHSS, ASPECTS, and the modified Rankin Scale score 90 days after the event. CONCLUSION The use of sequential window acquisition of all theoretical spectra-mass spectrometry in thrombi from patients who experienced an ischemic stroke has provided new insights into pathways and players involved in its etiology, severity, and prognosis. The prominent role of the innate immune system identified might pave the way for the development of new biomarkers and therapeutic approaches in this disease.
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Affiliation(s)
- Chary Lopez-Pedrera
- Rheumatology Service, Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, Córdoba, Spain.
| | - Rafael Oteros
- Diagnostic and Therapeutic Neuroradiology Unit, Reina Sofia Hospital, Córdoba, Spain
| | - Alejandro Ibáñez-Costa
- Rheumatology Service, Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, Córdoba, Spain; Department of Cell Biology, Immunology and Physiology, Agrifood Campus of International Excellence, University of Córdoba, ceiA3, Córdoba, Spain
| | - María Luque-Tévar
- Rheumatology Service, Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, Córdoba, Spain
| | - Laura Muñoz-Barrera
- Rheumatology Service, Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, Córdoba, Spain
| | - Nuria Barbarroja
- Rheumatology Service, Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, Córdoba, Spain; Cobiomic Bioscience SL, EBT University of Córdoba/IMIBIC, Córdoba, Spain
| | - Eduardo Chicano-Gálvez
- IMIBIC Mass Spectrometry and Molecular Imaging Unit, Maimonides Biomedical Research Institute of Córdoba, Reina Sofia University Hospital, University of Córdoba, Córdoba, Spain
| | - Juan Marta-Enguita
- Atherothrombosis-Laboratory, Cardiovascular Diseases Program, CIMA-Universidad Navarra, IdiSNA, Pamplona, Spain; Neurology Department, Hospital Universitario Navarra, Pamplona, Spain; RICORS-ICTUS, Instituto Salud Carlos III, Madrid, Spain
| | - Josune Orbe
- Atherothrombosis-Laboratory, Cardiovascular Diseases Program, CIMA-Universidad Navarra, IdiSNA, Pamplona, Spain; RICORS-ICTUS, Instituto Salud Carlos III, Madrid, Spain
| | - Francisco Velasco
- Department of Medicine, University of Córdoba, Maimonides Biomedical Research Institute of Córdoba, Córdoba, Spain
| | - Carlos Perez-Sanchez
- Rheumatology Service, Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, Córdoba, Spain; Department of Cell Biology, Immunology and Physiology, Agrifood Campus of International Excellence, University of Córdoba, ceiA3, Córdoba, Spain; Cobiomic Bioscience SL, EBT University of Córdoba/IMIBIC, Córdoba, Spain. https://twitter.com/carlosps85
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Costamagna G, Bonato S, Corti S, Meneri M. Advancing Stroke Research on Cerebral Thrombi with Omic Technologies. Int J Mol Sci 2023; 24:ijms24043419. [PMID: 36834829 PMCID: PMC9961481 DOI: 10.3390/ijms24043419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/05/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
Cerebrovascular diseases represent a leading cause of disability, morbidity, and death worldwide. In the last decade, the advances in endovascular procedures have not only improved acute ischemic stroke care but also conceded a thorough analysis of patients' thrombi. Although early anatomopathological and immunohistochemical analyses have provided valuable insights into thrombus composition and its correlation with radiological features, response to reperfusion therapies, and stroke etiology, these results have been inconclusive so far. Recent studies applied single- or multi-omic approaches-such as proteomics, metabolomics, transcriptomics, or a combination of these-to investigate clot composition and stroke mechanisms, showing high predictive power. Particularly, one pilot studies showed that combined deep phenotyping of stroke thrombi may be superior to classic clinical predictors in defining stroke mechanisms. Small sample sizes, varying methodologies, and lack of adjustments for potential confounders still represent roadblocks to generalizing these findings. However, these techniques hold the potential to better investigate stroke-related thrombogenesis and select secondary prevention strategies, and to prompt the discovery of novel biomarkers and therapeutic targets. In this review, we summarize the most recent findings, overview current strengths and limitations, and present future perspectives in the field.
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Affiliation(s)
- Gianluca Costamagna
- Dino Ferrari Centre, Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), University of Milan, Via Francesco Sforza 35, 20122 Milan, Italy
- Stroke Unit, Neurology Unit, Neuroscience and Mental Health Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Correspondence:
| | - Sara Bonato
- Stroke Unit, Neurology Unit, Neuroscience and Mental Health Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Stefania Corti
- Dino Ferrari Centre, Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), University of Milan, Via Francesco Sforza 35, 20122 Milan, Italy
- Stroke Unit, Neurology Unit, Neuroscience and Mental Health Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Megi Meneri
- Dino Ferrari Centre, Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), University of Milan, Via Francesco Sforza 35, 20122 Milan, Italy
- Stroke Unit, Neurology Unit, Neuroscience and Mental Health Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
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6
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Mereuta OM, Agarwal T, Ghozy S, Dai D, Arul S, Brinjikji W, Kallmes DF, Kadirvel R. Shell Versus Core Architecture and Biology of Thrombi in Acute Ischemic Stroke: A Systematic Review. Clin Appl Thromb Hemost 2023; 29:10760296231213632. [PMID: 37960892 PMCID: PMC10647960 DOI: 10.1177/10760296231213632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 10/02/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND The presence of an outer shell has been recently described as a common feature of acute ischemic stroke (AIS) thrombi. We performed a systematic review of the current literature on shell genesis, structure, and clinical significance. METHODS Following PRISMA guidelines, we searched Ovid Cochrane Central Register of Controlled Trials, Embase, Medline, Scopus, and Web of Science for studies reporting the composition and structure of AIS thrombi and clot analogs. Identified studies were added to Covidence software for primary screening. Two reviewers independently screened titles and abstracts followed by full-text screening. RESULTS From 1290 identified studies, 10 were included in this review. Studies using histology/immunohistochemistry/immunofluorescence described fibrin, platelets, von Willebrand factor, and neutrophil extracellular traps as the main components of the shell. Scanning electron microscopy demonstrated a dense, compact fibrin/platelet-rich shell, and a core rich in polyhedrocytes. Microfluidics studies identified highly activated P-selectin-positive platelets and fibrin forming the core while secondary agonists adenosine diphosphate and thromboxane, along with loosely packed P-selectin-negative platelets constituted the shell. CONCLUSIONS The composition, compaction, and integrity of the shell may impact thrombolysis and revascularization outcomes. The preponderance of studies supported this conclusion.
