pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2021-31-4-537-541pulmo-2417Research ArticleОБЗОРЫREVIEWОсложнения COVID-19-ассоциированной пневмонии: тромбоз ветвей легочных артерий (клинический случай)Thrombosis of the pulmonary arteries branches as a complication of COVID-19 pneumonia (a case report)https://orcid.org/0000-0003-0387-4937КаленчицТ. И.KalenchicT. I.

Каленчиц Тамара Ивановна – кандидат медицинских наук, доцент кафедры физиотерапии и медицинской реабилитации

220116, Минск, пр. Дзержинского, 83

Tamara I. Kalenchic, Candidate of Medicine, Associate Professor, Department of Medical Rehabilitation and Physiotherapy

Dzerzhinsky prosp. 83, Minsk, 220116

kalenchic@gmail.comhttps://orcid.org/0000-0002-7173-1818КабакС. Л.KabakS. L.

Кабак Сергей Львович – доктор медицинских наук, профессор, заведующий кафедрой морфологии человека

220116, Минск, пр. Дзержинского, 83

Sergey L. Kabak, Doctor of Medicine, Professor, Head of Department of Human Morphology

Dzerzhinsky prosp. 83, Minsk, 220116

kabakmorph@gmail.comhttps://orcid.org/0000-0002-8453-9016ДиденкоН. С.DidenkoN. S.

Диденко Наталья Сергеевна – врач-кардиолог

117420, Москв, ул. Наметкина, 16

Natalia S. Didenko, Сardiologist

ul. Nametkina 16, Moscow, 117420

kabaccio@mail.ruДулубИ. П.DulubI. P.

Дулуб Иван Петрович – заведующий пульмонологическим отделением № 1

2200371, Минск, ул. Уральская, 5

Ivan P. Dulub, Head of the Pulmonology Department

ul. Uralskaya 5, Minsk, 220371

dulubivan35@gmail.comХаустовичА. Ю.HaustovichA. Yu.

Хаустович Александр Юрьевич – врач-рентгенолог

2200371, Минск, ул. Уральская, 5

Aleksandr Y. Haustovich, Radiologist

ul. Uralskaya 5, Minsk, 220371

uz6gkb@tut.byУчреждение образования «Белорусский государственный медицинский университет»БеларусьEducational Institution “Belarusian State Medical University”BelarusЦентр диагностики и реабилитации Общества с ограниченной ответственностью «Газпром трансгаз Москва»РоссияCenter for Diagnostics and Rehabilitation, Limited Liability Company “Gazprom Transgaz Moscow”Russian FederationУчреждение здравоохранения «6-я Городская клиническая больница»БеларусьHealthcare Institutions “6th City Clinical Hospital of Minsk”Belarus202131072021314537541Copyright © Каленчиц Т.И., Кабак С.Л., Диденко Н.С., Дулуб И.П., Хаустович А.Ю., 20212021Каленчиц Т.И., Кабак С.Л., Диденко Н.С., Дулуб И.П., Хаустович А.Ю.Kalenchic T.I., Kabak S.L., Didenko N.S., Dulub I.P., Haustovich A.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.pulmonology.ru/pulm/article/view/2417

Представлен редкий случай тромбоза ветвей (ТВ) легочных артерий (ЛА), развившийся у пациента через 2 мес. после инфицирования вирусом SARS-CoV-2, вызвавшим двустороннюю полисегментарную пневмонию. Диагноз тромбоз верифицирован при проведении компьютерной томографии органов грудной клетки с контрастным усилением. Предиктором тромбоза являлся повышенный уровень плазменной концентрации D-димера. Ввиду отсутствия тромбов в венах нижних конечностей и таза сделано заключение, что у пациента не тромбоэмболия, а именно ТВ ЛА in situ. На основании отрицательных тестов на онкомаркеры и маркеры аутоиммунных заболеваний исключены такие возможные причины венозно-тромбоэмболических осложнений, как опухоли, системные заболевания соединительной ткани и антифосфолипидный синдром. Длительное пребывание пациента в стационаре было связано с невозможностью самостоятельно поддерживать нормальный уровень сатурации крови кислородом из-за большой площади поражения легких и ишемии легочной ткани, обусловленной ТВ ЛА.

