Thrombus in Transit and Impending Pulmonary Embolism Detected on POCUS in a Patient with COVID-19 Pneumonia

Pramod Theetha Kariyanna¹, Naseem A. Hossain¹, Apoorva Jayarangaiah², Nimrah A. Hossain³, Vaibhavi Uppin¹, Sudhanva Hegde¹, Violeta Capric¹, Moro O. Salifu¹ and Samy I. McFarlane^1,

¹Department of Internal Medicine, State University of New York, Downstate-Health Science University, Brooklyn, New York, USA, 11203

²Division of Hematology and Oncology, Department of Internal Medicine, Jacobi Medical Center, Albert Einstein School of Medicine, New York, USA- 10461

³Department of Internal Medicine, New York Presbyterian- Brooklyn Methodist Hospital, Brooklyn, New York, USA- 11215

Cite this paper

Pramod Theetha Kariyanna, Naseem A. Hossain, Apoorva Jayarangaiah, Nimrah A. Hossain, Vaibhavi Uppin, Sudhanva Hegde, Violeta Capric, Moro O. Salifu and Samy I. McFarlane. Thrombus in Transit and Impending Pulmonary Embolism Detected on POCUS in a Patient with COVID-19 Pneumonia. American Journal of Medical Case Reports. 2020; 8(8):225-228. doi: 10.12691/AJMCR-8-8-2

Abstract

Coronavirus disease 2019 (COVID-19) is a pandemic that started in China in December 2019 and carries a high risk of morbidity and mortality. To-date (4-22-2020) it affected over 2.6 million people and resulted in nearly 200,000 death worldwide mainly due to severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2). Among the major underlying pathophysiologic mechanisms in COVID 19 is hypercoagulability, leading to increased risk for deep vein thrombosis and pulmonary embolism that contribute to increased morbidity and mortality. In this report, we present the case of a 55-year-old man who presented with COVID-19 pneumonia, and was found to have a thrombus in transit by routine point of care ultrasound (POCUS). While computer tomography (CT) angiography is the test of choice, the utilization of point of care ultrasound (POCUS) has gained traction as an adjunctive means of surveillance for the development of VTE in patients with COVID-19. In this report, we discuss the clinical utility of POCUS in diagnosing thrombus in transit in COVID 19 populations.

Keywords

COVID 19, SARS-Cov-2, Pneumonia, deep vein thrombosis, pulmonary embolism, POCUS

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun. 2020; 109: 102433.
[2]	Guo YR, Cao QD, Hong ZS, et al. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak - an update on the status. Mil Med Res. 2020; 7(1): 11.
[3]	Fox SE, Akmatbekov A, Harbert JL, Li G, Brown JQ, Vander Heide RS. Pulmonary and Cardiac Pathology in Covid-19: The First Autopsy Series from New Orleans. medRxiv. 2020: 2020.2004.2006.20050575.
[4]	Ciceri F, Beretta L, Scandroglio AM, et al. Microvascular COVID-19 lung vessels obstructive thromboinflammatory syndrome (MicroCLOTS): an atypical acute respiratory distress syndrome working hypothesis. Crit Care Resusc. 2020.
[5]	Klok FA, Kruip M, van der Meer NJM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020.
[6]	Porfidia A, Pola R. Venous thromboembolism in COVID-19 patients. J Thromb Haemost. 2020.
[7]	Ng KHL, Wu AKL, Cheng VCC, et al. Pulmonary artery thrombosis in a patient with severe acute respiratory syndrome. Postgrad Med J. 2005; 81(956): e3-e3.
[8]	Tsang KW, Ooi GC, Ho PL. Diagnosis and pharmacotherapy of severe acute respiratory syndrome: what have we learnt? European Respiratory Journal. 2004; 24(6): 1025.
[9]	Xiang-hua Y, Le-min W, Ai-bin L, et al. Severe Acute Respiratory Syndrome and Venous Thromboembolism in Multiple Organs. American Journal of Respiratory and Critical Care Medicine. 2010; 182(3): 436-437.
[10]	Cui S, Chen S, Li X, Liu S, Wang F. Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia. Journal of Thrombosis and Haemostasis. 2020; n/a(n/a).
[11]	Danzi GB, Loffi M, Galeazzi G, Gherbesi E. Acute pulmonary embolism and COVID-19 pneumonia: a random association? Eur Heart J. 2020.
[12]	Marongiu F, Grandone E, Barcellona D. Pulmonary thrombosis in 2019-nCoV pneumonia? J Thromb Haemost. 2020.
[13]	Casey K, Iteen A, Nicolini R, Auten J. COVID-19 pneumonia with hemoptysis: Acute segmental pulmonary emboli associated with novel coronavirus infection. Am J Emerg Med. 2020.
[14]	Xie Y, Wang X, Yang P, Zhang S. COVID-19 Complicated by Acute Pulmonary Embolism. Radiology: Cardiothoracic Imaging. 2020; 2(2): e200067.
[15]	Tang N, Bai H, Chen X, Gong J, Li D, Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost. 2020.
[16]	Ranucci M, Ballotta A, Di Dedda U, et al. The procoagulant pattern of patients with COVID-19 acute respiratory distress syndrome. J Thromb Haemost. 2020.
[17]	Agarwal V, Nalluri N, Shariff MA, et al. Large embolus in transit - an unresolved therapeutic dilemma (case report and review of literature). Heart Lung. 2014; 43(2): 152-154.
[18]	Kahl N, Gabriel C, Lahham S, Thompson M, Hoonpongsimanont W. Point-of-care Ultrasound Diagnosis of Pulmonary Embolism with Thrombus in Transit. Clin Pract Cases Emerg Med. 2019; 3(1): 11-12.
[19]	Kariyanna PT, Celenza-Salvatore J, Jayarangaiah A, Punnakudiyil GJ, McFarlane IM. A Case of Thrombus in Transit: Role of POCUS in Early Diagnosis of Pulmonary Thromboembolism. Am J Med Case Rep. 2020; 8(2): 67-69.
[20]	Sabbagh E, Elzanaty AM, Alhourani O, Sheikh M. “Clot in Transit”: Percutaneous or Surgical Approach?.
[21]	Sikachi R, Agrawal A. Whole body point of care ultrasound for COVID-19: a multi-system approach to a multi-system disease. Anaesthesia. 2020.
[22]	Hope MD, Raptis CA, Henry TS. Chest Computed Tomography for Detection of Coronavirus Disease 2019 (COVID-19): Don't Rush the Science. Annals of Internal Medicine. 2020.