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Affiliation(s)
| | - Tamanna Agarwal
- Faculty of Medicine in Hradec Kralove, Charles University, Prague, Czech Republic
| | - Sherief Ghozy
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Daying Dai
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Santhosh Arul
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | | | - Ram Kadirvel
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
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Goyal A, Niwariya Y, Goel G, Joshi D, Saigal S, Gella DV. Pathological changes in COVID-19 pneumonia on limited post-mortem sampling of lung: A saga of inflammation and thrombosis. INDIAN J PATHOL MICR 2022; 65:653-656. [PMID: 35900495 DOI: 10.4103/ijpm.ijpm_1158_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
We describe three postmortem open lung-biopsy findings among patients with COVID-19 pneumonia who were on anticoagulant therapy. The spectrum of histopathological findings included lung inflammation in the form of diffuse alveolar damage (DAD) in exudative and organizing phases, with or without pulmonary artery thrombosis in different stages of evolution. This spectrum of inflammation and thrombosis may be indicative of a natural history of severe COVID-19 pneumonia or demonstrative of variation in therapeutics.
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Affiliation(s)
- Abhishek Goyal
- Department of Pulmonary Medicine, AIIMS Bhopal, Bhopal, Madhya Pradesh, India
| | - Yogesh Niwariya
- Department of CTVS, AIIMS Bhopal, Bhopal, Madhya Pradesh, India
| | - Garima Goel
- Department of Pathology and Lab Medicine, AIIMS Bhopal, Bhopal, Madhya Pradesh, India
| | - Deepti Joshi
- Department of Pathology and Lab Medicine, AIIMS Bhopal, Bhopal, Madhya Pradesh, India
| | - Saurabh Saigal
- Department of Anesthesia, AIIMS Bhopal, Bhopal, Madhya Pradesh, India
| | - Druva Vinay Gella
- Department of Pulmonary Medicine, AIIMS Bhopal, Bhopal, Madhya Pradesh, India
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Angelini F, Bocchino PP, Peyracchia M, Saglietto A, Magnano M, Patanè N, D’Ascenzo F, Giustetto C, Anselmino M, Gaita F, Toso E. Prevalence and predictors of left atrial thrombosis in atrial fibrillation patients treated with non-vitamin K antagonist oral anticoagulants. Acta Cardiol 2021; 78:290-297. [PMID: 34821203 DOI: 10.1080/00015385.2021.2005307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Few data are available regarding the prevalence of left atrium (LA) thrombi in atrial fibrillation (AF) patients treated with non-vitamin K antagonist oral anticoagulants (NOACs). Methods: We evaluated the prevalence and predictors of LA/LA appendage (LAA) thrombi in non-valvular AF patients treated with NOACs referring to a single centre for a scheduled electrical cardioversion (ECV) or catheter ablation (CA). Transesophageal echocardiography (TEE) was performed within 12 h prior to the index procedure. RESULTS A total of 352 consecutive patients with non-valvular AF treated with NOACs were included in this analysis (ECV group n = 176 and CA group n = 176) between 2013 and 2018. 85 patients (24.2%) were on dabigatran, 150 (42.7%) on rivaroxaban, 104 (29.6%) on apixaban and 13 (3.7%) on edoxaban. A LA/LAA thrombus was detected by TEE in 27 (7.7%) patients, 18 in the ECV group and nine in the ablation group; 18 (5.1%) patients presented dense LA/LAA spontaneous echo contrast (SEC). Predictors of LA/LAA thrombi were a CHA2DS2-VASc score > 3 (OR 4.54, 95% CI 1.50 - 13.70, p value = .007) and obesity (OR 6.01, 95% CI 1.95 - 18.50, p value = .001). CONCLUSIONS Among real-world patients with non-valvular AF treated with NOACs, we found a high incidence of LA/LAA thrombi compared to previous reports. The main predictors of LA/LAA thrombosis were a CHA2DS2-VASc score > 3 and obesity.
