tetano
Editor, Senior Moderator
Sci Rep
. 2021 Aug 6;11(1):16039.
doi: 10.1038/s41598-021-95694-0.
Evidence for a thromboembolic pathogenesis of lung cavitations in severely ill COVID-19 patients
Jan Matthias Kruse[SUP] 1 [/SUP], Daniel Zickler[SUP] 2 [/SUP], Willie M Lüdemann[SUP] 3 [/SUP], Sophie K Piper[SUP] 4 [/SUP], Inka Gotthardt[SUP] 2 [/SUP], Jana Ihlow[SUP] 5 [/SUP], Selina Greuel[SUP] 5 [/SUP], David Horst[SUP] 5 [/SUP], Andreas Kahl[SUP] 2 [/SUP], Kai-Uwe Eckardt[SUP] 2 [/SUP], Sefer Elezkurtaj[SUP] 6 [/SUP]
Affiliations
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) induces lung injury of varying severity, potentially causing severe acute respiratory distress syndrome (ARDS). Pulmonary injury patterns in COVID-19 patients differ from those in patients with other causes of ARDS. We aimed to explore the frequency and pathogenesis of cavitary lung lesions in critically ill patients with COVID-19. Retrospective study in 39 critically ill adult patients hospitalized with severe acute respiratory syndrome coronavirus 2 including lung injury of varying severity in a tertiary care referral center during March and May 2020, Berlin/Germany. We observed lung cavitations in an unusually large proportion of 22/39 (56%) COVID-19 patients treated on intensive care units (ICU), including 3/5 patients without mechanical ventilation. Median interquartile range (IQR) time between onset of symptoms and ICU admission was 11.5 (6.25-17.75) days. In 15 patients, lung cavitations were already present on the first CT scan, performed after ICU admission; in seven patients they developed during a subsequent median (IQR) observation period of 48 (35-58) days. In seven patients we found at least one cavitation with a diameter > 2 cm (maximum 10 cm). Patients who developed cavitations were older and had a higher body mass index. Autopsy findings in three patients revealed that the cavitations reflected lung infarcts undergoing liquefaction, secondary to thrombotic pulmonary artery branch occlusions. Lung cavitations appear to be a frequent complication of severely ill COVID-19 patients, probably related to the prothrombotic state associated with COVID-19.
. 2021 Aug 6;11(1):16039.
doi: 10.1038/s41598-021-95694-0.
Evidence for a thromboembolic pathogenesis of lung cavitations in severely ill COVID-19 patients
Jan Matthias Kruse[SUP] 1 [/SUP], Daniel Zickler[SUP] 2 [/SUP], Willie M Lüdemann[SUP] 3 [/SUP], Sophie K Piper[SUP] 4 [/SUP], Inka Gotthardt[SUP] 2 [/SUP], Jana Ihlow[SUP] 5 [/SUP], Selina Greuel[SUP] 5 [/SUP], David Horst[SUP] 5 [/SUP], Andreas Kahl[SUP] 2 [/SUP], Kai-Uwe Eckardt[SUP] 2 [/SUP], Sefer Elezkurtaj[SUP] 6 [/SUP]
Affiliations
- PMID: 34362979
- DOI: 10.1038/s41598-021-95694-0
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) induces lung injury of varying severity, potentially causing severe acute respiratory distress syndrome (ARDS). Pulmonary injury patterns in COVID-19 patients differ from those in patients with other causes of ARDS. We aimed to explore the frequency and pathogenesis of cavitary lung lesions in critically ill patients with COVID-19. Retrospective study in 39 critically ill adult patients hospitalized with severe acute respiratory syndrome coronavirus 2 including lung injury of varying severity in a tertiary care referral center during March and May 2020, Berlin/Germany. We observed lung cavitations in an unusually large proportion of 22/39 (56%) COVID-19 patients treated on intensive care units (ICU), including 3/5 patients without mechanical ventilation. Median interquartile range (IQR) time between onset of symptoms and ICU admission was 11.5 (6.25-17.75) days. In 15 patients, lung cavitations were already present on the first CT scan, performed after ICU admission; in seven patients they developed during a subsequent median (IQR) observation period of 48 (35-58) days. In seven patients we found at least one cavitation with a diameter > 2 cm (maximum 10 cm). Patients who developed cavitations were older and had a higher body mass index. Autopsy findings in three patients revealed that the cavitations reflected lung infarcts undergoing liquefaction, secondary to thrombotic pulmonary artery branch occlusions. Lung cavitations appear to be a frequent complication of severely ill COVID-19 patients, probably related to the prothrombotic state associated with COVID-19.