tetano
Editor, Senior Moderator
Eur Heart J Case Rep
. 2020 Dec 7;4(6):1-6.
doi: 10.1093/ehjcr/ytaa437. eCollection 2020 Dec.
Saddle pulmonary embolism and clot in transit in COVID-19 infection: a case report of catastrophic venous thromboembolism
Shunsuke Aoi[SUP] 1 [/SUP], Amit M Kakkar[SUP] 1 [/SUP], Yosef Golowa[SUP] 2 [/SUP], Michael Grushko[SUP] 1 [/SUP], Christina M Coyle[SUP] 3 [/SUP], Tarek Elrafei[SUP] 4 [/SUP], Matthew D Langston[SUP] 5 [/SUP], Robert T Faillace[SUP] 1 [/SUP], Sripal Bangalore[SUP] 6 [/SUP], Seth I Sokol[SUP] 1 [/SUP]
Affiliations
Abstract
Background : Coronavirus disease 2019 (COVID-19) is associated with a coagulopathy favouring thrombosis over bleeding that imparts a poor prognosis. Clot in transit (CIT) is considered a rare entity and the most severe form of venous thromboembolism (VTE), carrying a higher mortality than isolated pulmonary embolism (PE). The incidence of this phenomenon in patients with COVID-19 infection is unknown and likely under-recognized.
Case summary : During the peak of the COVID-19 pandemic in New York City, a 70-year-old Hispanic female presented with syncope due to a saddle PE further complicated by a highly mobile CIT. Polymerase chain reaction was positive for COVID-19 infection, however, there was no evidence of lung parenchymal involvement or hyper-inflammation. Based on consensus from a multidisciplinary team, aspiration thrombectomy was attempted to treat this extreme case of VTE, however, the patient died during the procedure.
Discussion : This case raises awareness to the most catastrophic form of VTE, presenting in an early phase of COVID-19 infection without the typical hyper-inflammation and severe lung injury associated with development of COVID-related coagulopathy. It also serves to inform on the critical role echocardiography has in the comprehensive evaluation and re-evaluation of hospitalized patients with COVID-19, and the importance of a multidisciplinary organized approach in clinical decision-making for this complex and poorly understood disease and its sequelae.
Keywords: COVID-19; Case report; Clot in transit; Pulmonary embolism.
. 2020 Dec 7;4(6):1-6.
doi: 10.1093/ehjcr/ytaa437. eCollection 2020 Dec.
Saddle pulmonary embolism and clot in transit in COVID-19 infection: a case report of catastrophic venous thromboembolism
Shunsuke Aoi[SUP] 1 [/SUP], Amit M Kakkar[SUP] 1 [/SUP], Yosef Golowa[SUP] 2 [/SUP], Michael Grushko[SUP] 1 [/SUP], Christina M Coyle[SUP] 3 [/SUP], Tarek Elrafei[SUP] 4 [/SUP], Matthew D Langston[SUP] 5 [/SUP], Robert T Faillace[SUP] 1 [/SUP], Sripal Bangalore[SUP] 6 [/SUP], Seth I Sokol[SUP] 1 [/SUP]
Affiliations
- PMID: 33628997
- PMCID: PMC7891250
- DOI: 10.1093/ehjcr/ytaa437
Abstract
Background : Coronavirus disease 2019 (COVID-19) is associated with a coagulopathy favouring thrombosis over bleeding that imparts a poor prognosis. Clot in transit (CIT) is considered a rare entity and the most severe form of venous thromboembolism (VTE), carrying a higher mortality than isolated pulmonary embolism (PE). The incidence of this phenomenon in patients with COVID-19 infection is unknown and likely under-recognized.
Case summary : During the peak of the COVID-19 pandemic in New York City, a 70-year-old Hispanic female presented with syncope due to a saddle PE further complicated by a highly mobile CIT. Polymerase chain reaction was positive for COVID-19 infection, however, there was no evidence of lung parenchymal involvement or hyper-inflammation. Based on consensus from a multidisciplinary team, aspiration thrombectomy was attempted to treat this extreme case of VTE, however, the patient died during the procedure.
Discussion : This case raises awareness to the most catastrophic form of VTE, presenting in an early phase of COVID-19 infection without the typical hyper-inflammation and severe lung injury associated with development of COVID-related coagulopathy. It also serves to inform on the critical role echocardiography has in the comprehensive evaluation and re-evaluation of hospitalized patients with COVID-19, and the importance of a multidisciplinary organized approach in clinical decision-making for this complex and poorly understood disease and its sequelae.
Keywords: COVID-19; Case report; Clot in transit; Pulmonary embolism.