News | Coronavirus (COVID-19) | April 23, 2020

New Research Highlights Blood Clot Dangers of COVID-19

#COVID19 #Coronavirus #2019nCoV #Wuhanvirus #SARScov2 Pulmonary CT angiography of a 68 year old male. The CT scan was obtained 10 days after the onset of COVID-19 symptoms and on the day the patient was transferred to the intensive care unit.

Figure 2: Pulmonary CT angiography of a 68 year old male. The CT scan was obtained 10 days after the onset of COVID-19 symptoms and on the day the patient was transferred to the intensive care unit. Axial CT images (lung windows) (a,b) show peripheral ground-glass opacities (arrow) associated with areas of consolidation in dependent portions of the lung (arrowheads). Interlobular reticulations, bronchiectasis (black arrow) and lung architectural distortion are present. Involvement of the lung volume was estimated to be between 25% and 50%. Coronal CT reformations (mediastinum windows) (c,d) show bilateral lobar and segmental pulmonary embolism (black arrows). Courtesy of RSNA

April 23, 2020 — A special report published in the journal Radiology outlines prevention, diagnosis and treatment of complications stemming from blood clots in patients with COVID-19. The journal also published two research letters and a case study on this topic.

Clinicians worldwide face this new severe infectious lung disease with no proven therapies. Based on recent reports that demonstrated a strong association between elevated D-dimer levels and poor prognosis, concerns have risen about thrombotic complications in patients with COVID-19.

The National Institute for Public Health of the Netherlands asked a group of radiology and vascular medicine experts to provide guidance for the imaging workup and treatment of these important complications. Their report summarizes evidence for thromboembolic disease and potential diagnostic and preventive actions that can be taken.

“Worldwide, COVID-19 is being treated as a primary pulmonary disease,” said Edwin J.R. van Beek, M.D., Ph.D., director at Edinburgh Imaging, Queens Medical Research Institute, at the University of Edinburgh, U.K. “From the analysis of all available current medical, laboratory and imaging data on COVID-19, it became clear that symptoms and diagnostic tests could not be explained by impaired pulmonary ventilation alone.”

Recent observations suggest that respiratory failure in COVID-19 is not driven by the development of the acute respiratory distress syndrome alone, but that microvascular thrombotic processes may play a role. This may have important consequences for the diagnostic and therapeutic management of these patients. There is a strong association between D-dimer levels, disease progression and chest CT features suggesting venous thrombosis. In addition, various studies in patients with COVID-19 have shown a very strong association between increased D-dimer levels and severe disease/poor prognosis.

The report authors stress that careful attention needs to be paid to the initial diagnosis and treatment of the prothrombotic and thrombotic state that can occur in a substantial percentage of COVID-19 patients.

“Imaging and pathological investigations confirmed the COVID-19 syndrome is a thrombo-inflammatory process that initially affects lung perfusion, but consecutively affects all organs of the body,” Professor van Beek said. “This highly thrombotic syndrome leads to macro-thrombosis and embolism. Therefore, strict thrombosis prophylaxis, close laboratory and appropriate imaging monitoring with early anti-coagulant therapy in case of suspected venous thromboembolism are indicated.”

Recommendations for diagnostic and therapeutic management, which vary based on patient symptoms and risk profiles, include prophylactic-dose heparin, chest CT, CT pulmonary angiography and routine D-dimer testing.

Findings have also emerged linking COVID-19 more specifically with pulmonary embolism. A research letter from Hôpitaux Universitaires de Strasbourg published today in Radiology reported that of 106 pulmonary CT angiograms performed for COVID-19 patients over a one-month period in a tertiary care center in France, 32 patients (30%) had acute pulmonary embolus (PE). This rate of PE is much higher than usually encountered in critically ill patients without COVID-19 infection (1.3%,) or in emergency department patients (3 to 10%). In the study, a D-dimer threshold of 2660 μg/L detected all patients with PE on chest CT.

A second research letter published today described a study from Centre Hospitalier Universitaire de Besancon in France pointed to high proportion (23%) of COVID-19 patients with contrast CT had PE. PE was diagnosed at mean of 12 days from symptom onset. Patients with PE were more likely require care in the critical care unit and to require mechanical ventilation.

Lastly, a case report from Cooper University Hospital in Camden, New Jersey, describes multiple areas of pulmonary and arterial thrombosis in an 84-year-old man with COVID-19.

“COVID-19 is more than a lung infection,” Professor van Beek said. “It affects the vasculature of the lungs and other organs and has a high thrombosis risk with acute life-threatening events that require adequate treatment with anticoagulants based on laboratory monitoring with appropriate imaging tests as required.”

