scholarly journals 264 Cardiac and pulmonary sequelae after COVID-19 pneumonia: a case series

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Jacopo Marazzato ◽  
Fabio Angeli ◽  
Paolo Verdecchia ◽  
Sergio Masnaghetti ◽  
Dina Visca ◽  
...  
Keyword(s):  
Case Series ◽  
Right Ventricular Dysfunction ◽  
Pulmonary Involvement ◽  
Diagnostic Tools ◽  
Systolic Pulmonary Artery Pressure ◽  
Pathological Findings ◽  
Vein Thrombosis ◽  
Thoracic Computed Tomography ◽  
Compression Ultrasound ◽  
High Prevalence

Abstract Aims Although the new coronavirus (SARS-CoV-2) may cause an acute multiorgan syndrome (COVID-19), data are emerging on mid- and long-term sequelae of COVID-19 pneumonia. Since no study has hitherto investigated the role of both cardiac and pulmonary ultrasound techniques in detecting such sequelae, this study aimed at evaluating these simple diagnostic tools to appraise the cardiopulmonary involvement occurring after COVID-19 pneumonia. Methods and results Twenty-nine patients fully recovered from COVID-19 pneumonia were considered at our centre. On admission, all patients underwent 12-lead electrocardiogram (ECG) and transthoracic echocardiography (TTE) evaluation. Compression ultrasound (CUS) and lung ultrasound (LUS) were also performed. Finally, in each patient, pathological findings detected on LUS were correlated with the pulmonary involvement occurring after COVID-19 pneumonia as assessed on thoracic computed tomography (CT). Out of 29 patients (mean age 70 ± 10 years old; M 69%), prior cardiovascular and pulmonary comorbidities were recorded in 22 (76%). Twenty-seven patients (93%) were in sinus rhythm and two (7%) in atrial fibrillation. ECG repolarization abnormalities were extremely common (93%) and reflected the high prevalence of pericardial involvement on TTE (86%). Likewise, pleural abnormalities were frequently observed (66%). TTE signs of left and right ventricular dysfunction were reported in two patients only, but values of systolic pulmonary artery pressure were abnormal in 16 (55%) despite absence of prior comorbidities in 44% of them. Regarding LUS evaluation, most patients displayed abnormal values of diaphragmatic thickness and excursion (93%) which well correlated with the high prevalence (76%) of on pathological findings on CT scan. CUS ruled out deep vein thrombosis in all patients. Conclusions Data on cardiopulmonary sequelae after COVID-19 pneumonia are scarce. In our study, simple diagnostic tools (TTE and LUS) proved clinically useful for detection of cardiopulmonary involvement after COVID-19 pneumonia.

scholarly journals Combined Use of Electrocardiography and Ultrasound to Detect Cardiac and Pulmonary Involvement after Recovery from COVID-19 Pneumonia: A Case Series

2021 ◽  
Vol 8 (10) ◽  
pp. 133
Author(s):  
Jacopo Marazzato ◽  
Roberto De Ponti ◽  
Paolo Verdecchia ◽  
Sergio Masnaghetti ◽  
Dina Visca ◽  
...  
Keyword(s):  
Case Series ◽  
Right Ventricular Dysfunction ◽  
Pulmonary Involvement ◽  
Diagnostic Tools ◽  
Systolic Pulmonary Artery Pressure ◽  
Pathological Findings ◽  
Vein Thrombosis ◽  
Thoracic Computed Tomography ◽  
Compression Ultrasound ◽  
High Prevalence