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Affiliation(s)
- Filippo Angelini
- Division of Cardiology, Cardiovascular and Thoracic Department of Medical Sciences, University of Turin and ‘Città della Salute e della Scienza’ Hospital, Turin, Italy
| | - Pier Paolo Bocchino
- Division of Cardiology, Cardiovascular and Thoracic Department of Medical Sciences, University of Turin and ‘Città della Salute e della Scienza’ Hospital, Turin, Italy
| | - Mattia Peyracchia
- Division of Cardiology, Cardiovascular and Thoracic Department of Medical Sciences, University of Turin and ‘Città della Salute e della Scienza’ Hospital, Turin, Italy
| | - Andrea Saglietto
- Division of Cardiology, Cardiovascular and Thoracic Department of Medical Sciences, University of Turin and ‘Città della Salute e della Scienza’ Hospital, Turin, Italy
| | - Massimo Magnano
- Division of Cardiology, Cardiovascular and Thoracic Department of Medical Sciences, University of Turin and ‘Città della Salute e della Scienza’ Hospital, Turin, Italy
| | - Nicolò Patanè
- Division of Cardiology, Cardiovascular and Thoracic Department of Medical Sciences, University of Turin and ‘Città della Salute e della Scienza’ Hospital, Turin, Italy
| | - Fabrizio D’Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department of Medical Sciences, University of Turin and ‘Città della Salute e della Scienza’ Hospital, Turin, Italy
| | - Carla Giustetto
- Division of Cardiology, Cardiovascular and Thoracic Department of Medical Sciences, University of Turin and ‘Città della Salute e della Scienza’ Hospital, Turin, Italy
| | - Matteo Anselmino
- Division of Cardiology, Cardiovascular and Thoracic Department of Medical Sciences, University of Turin and ‘Città della Salute e della Scienza’ Hospital, Turin, Italy
| | - Fiorenzo Gaita
- Division of Cardiology, Cardiovascular and Thoracic Department of Medical Sciences, University of Turin and ‘Città della Salute e della Scienza’ Hospital, Turin, Italy
| | - Elisabetta Toso
- Division of Cardiology, Cardiovascular and Thoracic Department of Medical Sciences, University of Turin and ‘Città della Salute e della Scienza’ Hospital, Turin, Italy
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9
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Kolivras A, Thompson C, Pastushenko I, Mathieu M, Bruderer P, de Vicq M, Feoli F, Harag S, Meiers I, Olemans C, Sass U, Dehavay F, Fakih A, Lam-Hoai XL, Marneffe A, Van De Borne L, Vandersleyen V, Richert B. A clinicopathological description of COVID-19-induced chilblains (COVID-toes) correlated with a published literature review. J Cutan Pathol 2021; 49:17-28. [PMID: 34272741 PMCID: PMC8444728 DOI: 10.1111/cup.14099] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 06/14/2021] [Accepted: 07/12/2021] [Indexed: 12/17/2022]
Abstract
Background The abundance of publications of COVID‐19‐induced chilblains has resulted in a confusing situation. Methods This is a prospective single‐institution study from 15 March to 13 May 2020. Thirty‐two patients received PCR nasopharyngeal swabs. Of these, 28 patients had a thoracic CT‐scan, 31 patients had blood and urine examinations, 24 patients had skin biopsies including immunohistochemical and direct immunofluorescence studies, and four patients had electron microscopy. Results COVID‐19‐induced chilblains are clinically and histopathologically identical to chilblains from other causes. Although intravascular thrombi are sometimes observed, no patient had a systemic coagulopathy or severe clinical course. The exhaustive clinical, radiological, and laboratory work‐up in this study ruled‐out other primary and secondary causes. Electron microscopy revealed rare, probable viral particles whose core and spikes measured from 120 to 133 nm within endothelium and eccrine glands in two cases. Conclusion This study provides further clinicopathologic evidence of COVID‐19‐related chilblains. Negative PCR and antibody tests do not rule‐out infection. Chilblains represent a good prognosis, occurring later in the disease course. No systemic coagulopathy was identified in any patient. Patients presenting with acral lesions should be isolated, and chilblains should be distinguished from thrombotic lesions (livedo racemosa, retiform purpura, or ischemic acral necrosis).
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Affiliation(s)
- Athanassios Kolivras
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium.,Department of Dermatopathology, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Curtis Thompson
- Departments of Dermatology and Pathology, Oregon Health and Science University, Portland, Oregon, USA.,CTA Pathology, Portland, Oregon, USA
| | - Ievgenia Pastushenko
- Laboratory of Stem Cells and Cancer, Université Libre de Bruxelles, Brussels, Belgium
| | - Marisa Mathieu
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Pascal Bruderer
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium.,Department of Dermatopathology, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Marine de Vicq
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium.,Department of Dermatopathology, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Francesco Feoli
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium.,Department of Dermatopathology, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Saadia Harag
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium.,Department of Dermatopathology, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Isabelle Meiers
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium.,Department of Dermatopathology, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Catherine Olemans
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium.,Department of Dermatopathology, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Ursula Sass
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium.,Department of Dermatopathology, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Florence Dehavay
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Ali Fakih
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Xuan-Lan Lam-Hoai
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Alice Marneffe
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Laura Van De Borne
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Valerie Vandersleyen
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium.,Department of Dermatopathology, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Bertrand Richert
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
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Alshehri FSM, Whyte CS, Tuncay A, Williams ML, Wilson HM, Mutch NJ. Monocytes Expose Factor XIII-A and Stabilize Thrombi against Fibrinolytic Degradation. Int J Mol Sci 2021; 22:ijms22126591. [PMID: 34205443 PMCID: PMC8234680 DOI: 10.3390/ijms22126591] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/10/2021] [Accepted: 06/15/2021] [Indexed: 12/24/2022] Open
Abstract
Factor XIII (FXIII) is a transglutaminase that promotes thrombus stability by cross-linking fibrin. The cellular form, a homodimer of the A subunits, denoted FXIII-A, lacks a classical signal peptide for its release; however, we have shown that it is exposed on activated platelets. Here we addressed whether monocytes expose intracellular FXIII-A in response to stimuli. Using flow cytometry, we demonstrate that FXIII-A antigen and activity are up-regulated on human monocytes in response to stimulation by IL-4 and IL-10. Higher basal levels of the FXIII-A antigen were noted on the membrane of the monocytic cell line THP-1, but activity was significantly enhanced following stimulation with IL-4 and IL-10. In contrast, treatment with lipopolysaccharide did not upregulate exposure of FXIII-A in THP-1 cells. Quantification of the FXIII-A activity revealed a significant increase in THP-1 cells in total cell lysates following stimulation with IL-4 and IL-10. Following fractionation, the largest pool of FXIII-A was membrane associated. Monocytes were actively incorporated into the fibrin mesh of model thrombi. We found that stimulation of monocytes and THP-1 cells with IL-4 and IL-10 stabilized FXIII-depleted thrombi against fibrinolytic degradation, via a transglutaminase-dependent mechanism. Our data suggest that monocyte-derived FXIII-A externalized in response to stimuli participates in thrombus stabilization.
