Interventional Radiology Unit, Department of Biomedicine and Prevention, University Hospital Policlinico Tor Vergata, Rome Italy.
Eur Rev Med Pharmacol Sci. 2021 Feb;25(3):1680-1683. doi: 10.26355/eurrev_202102_24879.
Although pulmonary involvement represents the primary and most characteristic presentation of Sars-Cov-2 infection, due to its innate tropism for endothelium, it is also associated with systemic pro-coagulative changes and thromboses. This paper describes a COVID-19 atypical presentation with massive thrombotic occlusion of the splenoportal-mesenteric axis and the splenic artery in the absence of clinical or radiological manifestation of pulmonary involvement.
Female patient, with no history of disease, trauma or fever in the last 30 days, was admitted to ER for persistent left subcostal pain. Laboratory exams, including inflammation, coagulation markers and Sars-CoV-2 serology, were requested. Whole-body CT with contrast media injection was performed.
Laboratory exams showed elevated reactive C-protein, bilirubin, γ-GT and D-dimer. Whole-body CT showed: splenic artery occlusion, thrombosis of splenic, mesenteric and portal veins with portal intra-hepatic branches ectasia, juxta-hilar portal cavernomatosis of probable acute onset (absence of signs of chronic hepatopathy and of varices), a hypodense area in the spleen indicating ischemic parenchymal suffering. The patient resulted positive for Sars-CoV-2 IgG, thus in the absence of typical clinics or pulmonary parenchymal abnormality at chest CT.
A case of acute venous thrombosis and arterial occlusion as primary manifestations of COVID-19.
尽管肺脏受累是 SARS-CoV-2 感染的主要且最具特征性表现，但由于其对内皮细胞的固有趋向性，它也与全身性促凝变化和血栓形成有关。本文描述了一种 COVID-19 的非典型表现，即脾门静脉-肠系膜轴和脾动脉的巨大血栓性闭塞，而无肺实质受累的临床或影像学表现。
女性患者，无疾病、创伤或发热史在过去 30 天内，因持续性左侧肋下疼痛而到急诊就诊。要求进行实验室检查，包括炎症、凝血标志物和 SARS-CoV-2 血清学检查。进行全身 CT 检查并注射造影剂。
实验室检查显示 C 反应蛋白、胆红素、γ-GT 和 D-二聚体升高。全身 CT 显示：脾动脉闭塞，脾、肠系膜和门静脉血栓形成，门静脉肝内分支扩张，可能为急性发病的肝门周围海绵状变性（无慢性肝病和静脉曲张的迹象），脾脏内的低密区提示缺血性实质损伤。该患者 SARS-CoV-2 IgG 检测结果为阳性，因此在胸部 CT 上无典型临床症状或肺实质异常。
COVID-19 的急性静脉血栓形成和动脉闭塞作为主要表现的病例。