Background: Although severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) may cause an acute multiorgan syndrome (coronavirus disease 2019 (COVID-19)), data are emerging on mid- and long-term sequelae of COVID-19 pneumonia. Since no study has hitherto investigated the role of both cardiac and pulmonary ultrasound techniques in detecting such sequelae, this study aimed at evaluating these simple diagnostic tools to appraise the cardiopulmonary involvement after COVID-19 pneumonia. Methods: Twenty-nine patients fully recovered from COVID-19 pneumonia were considered at our centre. On admission, all patients underwent 12-lead electrocardiogram (ECG) and transthoracic echocardiography (TTE) evaluation. Compression ultrasound (CUS) and lung ultrasound (LUS) were also performed. Finally, in each patient, pathological findings detected on LUS were correlated with the pulmonary involvement occurring after COVID-19 pneumonia, as assessed on thoracic computed tomography (CT). Results: Out of 29 patients (mean age 70 ± 10 years; males 69%), prior cardiovascular and pulmonary comorbidities were recorded in 22 (76%). Twenty-seven patients (93%) were in sinus rhythm and two (7%) in atrial fibrillation. Persistence of ECG abnormalities from the acute phase was common, and nonspecific repolarisation abnormalities (93%) reflected the high prevalence of pericardial involvement on TTE (86%). Likewise, pleural abnormalities were frequently observed (66%). TTE signs of left and right ventricular dysfunction were reported in two patients, and values of systolic pulmonary artery pressure were abnormal in 16 (55%, despite the absence of prior comorbidities in 44% of them). Regarding LUS evaluation, most patients displayed abnormal values of diaphragmatic thickness and excursion (93%), which correlated well with the high prevalence (76%) of pathological findings on CT scan. CUS ruled out deep vein thrombosis in all patients. Conclusions: Data on cardiopulmonary involvement after COVID-19 pneumonia are scarce. In our study, simple diagnostic tools (TTE and LUS) proved clinically useful for the detection of cardiopulmonary complications after COVID-19 pneumonia.

Features of Thrombi and Diagnostic Accuracy of Impedance Plethysmography in Symptomatic and Asymptomatic Deep Vein Thrombosis

1993 ◽  
Vol 70 (02) ◽  
pp. 266-269 ◽  
Author(s):  
Giancarlo Agnelli ◽  
Benilde Cosmi ◽  
Stefano Radicchia ◽  
Franca Veschi ◽  
Enrico Boschetti ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Diagnostic Accuracy ◽  
High Sensitivity ◽  
Impedance Plethysmography ◽  
Surveillance Programme ◽  
Vein Thrombosis ◽  
Asymptomatic Patients ◽  
High Prevalence ◽  
The Mean ◽  
Deep Vein

SummaryImpedance plethysmography (IPG) has high sensitivity and specificity in patients with symptomatic deep vein thrombosis (DVT) while it fails to detect asymptomatic DVT. The aim of this study was to determine whether the features of thrombi such as location, size and occlusiveness could explain the different accuracy of IPG in symptomatic and asymptomatic DVT patients. One-hundred and seventeen consecutive outpatients with a clinical suspicion of DVT and 246 consecutive patients undergoing hip surgery were admitted to the study. In symptomatic patients IPG was performed on the day of referral, followed by venography, while in asymptomatic patients IPG was performed as a surveillance programme, followed by bilateral venography.A venography proved DVT was observed in 37% of the symptomatic patients and 34% of the asymptomatic limbs. A significantly higher proportion of proximal DVTs was found in symptomatic patients than in asymptomatic patients (78% vs 46%; p = 0.001). The mean Marder score, taken as an index of thrombus size, was significantly higher in symptomatic patients than in asymptomatic patients (19.0 vs 9.6; p = 0.0001). A significantly higher proportion of occlusive DVTs was observed in symptomatic than in asymptomatic patients (69% vs 36%; p = 0.001).We conclude that the unsatisfactory diagnostic accuracy of IPG in asymptomatic DVT is due to the high prevalence of distal, small and non occlusive thrombi. Such thrombi are unlikely to cause a critical obstruction of the venous outflow and therefore to produce a positive IPG.

Prophylaxis of Venous Thromboembolism Following Orthopedic Surgery: Mechanical and Pharmacological Approaches and the Need for Extended Prophylaxis

1999 ◽  
Vol 82 (08) ◽  
pp. 918-924 ◽  
Author(s):  
R.D. Hull ◽  
G.F Pineo
Keyword(s):  
Clinical Trials ◽  
Venous Thromboembolism ◽  
Orthopedic Surgery ◽  
Total Joint Replacement ◽  
Case Series ◽  
Pharmacological Agents ◽  
Thrombotic Disease ◽  
Vein Thrombosis ◽  
Major Orthopedic Surgery ◽  
Mechanical Devices