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Magdás A, Podoleanu C, Frigy A. Extensive Left Ventricular Thrombosis with Concomitant Pulmonary Embolism. Clin Pract 2021; 11:303-308. [PMID: 34069763 PMCID: PMC8161442 DOI: 10.3390/clinpract11020043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 04/28/2021] [Accepted: 05/06/2021] [Indexed: 11/16/2022] Open
Abstract
A 57-year-old non-obese female patient with a history of heavy smoking, chronic obstructive pulmonary disease and hypertension was admitted to the hospital as an emergency for acute hemoptysis and signs of congestive heart failure. To assess the source of hemoptysis, computed tomography (CT) pulmonary angiography was performed, which confirmed a bilateral pulmonary embolism of the apical branches. The routinely performed transthoracic echocardiography (TTE) revealed an enlarged left ventricle with severely reduced ejection fraction (EF = 25%) due to global hypokinesia and multiple, mobile, echogenic masses. To increase the diagnostic accuracy, real-time three-dimensional (Live 3D) imaging of the masses was added which described multiple left ventricular (LV) thrombi. Successful resolution of intraventricular thrombi was noticed after treatment with oral anticoagulant therapy (acenocumarol), despite the lack of regular INR control.
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Affiliation(s)
- Annamária Magdás
- Department of Internal Medicine, County Clinical Hospital Mureș, 1 Gheorghe Marinescu Street, 540103 Târgu Mureș, Romania
- George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu-Mureș, 38 Gheorghe Marinescu Street, 540142 Târgu Mureș, Romania; (C.P.); (A.F.)
- Correspondence: or ; Tel.: +40-740962529
| | - Cristian Podoleanu
- George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu-Mureș, 38 Gheorghe Marinescu Street, 540142 Târgu Mureș, Romania; (C.P.); (A.F.)
- Department of Cardiology, County Clinical Hospital Mureș, 1 Gheorghe Marinescu Street, 540103 Târgu Mureș, Romania
| | - Attila Frigy
- George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu-Mureș, 38 Gheorghe Marinescu Street, 540142 Târgu Mureș, Romania; (C.P.); (A.F.)
- Department of Cardiology, County Clinical Hospital Mureș, 1 Gheorghe Marinescu Street, 540103 Târgu Mureș, Romania
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Matsukura T, Kataoka C, Kawana Y, Fujita M, Kashiwada S. Silver nanocolloid affects hindbrain vascular formation during medaka embryogenesis. Environ Toxicol 2021; 36:417-424. [PMID: 33098621 DOI: 10.1002/tox.23047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/29/2020] [Accepted: 10/09/2020] [Indexed: 06/11/2023]
Abstract
Angiogenesis is essential for the normal development of an embryo. Silver nanocolloid (SNC) is known to induce vascular malformation in the medaka embryo. We focused on the development of the central arteries (CtAs) in the hindbrain of Japanese medaka. The CtAs and the basilar artery from which they branch are essential for transporting the blood and nutrients necessary to support the hindbrain parenchyma and the development of the pons and cerebellum from the hindbrain. We exposed medaka embryos at developmental stage 21 (6 somite stage), to 0, 0.5, 5, or 10 mg/L SNC and evaluated hatching rate, number of thrombi per embryo, head size (length and width), body length, and angiogenesis. Although all SNC-exposed embryos hatched, their head size and body length were small in comparison to controls; in addition, the number of thrombi in the head increased and head size and body length decreased as the SNC concentration increased. To evaluate vasculogenic abnormalities, we performed whole-mount in situ hybridization using a vascular marker (eg, fl7) and visualized the CtAs in medaka embryos. In control embryos, CtAs started to sprout at stage 32 (somite completion stage) and their extension was complete by stage 35 (pectoral fin blood circulation stage). In contrast, CtAs failed to sprout in SNC-exposed embryos, and thrombi were present. Furthermore, qRT-PCR analysis showed that SNC significantly suppressed the egfl7 expression level at stage 35. Together, our findings suggest that SNC induced decreased developments of head and body in medaka embryos due to insufficient angiogenesis and hindbrain vascular formation.