For more information: www.rsna.org

Related Coronavirus Content:

VIDEO: Imaging COVID-19 With Point-of-Care Ultrasound (POCUS)

The Cardiac Implications of Novel Coronavirus

CT Provides Best Diagnosis for Novel Coronavirus (COVID-19)

Radiology Lessons for Coronavirus From the SARS and MERS Epidemics

Deployment of Health IT in China’s Fight Against the COVID-19 Epidemic

Emerging Technologies Proving Value in Chinese Coronavirus Fight

Radiologists Describe Coronavirus CT Imaging Features

Coronavirus Update from the FDA

CT Imaging of the 2019 Novel Coronavirus (2019-nCoV) Pneumonia

CT Imaging Features of 2019 Novel Coronavirus (2019-nCoV)

Chest CT Findings of Patients Infected With Novel Coronavirus 2019-nCoV Pneumonia 

Find more related clinical content Coronavirus (COVID-19)

ACC COVID-19 recommendations for the cardiovascular care team

VIDEO: What Cardiologists Need to Know about COVID-19 — Interview with Thomas Maddox, M.D.

The Cardiac Implications of Novel Coronavirus

ESC Council on Hypertension Says ACE-I and ARBs Do Not Increase COVID-19 Mortality

Related Content

Shimadzu Medical Systems USA, a leading manufacturer of advanced medical X-ray imaging systems, has announced that the Trinias unity edition product line has been awarded a contract from Vizient, Inc., a healthcare performance improvement company, effective Sept. 1, 2021.
News | X-Ray | September 17, 2021
September 17, 2021 — Shimadzu Medical Systems USA, a leading manufacturer of advanced medical...
Strategies to help guide nuclear radiology teams at various healthcare systems in 2021 and beyond
Feature | Nuclear Imaging | September 16, 2021 | By Staff of the American Society of Nuclear Cardiology (ASNC)
A year after COVID-19 turned the world upside do
This is an example of 3-D ultrasound imaging on a breast, designed to help increase efficiency and diagnostic accuracy in any practice. Image courtesy of Hologic.

This is an example of TriVu ultrasound imaging on a breast, designed to help increase efficiency and diagnostic accuracy in any practice. Image courtesy of Hologic.

Feature | Breast Imaging | September 15, 2021 | By Jennifer Meade
The...
Revised guidelines for lung cancer screening eligibility are perpetuating disparities for racial/ethnic minorities, according to a new study in Radiology.

Getty Images

News | Lung Imaging | September 15, 2021
September 15, 2021 — Revised guidelines for...
As with all imaging technologies, COVID-19 is expected to continue to negatively impact the market.

Courtesy of Grand View Research

Feature | Magnetic Resonance Imaging (MRI) | September 14, 2021 | By Melinda Taschetta-Millane
Us2.ai, a Singapore-based medtech firm backed by Sequoia India and EDBI, has received U.S. Food and Drug Administration (FDA) clearance for Us2.v1, a completely automated AI decision support tool for cardiac ultrasound.
News | Cardiovascular Ultrasound | September 14, 2021
September 14, 2021 – Us2.ai, a Singapore-based medtech firm backed by Sequoia India and EDBI, has received U.S.
With a wealth of landmark studies in Breast, Cervical, Melanoma, Prostate, Colorectal, Oesophagus, Endocrine and Lung cancer, the ESMO Congress 2021 is a clear demonstration that oncology research has once again gathered momentum after being temporarily stopped in its tracks by the outbreak of the virus

Getty Images

News | Radiation Oncology | September 13, 2021
September 13, 2021 — At the opening press conference of the ...
Plan to attend RSNA21 at McCormick Place Chicago, Nov. 28 – Dec. 2, 2021

Getty Images

News | RSNA | September 13, 2021
September 13, 2021 — The Radiological Society of North America (RSNA) today announced highlights of the Technical Exh
New recommendations will help provide more reliable, reproducible results for MRI-based measurements of cartilage degeneration in the knee, helping to slow down disease and prevent progression to irreversible osteoarthritis, according to a special report published in the journal Radiology

Knee cartilage compartments with anatomic labels implemented in lateral (left side), central (middle), and medial (right side) MRI obtained with an intermediate weighted fat-saturated fast-spin-echo sequence (top row) and a spin-lattice relaxation time constant in rotating frame (T1r) magnetization-prepared angle-modulated partitioned k-space spoiled gradient echo snapshots sequence (bottom row, T1r maps). Study was performed without administration of intravenous gadolinium-based contrast material. The lateral femur (LF)/medial femur (MF) and lateral tibia (LT)/medial tibia (MT) can be further divided into subcompartments on the basis of meniscus anatomy according to Eckstein et al. P = patella, T = trochlea.  Chalian et al, Radiology 2021 301; 7 ©RSNA 2021

News | Magnetic Resonance Imaging (MRI) | September 10, 2021
September 10, 2021 — New recommendations will help provide more reliable, reproducible results for...