Del Nonno Franca, Colombo Daniele, Nardacci Roberta, Falasca Laura
Pathology Unit, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy.
Laboratory of Electron Microscopy, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy.
Thromb J. 2021 Jan 6;19(1):1. doi: 10.1186/s12959-020-00255-6.
A considerable number of SARS-CoV-2 infected individuals could be asymptomatic and don't need medical treatment. The clinical spectrum of SARS-CoV-2 infection ranges from asymptomatic cases, medium-intensity forms with mild to moderate symptoms, to severe ones with bilateral pneumonia and respiratory distress. In cases with severe presentation of SARS-CoV-2 infection, the induction of hypercoagulability is one of the pathophysiological mechanism that can contribute to death.
Here, we reported autoptic evidences of thrombotic pulmonary arterial fatal lesions in an asymptomatic COVID-19 patient, after swab negativization. Whole body complete post-mortem examination was performed, showing the presence of a large thrombus occluding the main pulmonary artery that was the cause of death. Histopathological analysis showed heterogeneous pattern of pathological changes in the lung tissue with numerous vascular thrombi, inflammatory cardiomyopathy and other histopathological modifications in kidneys, spleen and liver.
This study provides evidences that also asymptomatic patients may be at risk to develop thrombotic complications. An appropriate diagnostic screening for thrombotic complications and the early treatment recommendations of antithrombotic drugs could represent an important topic even in asymptomatic individuals.
相当数量的新冠病毒感染者可能无症状，无需治疗。新冠病毒感染的临床谱包括无症状病例、有轻度至中度症状的中度症状形式，以及伴有双侧肺炎和呼吸窘迫的严重症状形式。在新冠病毒感染严重的病例中，高凝状态的诱导是可能导致死亡的病理生理机制之一。
在此，我们报告了一名无症状新冠患者在咽拭子转阴后出现血栓性肺动脉致命病变的尸检证据。进行了全身完整的尸检，发现一个大血栓阻塞了主肺动脉，这是死亡原因。组织病理学分析显示肺组织病理变化呈异质性模式，有大量血管血栓形成，还有炎症性心肌病以及肾脏、脾脏和肝脏的其他组织病理学改变。
本研究提供了证据表明，即使是无症状患者也可能有发生血栓并发症的风险。即使在无症状个体中，对血栓并发症进行适当的诊断筛查以及抗血栓药物的早期治疗建议也可能是一个重要课题。