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Affiliation(s)
- Tomomi Matsukura
- Graduate School of Life Sciences, Toyo University, Itakura, Japan
| | | | - Yohei Kawana
- Department of Life Sciences, Toyo University, Itakura, Japan
| | - Misato Fujita
- Faculty of Science, Kanagawa University, Hiratsuka, Japan
| | - Shosaku Kashiwada
- Graduate School of Life Sciences, Toyo University, Itakura, Japan
- Department of Life Sciences, Toyo University, Itakura, Japan
- Research Centre for Life and Environmental Sciences, Toyo University, Itakura, Japan
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13
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Whyte CS, Mostefai HA, Baeten KM, Lucking AJ, Newby DE, Booth NA, Mutch NJ. Role of Shear Stress and tPA Concentration in the Fibrinolytic Potential of Thrombi. Int J Mol Sci 2021; 22:2115. [PMID: 33672724 DOI: 10.3390/ijms22042115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/11/2021] [Accepted: 02/13/2021] [Indexed: 11/16/2022] Open
Abstract
The resolution of arterial thrombi is critically dependent on the endogenous fibrinolytic system. Using well-established and complementary whole blood models, we investigated the endogenous fibrinolytic potential of the tissue-type plasminogen activator (tPA) and the intra-thrombus distribution of fibrinolytic proteins, formed ex vivo under shear. tPA was present at physiologically relevant concentrations and fibrinolysis was monitored using an FITC-labelled fibrinogen tracer. Thrombi were formed from anticoagulated blood using a Chandler Loop and from non-anticoagulated blood perfused over specially-prepared porcine aorta strips under low (212 s−1) and high shear (1690 s−1) conditions in a Badimon Chamber. Plasminogen, tPA and plasminogen activator inhibitor-1 (PAI-1) concentrations were measured by ELISA. The tPA–PAI-1 complex was abundant in Chandler model thrombi serum. In contrast, free tPA was evident in the head of thrombi and correlated with fibrinolytic activity. Badimon thrombi formed under high shear conditions were more resistant to fibrinolysis than those formed at low shear. Plasminogen and tPA concentrations were elevated in thrombi formed at low shear, while PAI-1 concentrations were augmented at high shear rates. In conclusion, tPA primarily localises to the thrombus head in a free and active form. Thrombi formed at high shear incorporate less tPA and plasminogen and increased PAI-1, thereby enhancing resistance to degradation.
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Sauter JL, Baine MK, Butnor KJ, Buonocore DJ, Chang JC, Jungbluth AA, Szabolcs MJ, Morjaria S, Mount SL, Rekhtman N, Selbs E, Sheng ZM, Xiao Y, Kleiner DE, Pittaluga S, Taubenberger JK, Rapkiewicz AV, Travis WD. Insights into pathogenesis of fatal COVID-19 pneumonia from histopathology with immunohistochemical and viral RNA studies. Histopathology 2020; 77:915-925. [PMID: 32614086 PMCID: PMC7361244 DOI: 10.1111/his.14201] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/27/2020] [Indexed: 01/08/2023]
Abstract
Introduction We describe post‐mortem pulmonary histopathologic findings of COVID‐19 pneumonia in patients with a spectrum of disease course, from rapid demise to prolonged hospitalisation. Methods and results Histopathologic findings in post‐mortem lung tissue from eight patients who died from COVID‐19 pneumonia were reviewed. Immunohistochemistry (IHC) and next‐generation sequencing (NGS) were performed to detect virus. Diffuse alveolar damage (DAD) was seen in all cases with a spectrum of acute phase and/or organising phase. IHC with monoclonal antibodies against SARS‐CoV‐2 viral nucleoprotein and spike protein detected virus in areas of acute but not organising DAD, with intracellular viral antigen and RNA expression seen predominantly in patients with duration of illness less than 10 days. Major vascular findings included thrombi in medium‐ and large‐calibre vessels, platelet microthrombi detected by CD61 IHC and fibrin microthrombi. Conclusions Presence of SARS‐CoV‐2 viral RNA by NGS early in the disease course and expression of viral antigen by IHC exclusively in the acute, but not in the organising phase of DAD, suggests that the virus may play a major role in initiating the acute lung injury of DAD, but when DAD progresses to the organising phase the virus may have been cleared from the lung by the patient's immune response. These findings suggest the possibility of a major change during the disease course of COVID‐19 pneumonia that may have therapeutic implications. Frequent thrombi and microthrombi may also present potential targets for therapeutic intervention.
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Affiliation(s)
- Jennifer L Sauter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marina K Baine
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kelly J Butnor
- Department of Laboratory Medicine and Pathology, University of Vermont Medical Center, Burlington, VT, USA
| | - Darren J Buonocore
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jason C Chang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Achim A Jungbluth
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Matthias J Szabolcs
- Department of Pathology and Cell Biology, Columbia University, New York, NY, USA
| | - Sejal Morjaria
- Infectious Disease, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Sharon L Mount
- Department of Laboratory Medicine and Pathology, University of Vermont Medical Center, Burlington, VT, USA
| | - Natasha Rekhtman
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elena Selbs
- Department of Pathology, New York University Long Island School of Medicine, Mineola, NY, USA
| | - Zong-Mei Sheng
- Viral Pathogenesis and Evolution Section, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Yongli Xiao
- Viral Pathogenesis and Evolution Section, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - David E Kleiner
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Stefania Pittaluga
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jeffery K Taubenberger
- Viral Pathogenesis and Evolution Section, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Amy V Rapkiewicz
- Department of Pathology, New York University Long Island School of Medicine, Mineola, NY, USA
| | - William D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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15
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Abstract
Emboli are common clinicopathologic findings. Recognition of the type of arterial emboli could be the first clue to the original source. Emboli with myxomatous changes are rare. Myxoma-like features in mural organizing thrombi have been reported. The most challenging differential diagnosis is between embolic cardiac myxomas and myxomatous thromboemboli. Emboli from sarcomas and arteriosclerotic plaques with myxoid features are also potential pitfalls. There is scarcity of studies focusing on myxoid emboli and their clinical and pathologic importance. We performed a retrospective study over 12 years. We retrieved all of the embolectomy specimens. We histologically screened the emboli for myxoid stroma, myxomatous changes, and mucinous degeneration. We retrieved 12 cases (3%) of myxoid emboli out of 391 embolectomy specimens. We found 4 cases of thromboemboli, 5 cases of atrial myxomas, 2 cases of atheromatous plaques, and a myxoid liposarcoma. The age range was between 35 and 71 years, with a mean age of 51 years. The male-to-female ratio was 3:2. Myxoid thromboemboli and myxomas were large, while atheromatous plaque emboli were small. Myxoid emboli arising from organizing mural thrombi can be histologically confused with cardiac myxomas and vice versa. Myxoid emboli from atheromatous plaque and myxoid sarcomas can mimic embolizing myxomas. Certain histologic features are helpful hints to differentiate between myxoid emboli. In doubtful cases, immunohistochemistry is helpful. Correct histologic recognition of the different types of myxoid emboli helps guide the clinicians to the most likely etiology and appropriate management in occlusive peripheral vascular diseases with clinically unrecognized lesions.
