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COVID-19-Associated Large- and Medium-Sized-Vessel Pathology: A Case Series
Stacey Chen1, Jad Malas1, Larry A Latson2
1Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York.
Insights
COVID-19 can cause rare but serious large- and medium-sized blood vessel issues. These cardiovascular complications may appear late after infection, requiring ongoing monitoring in patients with COVID-19.
Area of Science:
- Cardiovascular Imaging
- Infectious Disease Epidemiology
- Vascular Pathology
Background:
- Coronavirus disease-19 (COVID-19) remains a significant global health concern.
- The impact of COVID-19 on large- and medium-sized blood vessels is not fully understood.
- Characterizing these vascular complications is crucial for patient management.
Purpose of the Study:
- To identify patients with COVID-19-associated large- and medium-vessel pathology using computed tomography (CT) imaging.
- To describe the clinical and radiological features of this rare cardiovascular manifestation.
- To provide insights into the presentation and management of these cases.
Main Methods:
- A single-center retrospective review was conducted.
- Included patients had CT scans concerning for large- and medium-vessel pathology and confirmed COVID-19 infection.
- Data were collected from March 1, 2020, to October 31, 2020.
Main Results:
- Out of 6,553 reviewed CT reports, 139 patients had pertinent imaging. Eight COVID-19 positive patients (median age 59) were identified with vascular pathology.
- All patients had cardiovascular risk factors; three had autoimmune disease. Four were not hospitalized for COVID-19.
- Two patients presented with chest/back pain a median of 39 days post-COVID-19 diagnosis, revealing extensive aortic pathology; one required surgery.
Conclusions:
- COVID-19-associated large- and medium-vessel pathology presents heterogeneously.
- These vascular issues can manifest as a late finding following COVID-19 recovery.
- Clinical follow-up and surveillance imaging are recommended for COVID-19 patients.
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.
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