<i>In vivo</i> demonstration of pulmonary microvascular involvement in COVID-19 using dual-energy computed tomography

Si‐Mohamed, Salim; Chebib, Nader; Sigovan, Monica; Zumbihl, Léa; Turquier, Ségolène; Boccalini, Sara; Boussel, Loîc; Mornex, Jean‐François; Cottin, Vincent; Douek, Philippe

doi:10.1183/13993003.02608-2020

Cited by 35 publications

(33 citation statements)

References 10 publications

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“…The observed phenomenon is consistent with previously described increased parenchymal perfusion in COVID-19 GGO with dual-energy CT ( 6 ). Likewise, our patient exhibited hyperperfusion in GGO zones on iodine density maps ( Figures 1g,h ).…”

Section: Discussionsupporting

confidence: 92%

“…Imaging-based morphological vascular abnormalities in the lung described at CT may be categorized into three groups: thromboembolic events ( 3 ), vascular dilatation, also known as vascular “thickening” or “engorgement” ( 4 , 5 ), and perfusional changes ( 6 ). Mechanisms leading to vascular remodeling remain unclear, and their prevalence and distribution are a matter of debate.…”

Section: Vascular Changes In Covid-19 Pneumoniamentioning

confidence: 99%

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

2021

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Up to now, COVID-19-related vascular changes were mainly described as thrombo-embolic events. A handful of researchers reported another type of vascular abnormality referred to as “vascular thickening” or “vascular enlargement,” without specifying whether the dilated vessels are arteries or veins nor providing a physiopathological hypothesis. Our observations indicate that the vascular dilatation occurs in the venous compartment, and underlying mechanisms might include increased blood flow due to inflammation and the activation of arteriovenous anastomoses.

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Section: Discussionsupporting

confidence: 92%

Section: Vascular Changes In Covid-19 Pneumoniamentioning

confidence: 99%

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

2021

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“…In the early clinical phase of the disease, Si-Mohamed et al. reported diffuse bilateral ground-glass opacities associated with increased lung perfusion in the corresponding lobes in 2 patients [20] . The authors hypothesized that these vascular changes might correspond to the histopathological findings of intussusceptive angiogenesis reported in autopsy studies, describing the striking neovessels growth in severe COVID-19 pneumonia [ 13 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

“…In comparison with autopsy findings in influenza-associated respiratory failure, alveolar capillary microthrombi were found to be 9 times more prevalent in patients with COVID-19 who also exhibited a 2.7 times higher amount of new vessel growth [13] . In-vivo insight into this distal pulmonary angiopathy was reported in patients with mild to severe COVID-19 pneumonia who underwent dual-energy CT angiography [15] , [16] , [17] , [18] , [19] , [20] . In the early clinical phase, increased lung perfusion matching with ground-glass opacities was reported.…”

Section: Introductionmentioning

confidence: 98%

Assessment of pulmonary arterial circulation 3 months after hospitalization for SARS-CoV-2 pneumonia: Dual-energy CT (DECT) angiographic study in 55 patients

et al. 2021

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Background During COVID-19, the main manifestations of the disease are not only pneumonia but also coagulation disorders. The purpose of this study was to evaluate pulmonary vascular abnormalities 3 months after hospitalization for SARS-CoV-2 pneumonia in patients with persistent respiratory symptoms. Methods Among the 320 patients who participated in a systematic follow-up 3 months after hospitalization, 76 patients had residual symptoms justifying a specialized follow-up in the department of pulmonology. Among them, dual-energy CT angiography (DECTA) was obtained in 55 patients. Findings The 55 patients had partial ( n = 40; 72.7%) or complete ( n = 15; 27.3%) resolution of COVID-19 lung infiltration. DECTA was normal in 52 patients (52/55; 94.6%) and showed endoluminal filling defects in 3 patients (3/55; 5.4%) at the level of one ( n = 1) and two ( n = 1) segmental arteries of a single lobe and within central and peripheral arteries ( n = 1). DECT lung perfusion was rated as non-interpretable ( n = 2;3.6%), normal ( n = 17; 30.9%) and abnormal ( n = 36; 65.5%), the latter group comprising 32 patients with residual COVID-19 opacities (32/36; 89%) and 4 patients with normal lung parenchyma (4/36; 11%). Perfusion abnormalities consisted of (a) patchy defects (30/36; 83%), (b) PE-type defects (6/36; 16.6%) with ( n = 1) or without proximal thrombosis ( n = 5); and (c) focal areas of hypoperfusion (2/36; 5.5%). Increased perfusion was seen in 15 patients, always matching GGOs, bands and/or vascular tree-in- bud patterns. Interpretation DECT depicted proximal arterial thrombosis in 5.4% of patients and perfusion abnormalities suggestive of widespread microangiopathy in 65.5% of patients. Lung microcirculation was abnormal in 4 patients with normal lung parenchyma.

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“…Some image studies using CT, functional respiratory imaging on CT and dual-energy CT support the hypothesis of hyperperfusion associated with vasodilation. [1][2][3] In addition to vasodilation, vascular proliferation due to local angiogenesis might contribute to increased perfusion. Ackermann et al, 4 by using transmission and scanning electron microscopy and microvascular corrosion casts, elegantly demonstrated increased intussusceptive and sprouting angiogenesis in patients with COVID-19.…”

Section: Introductionmentioning

confidence: 99%

Pulmonary vascular proliferation in patients with severe COVID-19: an autopsy study

Pérez-Míes

Gómez-Rojo

Carretero‐Barrio

et al. 2021

Thorax

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Diffuse alveolar damage and thrombi are the most common lung histopathological lesions reported in patients with severe COVID-19. Although some studies have suggested increased pulmonary angiogenesis, the presence of vascular proliferation in COVID-19 lungs has not been well characterised. Glomeruloid-like microscopic foci and/or coalescent vascular proliferations measuring up to 2 cm were present in the lung of 14 out of 16 autopsied patients. These lesions expressed CD31, CD34 and vascular endothelial cadherin. Platelet-derived growth factor receptor-β immunohistochemistry and dual immunostaining for CD34/smooth muscle actin demonstrated the presence of pericytes. These vascular alterations may contribute to the severe and refractory hypoxaemia that is common in patients with severe COVID-19.

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In vivo demonstration of pulmonary microvascular involvement in COVID-19 using dual-energy computed tomography

Cited by 35 publications

References 10 publications

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

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

Assessment of pulmonary arterial circulation 3 months after hospitalization for SARS-CoV-2 pneumonia: Dual-energy CT (DECT) angiographic study in 55 patients

Pulmonary vascular proliferation in patients with severe COVID-19: an autopsy study

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