Lung Cavities in Chronic Thromboembolic Pulmonary Hypertension

Fernandes, Constantino José; Oliveira, E.P.; Salibe-Filho, Willian; Filho, Mário Terra; Jardim, Carlos; Kato-Morinaga, Luciana Tamie; Hoette, Susana; Souza, Rogério

doi:10.6061/clinics/2020/e1373

Cited by 4 publications

(8 citation statements)

References 19 publications

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“…Obesity has been associated with a prothrombotic state and hypofibrinolysis 20 – 24 . The “mosaic pattern” of the lung-parenchyma that we observed in accordance with previous publications and the lung cavities strikingly resemble findings in patients with chronic thromboembolic pulmonary hypertension 15 , 18 , 19 .…”

Section: Discussionsupporting

confidence: 91%

“…In general, infectious causes and ventilator induced lung injury are recognized as the main etiologies of lung cavities in critically ill patients 17 . Ischemia is less commonly considered as a cause, although cavitations are described in up to 32% of patients with pulmonary embolism and are a common finding in patients suffering from chronic thromboembolic pulmonary hypertension 18 , 19 . While the precise pathogenesis is difficult to ascertain in individual cases in our study, we believe that several lines of evidence indicate that an ischemic pathogenesis rather than alternative causes play a major role.…”

Section: Discussionmentioning

confidence: 99%

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Evidence for a thromboembolic pathogenesis of lung cavitations in severely ill COVID-19 patients

Kruse

Zickler

Lüdemann

et al. 2021

Sci Rep

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) induces lung injury of varying severity, potentially causing severe acute respiratory distress syndrome (ARDS). Pulmonary injury patterns in COVID-19 patients differ from those in patients with other causes of ARDS. We aimed to explore the frequency and pathogenesis of cavitary lung lesions in critically ill patients with COVID-19. Retrospective study in 39 critically ill adult patients hospitalized with severe acute respiratory syndrome coronavirus 2 including lung injury of varying severity in a tertiary care referral center during March and May 2020, Berlin/Germany. We observed lung cavitations in an unusually large proportion of 22/39 (56%) COVID-19 patients treated on intensive care units (ICU), including 3/5 patients without mechanical ventilation. Median interquartile range (IQR) time between onset of symptoms and ICU admission was 11.5 (6.25–17.75) days. In 15 patients, lung cavitations were already present on the first CT scan, performed after ICU admission; in seven patients they developed during a subsequent median (IQR) observation period of 48 (35–58) days. In seven patients we found at least one cavitation with a diameter > 2 cm (maximum 10 cm). Patients who developed cavitations were older and had a higher body mass index. Autopsy findings in three patients revealed that the cavitations reflected lung infarcts undergoing liquefaction, secondary to thrombotic pulmonary artery branch occlusions. Lung cavitations appear to be a frequent complication of severely ill COVID-19 patients, probably related to the prothrombotic state associated with COVID-19.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Evidence for a thromboembolic pathogenesis of lung cavitations in severely ill COVID-19 patients

Kruse

Zickler

Lüdemann

et al. 2021

Sci Rep

View full text Add to dashboard Cite

show abstract

“…17 Ischemia is less commonly considered as a cause, although cavitations are described in up to 32% of patients with pulmonary embolism and are a common nding in patients suffering from chronic thromboembolic pulmonary hypertension. 18,19 While the precise pathogenesis is di cult to ascertain in individual cases in our study, we believe that several lines of evidence indicate that an ischemic pathogenesis rather than alternative causes play a major role.…”

Section: Discussionmentioning

confidence: 74%

“…[20][21][22][23][24] The "mosaic pattern" of the lung-parenchyma that we observed in accordance with previous publications and the lung cavities strikingly resemble ndings in patients with chronic thromboembolic pulmonary hypertension. 15,18,19 During the time of this observational study critical care resources for COVID-19 patients were in no way compromised in our regional setting, enabling long-term ICU therapy. Together with a very large proportion of secondary referrals this might explain why others have to the best of our knowledge not yet reported similar observations.…”

Section: Discussionmentioning

confidence: 99%

A Cohort Study on Lung Cavitations in Severely Ill COVID-19 Patients – Evidence for a Thromboembolic Pathogenesis.

Kruse

Zickler

Lüdemann

et al. 2021

Preprint

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Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) induces lung injury of varying severity, potentially causing severe acute respiratory distress syndrome (ARDS). Pulmonary injury patterns in COVID-19 patients differ from those in patients with other causes of ARDS. We aimed to explore the frequency and pathogenesis of cavitary lung lesions in critically ill patients with COVID-19.Methods: Retrospective study in 39 critically ill adult patients hospitalized with severe acute respiratory syndrome coronavirus 2 including lung injury of varying severity in a tertiary care referral center during March and May 2020, Berlin/Germany.Results: We observed lung cavitations in an unusually large proportion of 22/39 (56%) COVID-19 patients treated on intensive care units (ICU), including 3/5 patients without mechanical ventilation. Median interquartile range (IQR) time between onset of symptoms and ICU admission was 11 5 (6 25-17 75) days. In 15 patients, lung cavitations were already present on the first CT scan, performed after ICU admission; in seven patients they developed during a subsequent median (IQR) observation period of 48 (35-58) days. In seven patients we found at least one cavitation with a diameter > 2 cm (maximum 10 cm). Patients who developed cavitations were older and had a higher body mass index. Autopsy findings in three patients revealed that the cavitations reflected lung infarcts undergoing liquefaction, secondary to thrombotic pulmonary artery branch occlusions.Conclusion: Lung cavitations appear to be a frequent complication of severely ill COVID-19 patients, probably related to the prothrombotic state associated with COVID-19.

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“…CTEPH has been observed in a patient with Proteus syndrome who notably presented with lung cavitations as well as in patients with other overgrowth syndromes. 9 , 16 Treatment is pulmonary thromboendarterectomy for those who are surgical candidates. Given our patient's history of pulmonary emboli, CTEPH was among the initial principal considerations for her longstanding, progressive dyspnea.…”

Section: Discussionmentioning

confidence: 99%

Precapillary pulmonary arterial hypertension in a patient with Proteus syndrome

Mathavan

Vahdatpour

et al. 2022

Pulm. circ.

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Proteus syndrome is a rare progressive multisystem disorder characterized by asymmetric, disproportionate overgrowth of bone, skin, and other tissue types. Molecular pathogenesis has been identified as somatic activating mutations of the AKT1 gene. The presentation of Proteus syndrome is exceptionally variable. Respiratory complications include emphysematous lung disease and predisposition to pulmonary emboli, the latter of which is a significant source of mortality. Pulmonary hypertension due to longstanding hypoxic lung disease as well as chronic thromboembolic events has been observed in this population. In contrast, precapillary pulmonary arterial hypertension in the absence of chronic pulmonary emboli and parenchymal lung disease has not been described in the literature on patients with Proteus syndrome. We report such a case in a young patient with Proteus syndrome, reviewing subsequent management and emphasizing the need for a detailed investigation of dyspnea.

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Lung Cavities in Chronic Thromboembolic Pulmonary Hypertension

Cited by 4 publications

References 19 publications

Evidence for a thromboembolic pathogenesis of lung cavitations in severely ill COVID-19 patients

Evidence for a thromboembolic pathogenesis of lung cavitations in severely ill COVID-19 patients

A Cohort Study on Lung Cavitations in Severely Ill COVID-19 Patients – Evidence for a Thromboembolic Pathogenesis.

Precapillary pulmonary arterial hypertension in a patient with Proteus syndrome

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