In Situ Pulmonary Arterial Thrombosis: Literature Review and Clinical Significance of a Distinct Entity

Baranga, Latika; Khanuja, Simrandeep; Scott, Jinel; Provancha, Ian; Gosselin, Marc V.; Walsh, James; Arancibia, Rosa; Bruno, Michael A.; Waite, Stephen

doi:10.2214/ajr.23.28996

Cited by 9 publications

(4 citation statements)

References 83 publications

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“…In situ PAT is an underestimated cause of circulatory disorders in the lungs. PAT is usually peripheral and is infrequently associated with signs of right heart overload [ 41 ]. The lack of a reference standard limits clinicians’ ability to diagnose in situ PAT.…”

Section: Discussionmentioning

confidence: 99%

Spectrum of Thrombotic Complications in Fatal Cases of COVID-19: Focus on Pulmonary Artery Thrombosis In Situ

Babkina

Yadgarov

Волков

et al. 2023

Viruses

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COVID-19-related thrombosis affects the venous and arterial systems. Data from 156 autopsies of COVID-19 patients were retrospectively analyzed to investigate the pattern of thrombotic complications and factors associated with pulmonary artery thrombosis and thromboembolism. Thrombotic complications were observed in a significant proportion (n = 68, 44%), with pulmonary artery thrombosis the most frequently identified thrombotic event (42, 27%). Multivariate analysis revealed that the length of hospital stay (OR 1.1, p = 0.004), neutrophil infiltration in the alveolar spaces (OR 3.6, p = 0.002), and the absence of hyaline membranes (OR 0.1, p = 0.01) were associated with thrombotic complications. Neutrophil infiltration in the alveolar spaces (OR 8, p < 0.001) and the absence of hyaline membranes (OR 0.1, p = 0.003) were also independent predictors of pulmonary artery thrombosis. The association of pulmonary artery thrombosis with an absence of hyaline membranes suggests it occurs later in the course of COVID-19 infection. As neutrophil infiltration in the alveolar spaces may indicate bacterial infection, our studies suggest the consideration of bacterial infections in these critically ill patients.

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Section: Discussionmentioning

confidence: 99%

Spectrum of Thrombotic Complications in Fatal Cases of COVID-19: Focus on Pulmonary Artery Thrombosis In Situ

Babkina

Yadgarov

Волков

et al. 2023

Viruses

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“…It has been noted, however, that a variety of alternative processes can promote de novo thrombosis in the pulmonary arteries, i.e., in situ pulmonary artery thrombosis [51,52]. Some of these entities include abnormal pulmonary structures (such as a stump thrombus after pneumonectomy or lobectomy), sickle-cell disease, infection, or trauma [53].…”

Section: In Situ Pulmonary Artery Thrombosismentioning

confidence: 99%

Spectrum of Imaging Patterns of Lung Cancer following Radiation Therapy

Strange,

Erasmus,

Ahuja

et al. 2023

Diagnostics

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Radiation therapy using conventional or newer high-precision dose techniques, including three-dimensional conformal radiotherapy, intensity-modulated radiation therapy, stereotactic body radiation therapy, four-dimensional conformational radiotherapy, and proton therapy, is an important component of treating patients with lung cancer. Knowledge of the radiation technique used and the expected temporal evolution of radiation-induced lung injury, as well as patient-specific parameters such as previous radiotherapy, concurrent chemoradiotherapy, or immunotherapy, is important in image interpretation. This review discusses factors that affect the development and severity of radiation-induced lung injury and its radiological manifestations, as well as the differences between conventional and high-precision dose radiotherapy techniques.

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“…The high frequency of thrombotic complications seen in COVID‐19 contributes significantly to the high mortality, especially when compared with influenza 4,5 . In situ pulmonary arterial thrombosis as well as classic pulmonary thromboemboli—mostly originating in the leg veins—have been associated with SARS‐CoV‐2 5,6 . An increase in complement activation, cytokine storms, and vascular permeability play a vital role in COVID‐19 thrombosis, 7 although activation of these pathways is also present in influenza 8,9 .…”

Section: Introductionmentioning

confidence: 99%

“…4,5 In situ pulmonary arterial thrombosis as well as classic pulmonary thromboemboli-mostly originating in the leg veins-have been associated with SARS-CoV-2. 5,6 An increase in complement activation, cytokine storms, and vascular permeability play a vital role in COVID-19 thrombosis, 7 although activation of these pathways is also present in influenza. 8,9 The reason why this increase of the abovementioned pathways in thrombosis seems more activated in COVID-19 than in influenza is unclear.…”

Section: Introductionmentioning

confidence: 99%

Increase in venous thromboembolism in SARS‐CoV‐2 infected lung tissue: proteome analysis of lung parenchyma, isolated endothelium, and thrombi

Lopuhaä,

Guzel,

van der Lee

et al. 2024

Histopathology

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AimsCOVID‐19 pneumonia is characterized by an increased rate of deep venous thrombosis and pulmonary embolism. To better understand the pathophysiology behind thrombosis in COVID‐19, we performed proteomics analysis on SARS‐CoV‐2 infected lung tissue.MethodsLiquid chromatography mass spectrometry was performed on SARS‐CoV‐2 infected postmortem lung tissue samples. Five protein profiling analyses were performed: whole slide lung parenchyma analysis, followed by analysis of isolated thrombi and endothelium, both stratified by disease (COVID‐19 versus influenza) and thrombus morphology (embolism versus in situ). Influenza autopsy cases with pulmonary thrombi were used as controls.ResultsCompared to influenza controls, both analyses of COVID‐19 whole‐tissue and isolated endothelium showed upregulation of proteins and pathways related to liver metabolism including urea cycle activation, with arginase being among the top upregulated proteins in COVID‐19 lung tissue. Analysis of isolated COVID‐19 thrombi showed significant downregulation of pathways related to platelet activation compared to influenza thrombi. Analysis of isolated thrombi based on histomorphology shows that in situ thrombi have significant upregulation of coronavirus pathogenesis proteins.ConclusionsThe decrease in platelet activation pathways in severe COVID‐19 thrombi suggests a relative increase in venous thromboembolism, as thrombi from venous origin tend to contain fewer platelets than arterial thrombi. Based on histomorphology, in situ thrombi show upregulation of various proteins related to SARS‐CoV‐2 pathogenesis compared to thromboemboli, which may indicate increased in situ pulmonary thrombosis in COVID‐19. Therefore, this study supports the increase of venous thromboembolism without undercutting the involvement of in situ thrombosis in severe COVID‐19.

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In Situ Pulmonary Arterial Thrombosis: Literature Review and Clinical Significance of a Distinct Entity

Cited by 9 publications

References 83 publications

Spectrum of Thrombotic Complications in Fatal Cases of COVID-19: Focus on Pulmonary Artery Thrombosis In Situ

Spectrum of Thrombotic Complications in Fatal Cases of COVID-19: Focus on Pulmonary Artery Thrombosis In Situ

Spectrum of Imaging Patterns of Lung Cancer following Radiation Therapy

Increase in venous thromboembolism in SARS‐CoV‐2 infected lung tissue: proteome analysis of lung parenchyma, isolated endothelium, and thrombi

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