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Tytuł:
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Patterns of organizing pneumonia and microinfarcts as surrogate for endothelial disruption and microangiopathic thromboembolic events in patients with coronavirus disease 2019.
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Autorzy:
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Martini K; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.; Faculty of Medicine, University of Zurich, Zurich, Switzerland.
Blüthgen C; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.; Faculty of Medicine, University of Zurich, Zurich, Switzerland.
Walter JE; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.; Faculty of Medicine, University of Zurich, Zurich, Switzerland.
Nguyen-Kim TDL; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.; Faculty of Medicine, University of Zurich, Zurich, Switzerland.
Thienemann F; Faculty of Medicine, University of Zurich, Zurich, Switzerland.; Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland.
Frauenfelder T; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.; Faculty of Medicine, University of Zurich, Zurich, Switzerland.
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Źródło:
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PloS one [PLoS One] 2020 Oct 05; Vol. 15 (10), pp. e0240078. Date of Electronic Publication: 2020 Oct 05 (Print Publication: 2020).
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Typ publikacji:
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Journal Article
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Język:
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English
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Imprint Name(s):
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Original Publication: San Francisco, CA : Public Library of Science
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MeSH Terms:
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Coronavirus Infections/*pathology
Pneumonia, Viral/*pathology
Pulmonary Artery/*pathology
Pulmonary Infarction/*diagnostic imaging
Thromboembolism/*diagnostic imaging
Adult ; Aged ; Aged, 80 and over ; COVID-19 ; Coronavirus Infections/diagnostic imaging ; Female ; Humans ; Lung/blood supply ; Lung/pathology ; Male ; Middle Aged ; Pandemics ; Pneumonia, Viral/diagnostic imaging ; Retrospective Studies ; Tomography, X-Ray Computed
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Entry Date(s):
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Date Created: 20201005 Date Completed: 20201014 Latest Revision: 20240329
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Update Code:
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20240329
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PubMed Central ID:
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PMC7535037
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DOI:
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10.1371/journal.pone.0240078
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PMID:
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33017451
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Background: To evaluate chest-computed-tomography (CT) scans in coronavirus-disease-2019 (COVID-19) patients for signs of organizing pneumonia (OP) and microinfarction as surrogate for microscopic thromboembolic events.
Methods: Real-time polymerase-chain-reaction (RT-PCR)-confirmed COVID-19 patients undergoing chest-CT (non-enhanced, enhanced, pulmonary-angiography [CT-PA]) from March-April 2020 were retrospectively included (COVID-19-cohort). As control-groups served 175 patients from 2020 (cohort-2020) and 157 patients from 2019 (cohort-2019) undergoing CT-PA for pulmonary embolism (PE) during the respective time frame at our institution. Two independent readers assessed for presence and location of PE in all three cohorts. In COVID-19 patients additionally parenchymal changes typical of COVID-19 pneumonia, infarct pneumonia and OP were assessed. Inter-reader agreement and prevalence of PE in different cohorts were calculated.
Results: From 68 COVID-19 patients (42 female [61.8%], median age 59 years [range 32-89]) undergoing chest-CT 38 obtained CT-PA. Inter-reader-agreement was good (k = 0.781). On CT-PA, 13.2% of COVID-19 patients presented with PE whereas in the control-groups prevalence of PE was 9.1% and 8.9%, respectively (p = 0.452). Up to 50% of COVID-19 patients showed changes typical for OP. 21.1% of COVID-19 patients suspected with PE showed subpleural wedge-shaped consolidation resembling infarct pneumonia, while only 13.2% showed visible filling defects of the pulmonary artery branches on CT-PA.
Conclusion: Despite the reported hypercoagulability in critically ill patients with COVID-19, we did not encounter higher prevalence of PE in our patient cohort compared to the control cohorts. However, patients with suspected PE showed a higher prevalence of lung changes, resembling patterns of infarct pneumonia or OP and CT-signs of pulmonary-artery hypertension.
Competing Interests: The authors have declared that no competing interests exist.
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