IntroductionMajor orthopedic surgery, particularly total joint replacement or hip fracture, represents a high risk of future development of postoperative venous thromboembolism and warrants the routine use of prophylaxis with either mechanical devices or pharmacological agents. The aim of prophylaxis is to prevent fatal pulmonary embolism (PE) and the morbidity of deep vein thrombosis (DVT), particularly the development of post-thrombotic syndrome. Patterns of clinical practice, with respect to the prevention of venous thromboembolism and the appropriate use of anticoagulants for the treatment of thrombotic disease, have been strongly influenced by recent consensus conferences.1,2 Rules of evidence for assessing the literature have been applied to all recommendations regarding the prevention and treatment of thrombotic disease. These results were extrapolated using evidence gleaned from major clinical disorders and are based only on nonrandomized clinical trials or case series.1-3 Data from a large number of Level I clinical trials in patients undergoing orthopedic surgery have provided answers to many of the questions regarding prophylaxis of venous thromboembolism. In this review, we will discuss the prevention of venous thromboembolism following orthopedic surgery and discuss some of the controversial issues where further studies are required.

scholarly journals Incidental whole-body MRI evidence of COVID-19 in an asymptomatic patient in a high prevalence region

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Valentina Angelini ◽  
Alberta Villanacci ◽  
Angelo Belotti ◽  
Francesca Castagnoli ◽  
Barbara Frittoli ◽  
...  
Keyword(s):  
Asymptomatic Patient ◽  
Whole Body ◽  
Diagnostic Tools ◽  
Historical Period ◽  
Case Presentation ◽  
Whole Body Mri ◽  
High Prevalence ◽  
Chest X Ray ◽  
Full Knowledge ◽  
Polymerase Chain

Abstract Background The purpose of this case report is to emphasize the importance of curing any clinical radiological elements in this historical period, especially in the area of endemic to coronavirus disease 19 (COVID-19) such as Lombardy and to stress the importance of the management of the asymptomatic patient, their crucial role in the spread of contagion. Case presentation We reported the case of incidental diagnosis of interstitial pneumonia by first finding on whole-body MR (WB-MR) in the patient affected by multiple myeloma (MM), with a negative respiratory symptoms at the time and with previous (1 month before) negative chest X-ray. The patient was promptly subjected to chest CT, which confirmed the suspicion of interstitial COVID-19 pneumonia and, in hospitalization, performed nasopharyngeal swabs for real-time polymerase chain reaction (RNA-PCR), with a doubtful outcome. Once the bacterial nature of the alterations was serologically and radiologically excluded, the patient was definitively diagnosed with COVID-19 and appropriately treated in hospitalization. Conclusion The clinical choices must, therefore, to make use of all the diagnostic tools available and full knowledge of the limitation of each of them.

Mortality rates and risk factors for asymptomatic deep vein thrombosis in medical patients

2005 ◽  
Vol 93 (01) ◽  
pp. 76-79 ◽  
Author(s):  
Alain Leizorovicz ◽  
Alexander Cohen ◽  
Alexander Turpie ◽  
Carl-Gustav Olsson ◽  
Samuel Goldhaber ◽  
...  
Keyword(s):  
Risk Factors ◽  
Deep Vein Thrombosis ◽  
Mortality Rates ◽  
Hazard Ratio ◽  
Group Iii ◽  
Vein Thrombosis ◽  
Group I ◽  
Compression Ultrasound ◽  
The Difference ◽  
Deep Vein

SummaryThe clinical importance of asymptomatic proximal and distal deep vein thrombosis (DVT) remains uncertain and controversial. The aim of this retrospective,post-hoc analysis was to examine mortality and risk factors for development of proximal DVT in hospitalized patients with acute medical illness who were recruited into a randomized, prospective clinical trial of thromboprophylaxis with dalteparin (PREVENT).We analyzed 1738 patients who had not sustained a symptomatic venous thromboembolic event by Day 21 and who had a complete compression ultrasound of the proximal and distal leg veins on Day 21. We examined the 90-day mortality rates in patients with asymptomatic proximal DVT (Group I, N = 80), asymptomatic distal DVT (Group II, N = 118) or no DVT (Group III, N = 1540).The 90-day mortality rates were 13.75%, 3.39%, and 1.92% for Groups I–III, respectively. The difference in mortality between Group I and Group III was significant (hazard ratio 7.63, 95% CI = 3.8–15.3;p < 0.0001),whereas the difference between Groups II and III did not reach significance (hazard ratio 1.36, 95% CI = 0.41–4.45).The association of asymptomatic proximal DVT with increased mortality remained highly significant after adjusting for differences in baseline demographics and clinical variables. Risk factors significantly associated with the development of proximal DVT included advanced age (p = 0.0005), prior DVT (p = 0.001), and varicose veins (p = 0.04). In conclusion, the high mortality rate in patients with asymptomatic proximal DVT underscores its clinical relevance and supports targeting of asymptomatic proximal DVT as an appropriate endpoint in clinical trials of thromboprophylaxis.

