Pulmonary artery thrombi are co-located with opacifications in SARS-CoV2 induced ARDS

Katharina Mueller-Peltzer; Tobias Krauss; Matthias Benndorf; Corinna N Lang; Fabian Bamberg; Christoph Bode; Daniel Duerschmied; Dawid L Staudacher; Viviane Zotzmann

doi:10.1016/j.rmed.2020.106135

Pulmonary artery thrombi are co-located with opacifications in SARS-CoV2 induced ARDS

Respir Med. 2020 Oct:172:106135. doi: 10.1016/j.rmed.2020.106135. Epub 2020 Sep 11.

Authors

Katharina Mueller-Peltzer¹, Tobias Krauss¹, Matthias Benndorf¹, Corinna N Lang², Fabian Bamberg¹, Christoph Bode², Daniel Duerschmied², Dawid L Staudacher², Viviane Zotzmann³

Affiliations

¹ Department of Diagnostic and Interventional Radiology, Faculty of Medicine, University of Freiburg, Germany.
² Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Germany; Department of Medicine III (Interdisciplinary Internal Medicine Intensive Care), Faculty of Medicine, University of Freiburg, Germany.
³ Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Germany; Department of Medicine III (Interdisciplinary Internal Medicine Intensive Care), Faculty of Medicine, University of Freiburg, Germany. Electronic address: viviane.zotzmann@universitaets-herzzentrum.de.

Abstract

Purpose: Patients hospitalized for infection with SARS-CoV-2 typically present with pneumonia. The respiratory failure is frequently complicated by pulmonary embolism in segmental pulmonary arteries. The distribution of pulmonary embolism in regard to lung parenchymal opacifications has not been investigated yet.

Methods: All patients with COVID-19 treated at a medical intensive care unit between March 8th and April 15th, 2020 undergoing computed tomography pulmonary angiography (CTPA) were included. All CTPA were assessed by two radiologists independently in respect to parenchymal changes and pulmonary embolism on a lung segment basis.

Results: Out of 22 patients with severe COVID-19 treated within the observed time period, 16 (age 60.4 ± 10.2 years, 6 female SAPS2 score 49.2 ± 13.9) underwent CT. A total of 288 lung segment were analyzed. Thrombi were detectable in 9/16 (56.3%) patients, with 4.4 ± 2.9 segments occluded per patient and 40/288 (13.9%) segments affected in the whole cohort. Patients with thrombi had significantly worse segmental opacifications in CT (p < 0.05) and all thrombi were located in opacitated segments. There was no correlation between d-dimer level and number of occluded segmental arteries.

Conclusions: Thrombi in segmental pulmonary arteries are common in COVID-19 and are located in opacitated lung segments. This might suggest local clot formation.

Keywords: COVID19; CT-Scan; CTPA; Pulmonary artery thrombosis; Pulmonary embolism; SARS-CoV2.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Betacoronavirus / isolation & purification
Blood Coagulation
COVID-19
Computed Tomography Angiography* / methods
Computed Tomography Angiography* / statistics & numerical data
Coronavirus Infections* / blood
Coronavirus Infections* / physiopathology
Coronavirus Infections* / therapy
Correlation of Data
Female
Humans
Lung / diagnostic imaging*
Male
Middle Aged
Pandemics*
Pneumonia, Viral* / blood
Pneumonia, Viral* / diagnostic imaging
Pneumonia, Viral* / etiology
Pneumonia, Viral* / physiopathology
Pneumonia, Viral* / therapy
Pulmonary Artery / diagnostic imaging*
Pulmonary Embolism* / diagnosis
Pulmonary Embolism* / etiology
Radiography, Thoracic / methods
Radiography, Thoracic / statistics & numerical data
Respiratory Distress Syndrome* / diagnosis
Respiratory Distress Syndrome* / virology
Retrospective Studies
SARS-CoV-2
Thrombosis* / diagnostic imaging
Thrombosis* / etiology