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Wednesday, May 06, 2020

Is Vascular Thrombosis another clue that African Swine Fever virus might be a cofactor in COVID-19?

Hypoxaemia related to COVID-19: vascular and perfusion abnormalities on dual-energy CT 

Treatment for acute respiratory failure in patients with COVID-19 is challenging in part because of little understanding of the underlying pathophysiology. Our findings are atypical for acute respiratory distress syndrome or thrombotic vascular disease and point to a possible central role for previously underappreciated pulmonary vascular shunting. More detailed assessments of vascular and perfusion changes in patients with COVID-19 are urgently needed.

Studies have shown that some patients with coronavirus disease 2019 (COVID-19) and acute hypoxaemic respiratory failure have preserved lung compliance, suggesting that processes other than alveolar damage might be involved in hypoxaemia related to COVID-19 pneumonia.
The typical imaging features of COVID-19 pneumonia, including peripheral ground-glass opacities with or without consolidation, are also non-specific and can be seen in many other diseases.
There has been increasing attention on microvascular thrombi as a possible explanation for the severe hypoxaemia related to COVID-19.

Dual-energy CT imaging can be used to characterise lung perfusion and is done as part of the standard protocol for imaging pulmonary embolism at our institution. Three patients with COVID-19, as confirmed by nasopharyngeal RT-PCR at our hospital, who did not have a history of smoking, asthma, chronic obstructive pulmonary disease, or other pulmonary conditions, underwent dual-energy CT imaging for elevated concentrations of D-dimer (>1000 ng/mL) and clinical suspicion of pulmonary emboli. Although no pulmonary emboli were observed in these individuals, we noted striking perfusion abnormalities that have not been previously described; in retrospect, at least nine other COVID-19 cases also shared these findings. In addition to the typical CT features of COVID-19 pneumonia,
we observed considerable proximal and distal pulmonary vessel dilatation and tortuosity, predominately within, or surrounding, areas of lung opacities. Here, we present the first published images from dual-energy CT imaging of COVID-19 pneumonia that show profound vascular and perfusion abnormalitie
SOURCE: The Lancet

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