Case Report: Intrapulmonary Arteriovenous Anastomoses in COVID-19-Related Pulmonary Vascular Changes: A New Player in the Arena?

Qanadli, Salah D.; Rocha, Ana Carolina; Rotzinger, David C.

doi:10.3389/fmed.2021.639152

Cited by 6 publications

(10 citation statements)

References 14 publications

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“…It is worth mentioning that the CT sign of vascular enlargement was frequently seen in severe patients during hospitalization (57.6%), but was rarely seen in non-severe ones or patients after discharge. It was reported that in patients with COVID-19, due to inflammation and the activation of arteriovenous anastomoses, venous blood flow increases and results in the vascular dilatation in the venous compartment ( 32 , 33 ). This could help to understand the sign of vascular enlargement in severe patients with COVID-19 ( 34 ).…”

Section: Discussionmentioning

confidence: 99%

Longitudinal Radiological Findings in Patients With COVID-19 With Different Severities: From Onset to Long-Term Follow-Up After Discharge

Zhao

Wang

et al. 2021

Front. Med.

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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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Section: Discussionmentioning

confidence: 99%

Longitudinal Radiological Findings in Patients With COVID-19 With Different Severities: From Onset to Long-Term Follow-Up After Discharge

Zhao

Wang

et al. 2021

Front. Med.

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“…A patient subset may have acute respiratory distress syndrome (ARDS) with a severe or even lethal disease course [ 1 , 2 ] and/or cardiovascular complications [ 3 , 4 , 5 ]. From the pathophysiological point of view, interference between pulmonary and cardiovascular consequences, with or without morphologic expression, have been debated [ 6 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…On the other hand, areas of oligemia have been consistently described as well [ 8 , 15 ], which are seemingly contradictory to vascular dilatation suggestive of increased blood flow and blood volume [ 18 ]. The simultaneous presence of oligemia and vascular dilatation raises the question of intrapulmonary arteriovenous shunt mechanisms that may play a role in the discrepancy between the morphological appearance on imaging and severe hypoxia [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Acute Pulmonary Embolism in COVID-19: A Potential Connection between Venous Congestion and Thrombus Distribution

et al. 2022

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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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“…In addition, the CT scan revealed vascular congestion developed over ground-glass opacities ( Figures 1A–C ), associated with markedly dilated vessels ( Figures 2B,E ), suggesting microthrombosis lesions. These fibrosis-like lesions ( 11 ) and pulmonary vascular changes ( 12 ) related to COVID-19 have been described recently.…”

Section: Discussionmentioning

confidence: 88%

Case Report: Potential Role of Corticosteroids in the Management of Post-COVID-19 Pneumonia

et al. 2021

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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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Case Report: Intrapulmonary Arteriovenous Anastomoses in COVID-19-Related Pulmonary Vascular Changes: A New Player in the Arena?

Cited by 6 publications

References 14 publications

Longitudinal Radiological Findings in Patients With COVID-19 With Different Severities: From Onset to Long-Term Follow-Up After Discharge

Longitudinal Radiological Findings in Patients With COVID-19 With Different Severities: From Onset to Long-Term Follow-Up After Discharge

Acute Pulmonary Embolism in COVID-19: A Potential Connection between Venous Congestion and Thrombus Distribution

Case Report: Potential Role of Corticosteroids in the Management of Post-COVID-19 Pneumonia

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