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Mitchell JL, Wright S, Kazi S, Watson HG, Mutch NJ. Defective α 2 antiplasmin cross-linking and thrombus stability in a case of acquired factor XIII deficiency. Br J Haematol 2017; 178:794-799. [PMID: 28516512 DOI: 10.1111/bjh.14759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 03/20/2017] [Indexed: 12/01/2022]
Abstract
Acquired factor XIII (FXIII) deficiency is a rare and life-threatening condition that is often misdiagnosed or missed completely. A 72-year-old woman presented with symptoms of major unprovoked bleeding but routine coagulation screening tests and platelet count were normal. Low activated FXIII (FXIIIa) activity levels and abnormal urea clot stability led to diagnosis of acquired FXIII deficiency. A modified Bethesda inhibitor titre of 1.6 Bethesda units/ml indicated the presence of a FXIII inhibitor. Bleeding responded to a single dose of FXIII concentrate and immunosuppression with prednisolone induced remission. A subsequent relapse was treated with combined prednisolone and Rituximab resulting in a prolonged, ongoing remission. Here we analyse the mechanisms underlying this idiopathic case of acquired FXIII deficiency. Prospective analysis of patient plasma revealed minimal FXIIIa activity and antigen in presentation and relapse samples. Thrombi formed from these samples lysed rapidly and showed an absence of cross-linked α2 AP. Western blotting revealed the presence of FXIII-B, indicating only FXIII-A and FXIII-A2 B2 were affected. FXIII activity and antigen levels normalised on remission. Our data suggest the presence of inhibitor-induced clearance of FXIII from plasma. As a consequence, reduced thrombus stability was evident due to defective α2 AP cross-linking, thereby explaining symptoms of excessive bleeding.
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Affiliation(s)
| | - Sonja Wright
- Department of Haematology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Sajida Kazi
- Department of Haematology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Henry G Watson
- Department of Haematology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Nicola J Mutch
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
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17
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Di Salvo G, Bulbul Z, Siblini G, Fadel B, Al Joufan M, Al Halees Z. Tetralogy of Fallot, Down's Syndrome, Left Ventricular Noncompaction, and Multiples Thrombi. J Cardiovasc Echogr 2015; 25:108-110. [PMID: 28465947 PMCID: PMC5353417 DOI: 10.4103/2211-4122.172488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We report a unique case of left ventricular noncompaction (LVNC), tetralogy of Fallot, and multiples biventricular thrombi in a Down's syndrome. Of interest, speckle tracking analysis detected an abnormal LV myocardial longitudinal deformation, despite the normal ejection fraction and absence of NC at the baseline evaluation.
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Affiliation(s)
- Giovanni Di Salvo
- King Faisal Specialist Hospital and Research Center, Heart Center, Riyadh, Kingdom of Saudi Arabia
| | - Ziad Bulbul
- American University of Beirut, Pediatric Cardiology, Lebanon
| | - Ghassan Siblini
- King Faisal Specialist Hospital and Research Center, Heart Center, Riyadh, Kingdom of Saudi Arabia
| | - Bahaa Fadel
- King Faisal Specialist Hospital and Research Center, Heart Center, Riyadh, Kingdom of Saudi Arabia
| | - Mansour Al Joufan
- King Faisal Specialist Hospital and Research Center, Heart Center, Riyadh, Kingdom of Saudi Arabia
| | - Zohair Al Halees
- King Faisal Specialist Hospital and Research Center, Heart Center, Riyadh, Kingdom of Saudi Arabia
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18
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Hall SG, Gardner K, Larson DF, Smith R. Reliability of the Thoratec HeartMate II flow measurements and alarms in the presence of reduced or non-existent flow. Perfusion 2015. [PMID: 26220358 DOI: 10.1177/0267659115593625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The Thoratec Corporation has over 10,000 patients registered as recipients of the HeartMate II left ventricular assist device (LVAD) worldwide. Although it has undoubtedly prolonged the lifespan of heart failure patients, the most recognized risk associated with these devices is the development of thrombus. In the presence of a small or developing clot, the HeartMate II display module and system monitor indicate that there is a decrease in pump flow, adjusts its pump power and is accompanied by audible and visual alarms when flow rates drop below a fixed threshold established by Thoratec. In contrast, when thrombus completely inhibits flow through the device, the display module and system monitor have failed in previous case studies to indicate that flow has reduced to zero and do not produce any corresponding alarms. METHODS To test the efficacy of the HeartMate II alarms, a cardiovascular simulation tank was used to reproduce the hemodynamics of a typical heart failure patient. The hemodynamics were then improved by the addition of the HeartMate II LVAD and different partial and complete occlusions were applied to the inlet and outlet of the HeartMate II pump. CONCLUSIONS Partially occluding the inflow and/or outflow of the HeartMate II did display changes in flow and presented with alarms when flow was estimated to be below 2.5 L/min; however, complete occlusion of the inflow and/or outflow failed to produce any alarms or accurately measured changes in flow.
