tibljТуберкулез и болезни легкихTuberculosis and Lung Diseases2075-12302542-1506Медицинские знания и технологии10.58838/2075-1230-2024-102-1-66-71tiblj-1796Research ArticleКЛИНИЧЕСКИЕ НАБЛЮДЕНИЯCLINICAL OBSERVATIONSСубтотальный тромбоз ствола левой легочной артерии как осложнение COVID-19: клинический случайSubtotal Thrombosis of the Left Pulmonary Artery Trunk as a Complication of COVID-19: a Clinical Casehttps://orcid.org/0000-0003-0387-4937КаленчицТ. И.KalenchitsT. I.

Каленчиц Тамара Ивановна, к.м.н., доцент кафедры физиотерапии и медицинской реабилитации

220083,  г. Минск, пр. Дзержинского, 83

Tamara I. Kalenchits, Candidate of Medical Sciences, Associate Professor of Physiotherapy and Medical Rehabilitation Department 

83 Dzerzhinskogo Ave., Minsk, 220083

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

Кабак Сергей Львович, д.м.н., профессор, заведующий кафедрой морфологии человека

220083,  г. Минск, пр. Дзержинского, 83

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

83 Dzerzhinskogo Ave., Minsk, 220083

kabakmorph@gmail.comКореневскаяИ. В.KorenevskayaI. V.

Кореневская Инна Валерьевна, врач пульмонологического отделения № 1 

220037, г. Минск, ул. Уральская, д. 5

 

Inna V. Korenevskaya, Physician of Pulmonology Unit no. 1 

5 Uralskaya St., Minsk, 220037

inna.korenevskaya.31@mail.ruУО «Белорусский государственный медицинский университет»БеларусьBelarusian State Medical UniversityBelarusУЗ «6-я городская клиническая больница»БеларусьCity Clinical Hospital no. 6Belarus20242003202410216671Copyright © Каленчиц Т.И., Кабак С.Л., Кореневская И.В., 20242024Каленчиц Т.И., Кабак С.Л., Кореневская И.В.Kalenchits T.I., Kabak S.L., Korenevskaya I.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.tibl-journal.com/jour/article/view/1796

В статье описана история болезни 62-летнего пациента, инфицированного вирусом SARS-CoV-2, у которого через 15 дней после появления симптомов COVID-19 с поражением легких при компьютерной томографии органов грудной клетки с контрастированием были обнаружены одновременно субтотальная обструкция ствола легочной артерии и дефекты заполнения ее ветвей из-за тромбов, образовавшихся in situ. На фоне антикоагулянтной терапии в течение 13 дней произошло рассасывание тромбов как в центральных, так и в периферических отделах венозного русла легких.

The article describes a clinical case of a 62-year-old patient infected with SARS-CoV-2, in whom, 15 days after the onset of symptoms of COVID-19 with lung damage, chest computed tomography with contrast revealed concurrent subtotal obstruction of the pulmonary artery trunk and defects of its branches filling due to blood clots formed in situ. Against the background of anticoagulant therapy for 13 days, blood clots resolved in both central and peripheral parts of the lung venous bed.

