von der Thüsen Jan H, Ghariq Elyas, Overbeek Maria J, Leyten Eliane, Drijkoningen Tessa, Gietema Hester A, Prokop Mathias, Quarles van Ufford Henriette M E
Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands.
Department of Radiology, Haaglanden Medisch Centrum, The Hague, The Netherlands.
Crit Care Explor. 2020 Oct 21;2(10):e0266. doi: 10.1097/CCE.0000000000000266. eCollection 2020 Oct.
There is accumulating evidence of a distinct coagulopathy in severe acute respiratory syndrome coronavirus 2 infection which is associated with poor prognosis in coronavirus disease 2019. Coagulation abnormalities in blood samples resemble systemic coagulopathies in other severe infections but demonstrate specific features such as a very high d-dimer. These clinical observations are consistent with histopathologic findings of locally disturbed pulmonary microvascular thrombosis and angiopathy in end-stage coronavirus disease 2019. However, exact underlying processes and the sequence of events are not fully understood.
CT perfusion may provide insight in the dynamic aspect of the vascularity in pulmonary lesions in coronavirus disease 2019 infection as, in contrast to dual energy CT, a multiphase perfusion pattern is displayed.
In six patients with coronavirus disease 2019 pneumonia, findings on additional CT perfusion series were correlated with known histopathologic vascular patterns upon pulmonary autopsy of patients who had died of coronavirus disease 2019.
In this case series, we were able to show perfusion changes on CT scans in typical pulmonary lesions illustrating diverse patterns.
We demonstrated hyperperfusion in areas with ground glass and a severely decreased perfusion pattern in more consolidated areas often seen later in the course of disease. A combination was also observed, illustrating temporal heterogeneity.
These findings provide new insights into the pathophysiology of coronavirus disease 2019 pneumonia and further understanding of the mechanisms that lead to respiratory failure in these patients.
越来越多的证据表明，严重急性呼吸综合征冠状病毒2感染中存在一种独特的凝血病，这与2019冠状病毒病的不良预后相关。血液样本中的凝血异常类似于其他严重感染中的全身性凝血病，但表现出特定特征，如d - 二聚体非常高。这些临床观察结果与晚期2019冠状病毒病中局部肺微血管血栓形成和血管病的组织病理学发现一致。然而，确切的潜在过程和事件顺序尚未完全了解。
CT灌注可以提供关于2019冠状病毒病感染中肺部病变血管动态方面的见解，因为与双能CT不同，它显示多相灌注模式。
在6例2019冠状病毒病肺炎患者中，额外的CT灌注系列结果与死于2019冠状病毒病患者肺部尸检时已知的组织病理学血管模式相关。
在这个病例系列中，我们能够在典型肺部病变的CT扫描上显示灌注变化，呈现出不同模式。
我们证明了磨玻璃区域的高灌注以及在疾病后期更常见的实变区域灌注模式严重降低。还观察到了两者的组合，表明存在时间异质性。
这些发现为2019冠状病毒病肺炎的病理生理学提供了新的见解，并进一步理解了导致这些患者呼吸衰竭的机制。