The article presents a rare case of thrombosis of the pulmonary arteries branches, which developed in a patient two months after infection with the SARS-CoV-2 virus, that caused bilateral polysegmental pneumonia. The thrombosis was suspected because of a high plasma D-dimer level. Contrast-enhanced chest CT was performed to make a definitive diagnosis. The absence of blood clots in the veins of the lower extremities and pelvis allowed us to conclude that the patient did not have thromboembolism, but rather a pulmonary thrombosis in situ. Such possible causes of venousthromboembolic complications as tumors, systemic diseases of the connective tissue, and antiphospholipid syndrome were excluded based on negative tests for tumor and autoimmune diseases markers. The long-stay in the hospital was associated with the inability of the patient to maintain the normal level of blood oxygen saturation independently due to the large area of the lung damage associated with COVID-19 pneumonia and ischemia caused by thrombosis of the branches of the pulmonary arteries.

COVID-19пневмониятромбоз ветвей легочной артерииD-димерCOVID-19pneumoniathrombosis of the pulmonary artery branchesD-dimerReferencesBělohlávek J., Dytrych V., Linhart A. Pulmonary embolism, part I: Epidemiology, risk factors and risk stratification, pathophysiology, clinical presentation, diagnosis and nonthrombotic pulmonary embolism. Exp. Clin. Cardiol. 2013; 18 (2): 129–138.Bělohlávek J., Dytrych V., Linhart A. Pulmonary embolism, part I: Epidemiology, risk factors and risk stratification, pathophysiology, clinical presentation, diagnosis and nonthrombotic pulmonary embolism. Exp. Clin. Cardiol. 2013; 18 (2): 129–138.Torbicki A., Perrier A., Konstantinides S. et al. Guidelines on the diagnosis and management of acute pulmonary embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur. Heart J. 2008; 29 (18): 2276–2315. DOI: 10.1093/eurheartj/ehn310.Torbicki A., Perrier A., Konstantinides S. et al. Guidelines on the diagnosis and management of acute pulmonary embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur. Heart J. 2008; 29 (18): 2276–2315. DOI: 10.1093/eurheartj/ehn310.Rosovsky R.P., Grodzin C., Channick R. et al. Diagnosis and treatment of pulmonary embolism during the coronavirus disease 2019 pandemic: A Position Paper from the National PERT Consortium. Chest. 2020; 158 (6): 2590–2601. DOI: 10.1016/j.chest.2020.08.2064.Rosovsky R.P., Grodzin C., Channick R. et al. Diagnosis and treatment of pulmonary embolism during the coronavirus disease 2019 pandemic: A Position Paper from the National PERT Consortium. Chest. 2020; 158 (6): 2590–2601. DOI: 10.1016/j.chest.2020.08.2064.Sakr Y., Giovini M., Leone M. et al. Pulmonary embolism in patients with coronavirus disease-2019 (COVID-19) pneumonia: A narrative review. Ann. Intensive Care. 2020; 10: 124. DOI: 10.1186/s13613-020-00741-0.Sakr Y., Giovini M., Leone M. et al. Pulmonary embolism in patients with coronavirus disease-2019 (COVID-19) pneumonia: A narrative review. Ann. Intensive Care. 2020; 10: 124. DOI: 10.1186/s13613-020-00741-0.Malas M.B., Naazie I.N., Elsayed N. et al. Thromboembolism risk of COVID-19 is high and associated with a higher risk of mortality: A systematic review and meta-analysis. EClinicalMedicine. 2020; 29: 100639. DOI: 10.1016/j.eclinm.2020.100639.Malas M.B., Naazie I.N., Elsayed N. et al. Thromboembolism risk of COVID-19 is high and associated with a higher risk of mortality: A systematic review and meta-analysis. EClinicalMedicine. 