The vascular nature of COVID-19

Oudkerk, Matthijs; Kuijpers, Dirkjan; Oudkerk, Sytse F.; Beek, Edwin Jacques Rudolph van

doi:10.1259/bjr.20200718

Cited by 15 publications

(14 citation statements)

References 14 publications

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“…Pulmonary radiological findings in COVID-19 do not align with a model of SARS-CoV-2infection primarily causing disease of the airways of the lungs; the initial and dominant pathological features demonstrated radiologically are vascular in nature [4][5][6].…”

Section: Radiological Perspective-covid-19 Lung Disease 1 Pathologica...mentioning

confidence: 78%

“…Conversely, there are numerous studies within the radiological literature describing the pathogenesis of COVID-19 lung disease as driven by vascular phenomena [4][5][6][9][10][11][12][13][14]. Early in the pandemic period, the presence of "ground-glass opacities" visible on CT was reported to be the hallmark sign of COVID-19 lung disease [15].…”

Section: Evidence Of Pulmonary Vascular Phenomenamentioning

confidence: 99%

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The COVID-19 Pathway: A Proposed Oral-Vascular-Pulmonary Route Of SARS-CoV-2 Infection And The Importance Of Oral Healthcare Measures

Lloyd-Jones¹,

Molayem²,

Pontes³

et al. 2021

JOMDR

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Since the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in late 2019, the world has faced a major healthcare challenge. There remains limited understanding of the reasons for clinical variability of coronavirus disease 2019 (COVID-19), and a lack of biomarkers to identify individuals at risk of developing severe lung disease. This article aims to present a hypothesis on a vascular route of transfer of SARS-CoV-2 from the oral cavity to the lungs. Saliva is a reservoir of SARS-CoV-2, thus any breach in the immune defenses of the mouth may facilitate entrance of the virus to the vasculature through the gingival sulcus or periodontal pocket. From the oral vasculature, the virus would pass through veins of the neck and chest, and reach the heart, being pumped into pulmonary arteries, and to the small vessels in the lung periphery. The binding of the virus to the angiotensin-converting enzyme 2 receptor (ACE2), present on the endothelial surface of lung vessels, inactivates ACE2 and increases angiotensin-II levels, leading to pulmonary vasoconstriction and immunothrombosis (inflammatory-mediated clotting). This leads to vascular congestion, proximal vasodilatation, and subsequent lung parenchymal damage mediated by endothelial dysfunction. The biological rationale for the oral-vasculo-pulmonary route of infection is discussed in detail in this article, including pertinent radiological and oral cavity scientific findings. We propose that dental plaque accumulation and periodontal inflammation would further intensify this pathway. Therefore, it is suggested that daily oral hygiene and oral healthcare should be prioritized as such measures could be potentially lifesaving for COVID-19 patients. If this proposed pathological pathway is verified, it would be hugely significant in terms of understanding disease management. Simple low-cost measures, such as use of specific mouthwashes, could decrease the salivary viral load, and help prevent or mitigate the development of lung disease and severe COVID-19.

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Section: Radiological Perspective-covid-19 Lung Disease 1 Pathologica...mentioning

confidence: 78%

Section: Evidence Of Pulmonary Vascular Phenomenamentioning

confidence: 99%

The COVID-19 Pathway: A Proposed Oral-Vascular-Pulmonary Route Of SARS-CoV-2 Infection And The Importance Of Oral Healthcare Measures

Lloyd-Jones¹,

Molayem²,

Pontes³

et al. 2021

JOMDR

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“…The inflammatory component further enhances the thrombotic process in all organs. Imaging CT in combination with assessment of D-dimer levels provides biomarkers to diagnose and monitor these prothrombotic and embolic processes of COVID-19 [2].…”

Section: Discussionmentioning

confidence: 99%

Rare Thrombotic Complications of COVID-19: A Case Series

Vellanki¹,

Kumar²,

Stoffel³

et al. 2022

Cureus

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Coronavirus disease 2019 is known to manifest with bilateral pneumonia and acute respiratory distress syndrome. This infection with severe acute respiratory syndrome coronavirus 2 (SAR-CoV-2) is alarming because it not only affects the respiratory system but may also cause thromboembolic events. Multiple studies have reported procoagulation/hypercoagulable complications in COVID-19. This case series is a valuable addition to the literature because it reflects unique presentations of thrombotic events in COVID-19 patients. We report two cases in which patients presented with thromboembolic complications secondary to COVID-19 infection: one with severe bowel ischemia and the other with blue toe syndrome. To formulate management strategies to prevent fatal outcomes for patients with COVID-19, physicians must be vigilant in identifying life-threatening thromboembolic complications from this disease.

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“…CTPA detected impaired pulmonary ventilation, pulmonary embolism, and hypoperfusion areas in a COVID-19 patient with elevated D-dimer level [ 28 ], and revealed multiple pulmonary perfusion defects without demonstrable pulmonary embolism even before D-dimer elevation (Fig. 4 D) [ 29 ].…”

Section: Imaging Modalitiesmentioning

confidence: 99%

Imaging Pulmonary Blood Vessels and Ventilation-Perfusion Mismatch in COVID-19

2022

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COVID-19 hypoxemic patients although sharing a same etiology (SARS-CoV-2 infection) present themselves quite differently from one another. Patients also respond differently to prescribed medicine and to prone Vs supine bed positions. A severe pulmonary ventilation-perfusion mismatch usually triggers moderate to severe COVID-19 cases. Imaging can aid the physician in assessing severity of COVID-19. Although useful for their portability X-ray and ultrasound serving on the frontline to evaluate lung parenchymal abnormalities are unable to provide information about pulmonary vasculature and blood flow redistribution which is a consequence of hypoxemia in COVID-19. Advanced imaging modalities such as computed tomography, single-photon emission tomography, and electrical impedance tomography use a sharp algorithm visualizing pulmonary ventilation-perfusion mismatch in the abnormal and in the apparently normal parenchyma. Imaging helps to access the severity of infection, lung performance, ventilation-perfusion mismatch, and informs strategies for medical treatment. This review summarizes the capacity of these imaging modalities to assess ventilation-perfusion mismatch in COVID-19. Despite having limitations, these modalities provide vital information on blood volume distribution, pulmonary embolism, pulmonary vasculature and are useful to assess severity of lung disease and effectiveness of treatment in COVID-19 patients.

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The vascular nature of COVID-19

Cited by 15 publications

References 14 publications

The COVID-19 Pathway: A Proposed Oral-Vascular-Pulmonary Route Of SARS-CoV-2 Infection And The Importance Of Oral Healthcare Measures

The COVID-19 Pathway: A Proposed Oral-Vascular-Pulmonary Route Of SARS-CoV-2 Infection And The Importance Of Oral Healthcare Measures

Rare Thrombotic Complications of COVID-19: A Case Series

Imaging Pulmonary Blood Vessels and Ventilation-Perfusion Mismatch in COVID-19

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