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Affiliation(s)
- Seana G Hall
- Sarver Heart Center, College of Medicine, The University of Arizona, Tucson, AZ, USA
| | - Kayla Gardner
- Sarver Heart Center, College of Medicine, The University of Arizona, Tucson, AZ, USA
| | - Douglas F Larson
- Sarver Heart Center, College of Medicine, The University of Arizona, Tucson, AZ, USA
| | - Richard Smith
- Sarver Heart Center, College of Medicine, The University of Arizona, Tucson, AZ, USA
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Elikowski W, Błaszczyk E, Małek M, Bolewski A, Angerer D. [Multiple right ventricular thrombi in arrhythmogenic right ventricular cardiomyopathy - a case report]. Pol Merkur Lekarski 2015; 38:273-277. [PMID: 26039022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Typical complications of arrhythmogenic right ventricular cardiomyopathy (ARVC) are heart failure and ventricular arrhythmias which may lead to sudden cardiac death. Intracardiac thrombosis is diagnosed only in 2-4% of patients. The authors present a case of a 50-year-old male admitted to hospital due to symptomatic ventricular tachycardia. Echocardiography and cardiac magnetic resonance showed advanced ARVC with multiple right ventricular thrombi. The biggest one was localized in the inflow tract below the tricuspid valve, whereas the smallest one beneath it, on the inferior wall; the remaining two - in the apex. Chest computed tomography did not confirm pulmonary embolism. Disappearance of thrombi was observed after 4 weeks of anticoagulation. Detection and appropriate treatment of intracardiac thrombi in ARVC may have relevance in prevention of sudden death, not related to arrhythmia, and is of special importance before cardioverterdefibrillator implantation.
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Affiliation(s)
| | - Edyta Błaszczyk
- Józef Struś Hospital, Poznań, Poland: Department of Cardiology; Charité University Medicine, Working Group Cardiac MRT, Berlin, Germany
| | - Małgorzata Małek
- Józef Struś Hospital, Poznań, Poland: Department of Internal Medicine
| | | | - Dariusz Angerer
- Józef Struś Hospital, Poznań, Poland: Department of Cardiology
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Takeda Y, Wakui N, Asai Y, Dan N, Yamauchi Y, Ueki N, Otsuka T, Oba N, Nishinakagawa S, Minagawa M, Takeda Y, Shiono S, Kojima T. Spontaneous complete necrosis of hepatocellular carcinoma: A case report and review of the literature. Oncol Lett 2015; 9:1520-1526. [PMID: 25788993 PMCID: PMC4356411 DOI: 10.3892/ol.2015.2937] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 12/12/2014] [Indexed: 01/26/2023] Open
Abstract
The present study reports the case of a 68-year-old male patient who presented to Tokyo Rosai Hospital for the treatment of alcoholic liver disease. A high density was observed in liver segment S2, while a tumor, 30 mm in size, exhibiting a low density was observed in the delayed phase upon contrast-enhanced computed tomography (CT), which was performed prior to admission. The tumor appeared slightly poorly defined upon abdominal ultrasound and was observed as a 30 mm low-echoic nodule that was internally heterogeneous. A 5-mm thick contrast enhancement effect was observed in the tumor border in the vascular phase on Sonazoid contrast-enhanced ultrasonography, while a defect in the entire tumor was observed in the post-vascular phase. Dysphagia had commenced three months prior to presentation and a weight loss of ~3 kg was observed. Therefore, the patient was admitted to Tokyo Rosai Hospital due to the presence of a hepatic tumor, and to undergo a close inspection of the cause of the tumor. Upon close inspection, it was determined that the weight loss and aphagia were caused by progressive bulbar paralysis. A contrast-enhanced CT was performed on post-admission day 29 as a follow-up regarding the hepatic tumor. As a result, although no change in the tumor size was observed, the contrast enhancement in the tumor borderline had disappeared. Necrosis of the tumor was considered. However, as viable persistence of the malignant tumor could not be excluded, a hepatic left lobe excision was performed. The patient was diagnosed with hepatocellular carcinoma (HCC) based on the morphology of the cellular necrosis. In addition, occlusion due to thrombus was observed within the blood vessels passing inside the fibrous capsule. It was hypothesized that the formation of a thick fibrous capsule and occlusion due to thrombus in the feeding vessel were possibly involved as the cause of complete spontaneous necrosis. Written informed consent was obtained from the patient.