scholarly journals Cerebral Vein Thrombosis in the Antiphospholipid Syndrome: Analysis of a Series of 27 Patients and Review of the Literature

2021 ◽  
Vol 11 (12) ◽  
pp. 1641
Author(s):  
Alba Jerez-Lienas ◽  
Alexis Mathian ◽  
Jenifer Aboab ◽  
Isabelle Crassard ◽  
Miguel Hie ◽  
...  
Keyword(s):  
Antiphospholipid Syndrome ◽  
Medical Records ◽  
Case Reports ◽  
Case Series ◽  
Autoimmune Disorder ◽  
Point Of View ◽  
Cerebral Vein ◽  
Review Of The Literature ◽  
Cerebral Vein Thrombosis ◽  
Vein Thrombosis

(1) Background: The Antiphospholipid Syndrome (APS) is a systemic autoimmune disorder characterized by arterial and/or venous thrombosis, pregnancy morbidity and raised titers of antiphospholipid antibodies. Cerebral vein thrombosis (CVT) is a rare form of cerebrovascular accident and an uncommon APS manifestation; the information in the literature about this feature consists of case reports and small case series. Our purpose is to describe the particular characteristics of CVT when occurs as part of the APS and compare our series with the patients published in the literature. (2) Methods: We conducted a retrospective observational study collecting data from medical records in three referral centers for APS and CVT, and a systematic review of the literature for CVT cases in APS patients. (3) Results: Twenty-seven APS patients with CVT were identified in our medical records, the majority of them diagnosed as primary APS and with the CVT being the first manifestation of the disease; additional risk factors for thrombosis were identified. The review of the literature yielded 86 cases, with similar characteristics as those of our retrospective series. (4) Conclusions: To our knowledge, our study is the largest CVT series in APS patients published to date, providing a unique point of view in this rare thrombotic manifestation.

scholarly journals PRIMARY OSTEOSARCOMA DISTAL FEMUR;

2013 ◽  
Vol 20 (02) ◽  
pp. 256-260
Author(s):  
FAAIZ ALI SHAH ◽  
ABDUL AZIZ ZIA ◽  
ZAHIR KHAN ◽  
Kifayatullah -
Keyword(s):  
Pulmonary Metastasis ◽  
Distal Femur ◽  
Tertiary Care ◽  
Case Series ◽  
Pulmonary Involvement ◽  
Initial Presentation ◽  
Initial Assessment ◽  
Careful Examination ◽  
Care Hospital ◽  
Primary Osteosarcoma

Objectives: This study was designed to estimate the incidence rate of pulmonary metastasis at the time of diagnosis ofprimary osteosarcoma distal femur in a tertiary care hospital. Study Design: Descriptive case series. Setting and Duration: OrthopaedicSurgery Unit, Mardan Medical Complex Teaching hospital, Bacha Khan Medical College, Mardan, KPK, Pakistan from March 2011 toSeptember 2012. Methodology: Nine patients of primary osteosarcoma distal femur were assessed with CT chest for pulmonarymetastasis. The frequency and patterns of pulmonary metastasis on CT chest were documented. After the biopsy reports all patientswere referred for neo adjuvant chemotherapy before any definite surgical procedure. The histological types of osteosarcoma were noted.RESULTS: Nine patients including 7 male (77.7%) and 2 females (22.2%) with mean age 12.4 years were included in our study. 66.6 %(n=6, 5 males, 1 female) had pulmonary metastasis on CT chest at initial presentation while 33 %( n=3,2 males,1 female) had nopulmonary metastases on CT chest. Three (50%) patients had pulmonary metastasis in the right lung, 1(16.6%) had on left side while2(33.3%) had bilateral pulmonary involvement. Of the cases with metastases at diagnosis, 55.5% had osteoblastic histology ofosteosarcoma compared with 33.3% of those with non metastatic disease. Conclusions: Majority of osteosarcoma distal femurpresented with pulmonary metastasis at initial presentation. A high index of suspicion accompanied by careful examination of the limband appropriate radiographs at initial assessment may reduce the incidence of such delays in diagnosis and the associated risks.

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