CC BY 4.0 · Aorta (Stamford) 2022; 10(03): 104-113
DOI: 10.1055/s-0042-1748960
Original Research Article

COVID-19-Associated Large- and Medium-Sized-Vessel Pathology: A Case Series

Stacey Chen 
1   Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York
,
Jad Malas 
1   Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York
,
Larry A. Latson Jr
2   Department of Radiology, New York University Langone Health, New York, New York
,
Navneet Narula
3   Department of Pathology, New York University Langone Health, New York, New York
,
Amy V. Rapkiewicz
3   Department of Pathology, New York University Langone Health, New York, New York
,
David M. Williams
1   Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York
,
Harvey I. Pass
1   Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York
,
Aubrey C. Galloway 
1   Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York
,
Deane E. Smith
1   Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York
› Author Affiliations Funding None.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background Coronavirus disease-19 (COVID-19) remains a public health crisis. The epidemiology of COVID-19-associated large- and medium-sized-vessel pathology is not well characterized. The aim of this study is to identify patients with possible COVID-19-associated large- and medium-sized-vessel pathology based on computed tomography (CT) imaging to provide insight into this rare, but potentially devastating, cardiovascular manifestation.

Methods This is a single-center retrospective review of patients with CT chest, abdomen, and/or pelvis concerning for large- and medium-vessel pathology and confirmed COVID-19 infection from March 1, 2020 to October 31, 2020.

Results During the study period, 6,553 CT reports were reviewed and pertinent imaging was identified in 139 patients. Of these, 8 patients (median age: 59 years, range 51–82) were COVID-19 positive. All patients had preexisting cardiovascular risk factors and three (37.5%) had an autoimmune disease. Four patients were never hospitalized for COVID-19. Among these, two presented to the hospital at a median of 39 days (range: 27–50) after their initial COVID-19 test with chest and back pain where imaging revealed extensive aortic pathology. One patient required surgical management for aortic pathology. All other patients were treated with expectant management and outpatient follow-up.

Conclusion The clinical and radiological presentations of COVID-19-associated large- and medium-vessel pathology are heterogeneous and can be a late finding after COVID-19 recovery. Close clinical follow-up and surveillance imaging for large- and medium-sized-vessel pathology may be warranted in COVID-19 patients.

Keywords

COVID-19 - aortitis - large-vessel vasculitis - medium-vessel vasculitis


Publication History

Received: 25 March 2021

Accepted: 09 September 2021

Article published online:
01 November 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 COVID-19 Map. 2020. In: Johns Hopkins coronavirus resource center. Accessed January 16, 2021 at: https://coronavirus.jhu.edu/map.html
  • 2 Guan WJ, Ni ZY, Hu Y. et al; China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382 (18) 1708-1720
    CrossrefPubMedSearch in Google Scholar
  • 3 Peng Y, Meng K, He M. et al. Clinical characteristics and prognosis of 244 cardiovascular patients suffering from coronavirus disease in Wuhan, China. J Am Heart Assoc 2020; 9 (19) e016796
    CrossrefPubMedSearch in Google Scholar
  • 4 Pons S, Fodil S, Azoulay E, Zafrani L. The vascular endothelium: the cornerstone of organ dysfunction in severe SARS-CoV-2 infection. Crit Care 2020; 24 (01) 353
    CrossrefPubMedSearch in Google Scholar
  • 5 Ranucci M, Ballotta A, Di Dedda U. et al. The procoagulant pattern of patients with COVID-19 acute respiratory distress syndrome. J ThrombHaemost 2020; 18 (07) 1747-1751
    CrossrefPubMedSearch in Google Scholar
  • 6 Feldstein LR, Rose EB, Horwitz SM. et al; Overcoming COVID-19 Investigators, CDC COVID-19 Response Team. Multisystem inflammatory syndrome in U.S. children and adolescents. N Engl J Med 2020; 383 (04) 334-346
    CrossrefPubMedSearch in Google Scholar
  • 7 Alsaied T, Tremoulet AH, Burns JC. et al. Review of cardiac involvement in multisystem inflammatory syndrome in children. Circulation 2021; 143 (01) 78-88
    CrossrefPubMedSearch in Google Scholar
  • 8 Shergill S, Davies J, Bloomfield J. Florid aortitis following SARS-CoV-2 infection. Eur Heart J 2020; 41 (44) 4286
    CrossrefPubMedSearch in Google Scholar
  • 9 Oda R, Inagaki T, Ishikane M. et al. Case of adult large vessel vasculitis after SARS-CoV-2 infection. Ann Rheum Dis 2020 annrheumdis-2020-218440
    PubMed
  • 10 Salman R, Masand P, Huisman T. et al. A novel large-vessel arteritis in SARS-CoV-2-related multisystem inflammatory syndrome in children (MIS-C). RadiolCardiothorac Imaging 2021; 3 (01) e200535
    PubMedSearch in Google Scholar
  • 11 Manenti A, Farinetti A, Manco G, Mattioli A. Vasculitis and aortitis: COVID-19 challenging complications. J Vasc Surg 2021; 73 (01) 347-348
    CrossrefPubMedSearch in Google Scholar
  • 12 Hamming I, Cooper ME, Haagmans BL. et al. The emerging role of ACE2 in physiology and disease. J Pathol 2007; 212 (01) 1-11
    CrossrefPubMedSearch in Google Scholar
  • 13 Albini A, Noonan DM, Pelosi G, Di Guardo G, Lombardo M. The SARS-CoV-2 receptor, ACE-2, is expressed on many different cell types: implications for ACE-inhibitor- and angiotensin II receptor blocker-based antihypertensive therapies-reply. Intern Emerg Med 2020; 15 (08) 1583-1584
    CrossrefPubMedSearch in Google Scholar
  • 14 Roncati L, Ligabue G, Fabbiani L. et al. Type 3 hypersensitivity in COVID-19 vasculitis. Clin Immunol 2020; 217: 108487
    CrossrefPubMedSearch in Google Scholar
  • 15 Sollini M, Ciccarelli M, Cecconi M. et al. Vasculitis changes in COVID-19 survivors with persistent symptoms: an [(18)F]FDG-PET/CT study. Eur J Nucl Med Mol Imaging 2021; 48 (05) 1460-1466
    CrossrefPubMedSearch in Google Scholar
  • 16 Oderich GS, Kärkkäinen JM, Reed NR, Tenorio ER, Sandri GA. Penetrating aortic ulcer and intramural hematoma. Cardiovasc InterventRadiol 2019; 42 (03) 321-334
    PubMedSearch in Google Scholar
  • 17 Bournazos S, Gupta A, Ravetch JV. The role of IgG Fc receptors in antibody-dependent enhancement. Nat Rev Immunol 2020; 20 (10) 633-643
    CrossrefPubMedSearch in Google Scholar
  • 18 Wang B, Wang L, Kong X. et al. Long-term coexistence of SARS-CoV-2 with antibody response in COVID-19 patients. J Med Virol 2020; 92 (09) 1684-1689
    CrossrefPubMedSearch in Google Scholar
  • 19 Stone JR, Bruneval P, Angelini A. et al. Consensus statement on surgical pathology of the aorta from the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology: I. Inflammatory diseases. Cardiovasc Pathol 2015; 24 (05) 267-278
    CrossrefPubMedSearch in Google Scholar