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Affiliation(s)
- Yuki Takeda
- Department of Internal Gastroenterology and Hepatology, Tokyo Rosai Hospital, Tokyo 143-0013, Japan
| | - Noritaka Wakui
- Department of Internal Gastroenterology and Hepatology, Tokyo Rosai Hospital, Tokyo 143-0013, Japan
| | - Yasutsugu Asai
- Department of Internal Gastroenterology and Hepatology, Tokyo Rosai Hospital, Tokyo 143-0013, Japan
| | - Nobuhiro Dan
- Department of Internal Gastroenterology and Hepatology, Tokyo Rosai Hospital, Tokyo 143-0013, Japan
| | - Yoshiya Yamauchi
- Department of Internal Gastroenterology and Hepatology, Tokyo Rosai Hospital, Tokyo 143-0013, Japan
| | - Nobuo Ueki
- Department of Internal Gastroenterology and Hepatology, Tokyo Rosai Hospital, Tokyo 143-0013, Japan
| | - Takafumi Otsuka
- Department of Internal Gastroenterology and Hepatology, Tokyo Rosai Hospital, Tokyo 143-0013, Japan
| | - Nobuyuki Oba
- Department of Internal Gastroenterology and Hepatology, Tokyo Rosai Hospital, Tokyo 143-0013, Japan
| | - Shuta Nishinakagawa
- Department of Internal Gastroenterology and Hepatology, Tokyo Rosai Hospital, Tokyo 143-0013, Japan
| | - Masami Minagawa
- Department of Surgery, Tokyo Rosai Hospital, Tokyo 143-0013, Japan
| | - Yasushi Takeda
- Department of Surgery, Tokyo Rosai Hospital, Tokyo 143-0013, Japan
| | - Saori Shiono
- Department of Pathology, Tokyo Rosai Hospital, Tokyo 143-0013, Japan
| | - Tatsuya Kojima
- Department of Internal Gastroenterology and Hepatology, Tokyo Rosai Hospital, Tokyo 143-0013, Japan
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Gasparian GG, Sanossian N, Shiroishi MS, Liebeskind DS. Imaging of occlusive thrombi in acute ischemic stroke. Int J Stroke 2014; 10:298-305. [PMID: 25545291 DOI: 10.1111/ijs.12435] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 11/14/2014] [Indexed: 11/29/2022]
Abstract
Thrombi, or clots, often occlude proximal segments of the cerebral arterial circulation in acute ischemic stroke. Thromboembolic occlusion or thrombi superimposed on atherosclerotic plaque are the principal focus of acute stroke therapies such as thrombolysis or thrombectomy. We review the imaging characteristics of thrombi on multimodal computed tomography and magnetic resonance imaging, angiography, and ultrasonography, summarizing recent studies that facilitate therapeutic decision-making from these noninvasive studies. Information about the location, size, and imaging characteristics can be ascertained using these techniques. Imaging findings in relation to occlusive thrombus have been correlated with clot pathology, response to therapeutic interventions, and clinical outcome. Diagnostic evaluation of occlusive thrombi on noninvasive studies now constitutes an integral component of acute stroke management.
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Affiliation(s)
- Gregory G Gasparian
- Department of Radiology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
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Yamanaka T, Sakamoto H, Nakagawa T, Tanaka S, Matsumoto K, Ueno M. An immunohistochemical study of human platelets using a rabbit antibody against H18-K24 of apolipoprotein CIII (HATKTAK). Pathol Int 2013; 63:398-407. [PMID: 23957915 DOI: 10.1111/pin.12083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 06/25/2013] [Indexed: 11/28/2022]
Abstract
H18-K24 of human apolipopotein CIII (Apo CIII) (HATKTAK) is an activator of the macromolecular activators of phagocytosis from platelets (MAPPs). Using a rabbit antibody against HATKTAK, we performed an immunohistochemical study of human platelets. Indirect ELISA showed that this antibody reacts with Apo CIII-derived peptides with a C-terminal of HATKTAK, but not with Apo CIII. Immunoelectron microscopy revealed that reaction of anti-HATKTAK antibody occurred in the pseudopods of activated platelets. In blood coagula produced from the peripheral blood and formalin-fixed after various incubation periods, reaction of this antibody with platelets appeared rapidly with a peak at 3 to 6 h of incubation, and then diminished gradually. Leukocytes in the blood coagula were stained strongly positive. In tissue sections, fresh thrombi and hemorrhages with slight fibrin formation revealed a positive response of platelets to anti-HATKTAK antibody, whereas older ones with leukocytic infiltration, fibrin formation and organization did not. In addition to platelets, endothelial cells and leukocytes were stained positive by anti-HATKTAK antibody. All of the positive reactions by anti-HATKTAK antibody disappeared or diminished by co-incubation with HATKTAK. In conclusion, the anti-HATKTAK antibody reveals platelets during the early phase of activation.
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Affiliation(s)
- Takao Yamanaka
- Inflammation Pathology, Department of Pathology and Host Defense, Faculty of Medicine, Kagawa University, Kagawa, Japan
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Randhawa PS, Tsamandas AC, Magnone M, Jordan M, Shapiro R, Starzl TE, Demetris AJ. Microvascular changes in renal allografts associated with FK506 (Tacrolimus) therapy. Am J Surg Pathol 1996; 20:306-12. [PMID: 8772784 PMCID: PMC3019101 DOI: 10.1097/00000478-199603000-00007] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
FK506 (Tacrolimus) recently has been shown to be an effective immunosuppressant after renal transplantation. It is associated with less hypertension, hypercholesterolemia and steroid use compared with cyclosporine. We report 10 patients on FK506 who showed fibrin thrombi within the glomerular capillaries and/or arterioles at renal allograft biopsy. These biopsies were generally performed to assess increasing serum creatinine levels; laboratory evidence of hemolytic uremic syndrome was present in one instance. Plasma or whole blood FK506 levels were elevated in eight of 10 cases. Reduction of immunosuppression led to clinical improvement or biopsy-proven resolution of thrombi in all cases. These observations suggest that FK506 may occasionally produce microvascular changes in the renal allograft. The estimated incidence of this occurrence (1%) is comparable with that reported with cyclosporine (3%).
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Affiliation(s)
- P S Randhawa
- Division of Transplantation Pathology, University of Pittsburgh School of Medicine, Pennsylvania, USA
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