Related Experiment Video
Updated: Dec 19, 2025
09:43
Author Spotlight: Unveiling the Polyfunctionality and Heterogeneity in Immune Responses
Published on: March 8, 2024
2.3K
Hyperacute multi-organ thromboembolic storm in COVID-19: a case report
Sarah Chibane1, Guillaume Gibeau2, Frédéric Poulin2
1Faculty of Medicine, McGill University, Montreal, Canada.
Journal of Thrombosis and Thrombolysis
|June 8, 2020
Summary
This case study reveals that severe COVID-19 can manifest primarily as widespread blood clots (thromboembolism) affecting multiple organs, even without significant respiratory symptoms. This highlights the critical role of endothelial dysfunction in severe coronavirus disease 2019.
Area of Science:
- Cardiology
- Pathology
- Infectious Diseases
Background:
- Severe coronavirus disease 2019 (COVID-19) typically presents with pneumonia, hypoxemic respiratory failure, and a significant inflammatory response.
- The inflammatory state in COVID-19 can precipitate thromboembolic complications, even with prophylactic measures.
Observation:
- A 66-year-old female patient with post-mortem confirmed COVID-19 presented with livedo racemosa, acute kidney injury, and myocardial damage, notably lacking respiratory symptoms.
- Echocardiography revealed right heart strain and spontaneous echo contrast, suggesting pulmonary microvascular thrombosis or embolism.
- The patient experienced an acute ischemic stroke and expired despite anticoagulation therapy.
Findings:
- The patient's presentation was dominated by thromboembolic events, supporting the hypothesis of COVID-19 endotheliitis and associated hypercoagulability.
- Elevated D-dimer levels indicated a hypercoagulable state.
Implications:
- COVID-19 can present with a hyperacute, multi-organ thromboembolic storm that may overshadow or precede respiratory symptoms.
- This case underscores the importance of considering thromboembolic complications in COVID-19 patients, particularly those with endothelial dysfunction, even in the absence of typical respiratory signs.
Related Concept Videos
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
176
Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
176
01:29Pulmonary Embolism I: Introduction
391
Pulmonary embolism (PE) occurs when a thrombus, fat or air embolus, amniotic fluid, or tumor tissue blocks one or more pulmonary arteries. These blockages originate in the venous system or the right side of the heart.EtiologyPE primarily arises from deep vein thrombosis (DVT) and other hypercoagulable states, such as inherited thrombophilias. Additional etiological factors include venous stasis, commonly seen in obesity, and endothelial injury from surgery and trauma. Less common causes include...
391
01:30Acute Coronary Syndrome I: Introduction
548
Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
548
01:29Acute Kidney Injury III: Clinical Manifestations
647
Acute Kidney Injury (AKI) progresses through distinct clinical phases: the oliguric, diuretic, and recovery phases, each marked by unique manifestations and challenges.Oliguric Phase:The oliguric phase is the initial stage of AKI, typically lasting 10 to 14 days. This phase is marked by a significant reduction in urine output, usually less than 400 mL per day, indicating decreased kidney function. Fluid retention is a prominent feature, leading to symptoms such as edema, hypertension, and...
647
01:27Pulmonary Embolism III: Nursing Management
210
A pulmonary embolism occurs when a thrombus, amniotic fluid, tumor tissue, fat, or air embolus blocks one or more pulmonary arteries. Effective nursing management and patient education are crucial for improving outcomes and preventing recurrence.Nursing management starts with obtaining a comprehensive patient history, particularly noting any history of deep vein thrombosis (DVT). Assess for clinical manifestations, including dyspnea, chest pain, crackles, heart murmurs, and signs of right-sided...
210
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
282
The pathophysiology of Acute Coronary Syndrome [ACD] involves several key processes:The main underlying cause of ACD is atherosclerosis, a chronic inflammatory disease characterized by the buildup of lipid-laden plaques within the coronary arteries.As the atherosclerotic plaque grows in the coronary artery, it may become unstable due to the formation of a lipid-rich core and a thin fibrous cap. Inflammatory cells within the plaque, such as macrophages, secrete enzymes that degrade the...
282