2020; 29: 100639. DOI: 10.1016/j.eclinm.2020.100639.Porfidia A., Valeriani E., Pola R. et al. Venous thromboembolism in patients with COVID-19: Systematic review and meta-analysis. Thromb. Res. 2020; 196: 67–74. DOI: 10.1016/j.thromres.2020.08.020.Porfidia A., Valeriani E., Pola R. et al. Venous thromboembolism in patients with COVID-19: Systematic review and meta-analysis. Thromb. Res. 2020; 196: 67–74. DOI: 10.1016/j.thromres.2020.08.020.Kanso M., Cardi T., Marzak H. et al. Delayed pulmonary embolism after COVID-19 pneumonia: a case report. Eur. Heart J. Case Rep. 2020; 4 (6):1–4. DOI: 10.1093/ehjcr/ytaa449.Kanso M., Cardi T., Marzak H. et al. Delayed pulmonary embolism after COVID-19 pneumonia: a case report. Eur. Heart J. Case Rep. 2020; 4 (6):1–4. DOI: 10.1093/ehjcr/ytaa449.Vechi H.T., Maia L.R., Alves M.D.M. Late acute pulmonary embolism after mild coronavirus disease 2019 (COVID-19): a case series. Rev. Inst. Med. Trop. Sao Paulo. 2020; 62: e63. DOI: 10.1590/S1678-9946202062063.Vechi H.T., Maia L.R., Alves M.D.M. Late acute pulmonary embolism after mild coronavirus disease 2019 (COVID-19): a case series. Rev. Inst. Med. Trop. Sao Paulo. 2020; 62: e63. DOI: 10.1590/S1678-9946202062063.Fox S.E., Akmatbekov A., Harbert J.L. et al. Pulmonary and cardiac pathology in COVID-19: The first autopsy series from New Orleans. MedRxiv. [Preprint. Posted: April 10, 2020]. DOI: 10.1101/2020.04.06.20050575.Fox S.E., Akmatbekov A., Harbert J.L. et al. Pulmonary and cardiac pathology in COVID-19: The first autopsy series from New Orleans. MedRxiv. [Preprint. Posted: April 10, 2020]. DOI: 10.1101/2020.04.06.20050575.Lax S.F., Skok K., Zechner P. et al. Pulmonary arterial thrombosis in COVID-19 with fatal outcome: Results from a prospective, single-center, clinicopathologic case series. Ann. Intern. Med. 2020; 173 (5): 350–361. DOI: 10.7326/M20-2566.Lax S.F., Skok K., Zechner P. et al. Pulmonary arterial thrombosis in COVID-19 with fatal outcome: Results from a prospective, single-center, clinicopathologic case series. Ann. Intern. Med. 2020; 173 (5): 350–361. DOI: 10.7326/M20-2566.Ahmed S., Zimba O., Gasparyan A.Y. Thrombosis in coronavirus disease 2019 (COVID-19) through the prism of Virchow’s triad. Clin. Rheumatol. 2020; 39 (9): 2529–2543. DOI: 10.1007/s10067-020-05275-1.Ahmed S., Zimba O., Gasparyan A.Y. Thrombosis in coronavirus disease 2019 (COVID-19) through the prism of Virchow’s triad. Clin. Rheumatol. 2020; 39 (9): 2529–2543. DOI: 10.1007/s10067-020-05275-1.Hunt B., Retter A., McClintock C. Practical guidance for the prevention of thrombosis and management of coagulopathy and disseminated intravascular coagulation of patients infected with COVID-19. 25th March, 2020. Available at: https://b-s-h.org.uk/media/18171/thand-covid-25-march-2020-final.pdf [Accessed: December 25, 2020].Hunt B., Retter A., McClintock C. Practical guidance for the prevention of thrombosis and management of coagulopathy and disseminated intravascular coagulation of patients infected with COVID-19. 25th March, 2020. Available at: https://b-s-h.org.uk/media/18171/thand-covid-25-march-2020-final.pdf [Accessed: December 25, 2020].Галстян Г.М. Коагулопатия при COVID-19. Пульмонология. 2020; 30 (5): 645–657. DOI: 10.18093/0869-0189-2020-30-5-645-657.Galstyan G.M. Coagulopathy in COVID-19. Pul’monologiya. 2020; 30 (5): 645–657. DOI: 10.18093/0869-0189-2020-30-5-645-657 (in English, Russian).Eljilany I., Elzouki A.N. D-dimer, fibrinogen, and IL-6 in COVID-19 patients with suspected venous thromboembolism: a narrative review. Vasc. Health Risk Manag. 2020; 16: 455–462. DOI: 10.2147/VHRM.S280962.Eljilany I., Elzouki A.N. D-dimer, fibrinogen, and IL-6 in COVID-19 patients with suspected venous thromboembolism: a narrative review. Vasc. Health Risk Manag. 2020; 16: 455–462. DOI: 10.2147/VHRM.S280962.Di Tano G., Moschini L., Loffi M. et al. Late pulmonary embolism after COVID-19 pneumonia despite adequate rivaroxaban treatment. Eur. J. Case Rep. Intern. Med. 2020; 7 (7): 001790. DOI: 10.12890/2020_001790.Di Tano G., Moschini L., Loffi M. et al. Late pulmonary embolism after COVID-19 pneumonia despite adequate rivaroxaban treatment. Eur. J. Case Rep. Intern. Med. 2020; 7 (7): 001790. DOI: 10.12890/2020_001790.

The authors declare that there are no conflicts of interest present.