The coronavirus disease 19 (COVID-19) is a highly transmittable viral infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV-2 utilizes metallocarboxyl peptidase angiotensin receptor (ACE) 2 to gain entry into human cells. Activation of several proteases facilitates the interaction of viral spike proteins (S1) and ACE2 receptor. This leads to cleavage of host ACE2 receptors. ACE2 activity counterbalances the angiotensin II effect, its loss may lead to elevated angiotensin II levels with modulation of platelet function, size and activity. COVID-19 disease encompasses a spectrum of systemic involvement far beyond respiratory failure alone. Several features of this disease, including the etiology of acute kidney injury (AKI) and the hypercoagulable state, remain poorly understood. Here, we show that there is a high incidence of AKI (81%) in the critically ill adults with COVID-19 in the setting of elevated D-dimer, elevated ferritin, C reactive protein (CRP) and lactate dehydrogenase (LDH) levels. Strikingly, there were unique features of platelets in these patients, including larger, more granular platelets and a higher mean platelet volume (MPV). There was a significant correlation between measured D-dimer levels and MVP; but a negative correlation between MPV and glomerular filtration rates (GFR) in critically ill cohort. Our data suggest that activated platelets may play a role in renal failure and possibly hypercoagulability status in COVID19 patients.

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Hemangiopericytomas (HPC) are perivascular neoplasms that are rarely encountered as primary lung malignancy. Surgical resection remains the mainstay therapy of HPC. A 37-year old African American female initially presented with fatigue, chest pain and palpitations. Chest radiography showed a well-circumscribed large heterogeneous vascular mass of the right hemithorax. She underwent a CT-guided biopsy of the thoracic mass and was diagnosed with low-grade pulmonary hemangiopericytoma. High tumor vascularity burden and liver metastases precluded her from being a surgical candidate. Three years ago, she referred to our facility seeking further management. She did not tolerate systemic chemotherapy. Alternatively, she had been successfully managed with serial transarterial embolization and oral angiogenesis inhibitor to date. This therapeutic approach can be further explored for long term control of unresectable pulmonary HPC.

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