COVID-19тромбоз легочной артерииантикоагулянтная терапияCOVID-19pulmonary thrombosisanticoagulant therapyReferencesAghayev A., Furlan A., Patil A., Gumus S., Jeon K.N., Park B., Bae K.T. The rate of resolution of clot burden measured by pulmonary CT angiography in patients with acute pulmonary embolism // AJR Am J Roentgenol. – 2013. – Vol. 200. – № 4. – Р. 791–797. https://doi.org/10.2214/AJR.12.8624Aghayev A., Furlan A., Patil A., Gumus S., Jeon K.N., Park B., Bae K.T. The rate of resolution of clot burden measured by pulmonary CT angiography in patients with acute pulmonary embolism. AJR. Am. J. Roentgenol., 2013, vol. 200, no. 4, pp. 791–797. https://doi.org/10.2214/AJR.12.8624Bompard F., Monnier H., Saab I., Tordjman M., Abdoul H., Fournier L., Sanchez O., Lorut Ch., Chassagnon G., Revel M. P. Pulmonary embolism in patients with COVID-19 pneumonia // European Respiratory Journal. – 2020. – Vol. 56. – № 1. – Р. 2001365. https://doi.org/10.1183/13993003.01365-202Bompard F., Monnier H., Saab I., Tordjman M., Abdoul H., Fournier L., Sanchez O., Lorut Ch., Chassagnon G., Revel M.P. Pulmonary embolism in patients with COVID-19 pneumonia. European Respiratory Journal, 2020, vol. 56, no. 1, pp. 2001365. https://doi.org/10.1183/13993003.01365-20Cao Y., Geng C., Li Y., Zhang Y. In situ pulmonary artery thrombosis: a previously overlooked disease// Frontiers in Pharmacology. – 2021. – Vol. 12. – Р. 1762. https://doi.org/10.3389/fphar.2021.671589Cao Y., Geng C., Li Y., Zhang Y. In situ pulmonary artery thrombosis: a previously overlooked disease. Frontiers in Pharmacology, 2021, vol. 12, pp. 1762. https://doi.org/10.3389/fphar.2021.671589Cavagna E., Muratore F., Ferrari F. Pulmonary thromboembolism in COVID-19: venous thromboembolism or arterial thrombosis? // Radiology: Cardiothoracic Imaging. – 2020. – Vol. 2, № 4. – Р. e200289. https://doi.org/10.1148/ryct.2020200289Cavagna E., Muratore F., Ferrari F. Pulmonary thromboembolism in COVID-19: venous thromboembolism or arterial thrombosis? Radiology: Cardiothoracic Imaging, 2020, vol. 2, no. 4, pp. e200289. https://doi.org/10.1148/ryct.2020200289Choi K. J., Cha S. I., Shin K. M., Lim J. K., Yoo S. S., Lee, J., Shin-Yup, Chang-Ho K., Jae-Yong P., Lee, W. K. Factors determining clot resolution in patients with acute pulmonary embolism // Blood Coagulation & Fibrinolysis. – 2016. – Vol. 27, № 3. – P. 294-300. https://doi.org/110.1097/MBC.0000000000000425Choi K.J., Cha S.I., Shin K.M., Lim J.K., Yoo S.S., Lee J., Shin-Yup, Chang-Ho K., Jae-Yong P., Lee, W.K. Factors determining clot resolution in patients with acute pulmonary embolism. Blood Coagulation & Fibrinolysis, 2016, vol. 27, no. 3, pp. 294-300. https://doi.org/110.1097/MBC.0000000000000425den Exter P.L, van Es J., Kroft L.J., Erkens P.M., Douma R.A., Mos I.C., Jonkers G., Hovens M.M., Durian M.F., ten Cate H., Beenen L.F., Kamphuisen P.W., Huisman M.V.; Prometheus Follow-Up Investigators. Thromboembolic resolution assessed by CT pulmonary angiography after treatment for acute pulmonary embolism // Thromb Haemost. – 2015. – Vol.114, № 1. – P. 26–34. https://doi.org/10.1160/TH14-10-0842den Exter P.L, van Es J., Kroft L.J., Erkens P.M., Douma R.A., Mos I.C., Jonkers G., Hovens M.M., Durian M.F., ten Cate H., Beenen L.F., Kamphuisen P.W., Huisman M.V.; Prometheus Follow-Up Investigators. Thromboembolic resolution assessed by CT pulmonary angiography after treatment for acute pulmonary embolism. Thromb Haemost., 2015, vol. 114, no. 1, pp. 26-34. https://doi.org/10.1160/TH14-10-0842Gong X., Yuan B., Yuan Y. Incidence and prognostic value of pulmonary embolism in COVID-19: A systematic review and meta-analysis // PLoS One. – 2022. – Vol.17, No. 3 – Р. e0263580. https://doi.org/10.1371/journal.pone.0263580Gong X., Yuan B., Yuan Y. Incidence and prognostic value of pulmonary embolism in COVID-19: A systematic review and meta-analysis. PLoS One, 2022, vol. 17, no. 3, pp. e0263580. https://doi.org/10.1371/journal.pone.0263580Graziani A., Domenicali M., Zanframundo G., Palmese F., Caroli B., Graziani, L. Pulmonary artery thrombosis in COVID-19 patients // Pulmonology. – 2021. – Vol. 27, № 3. – P. 261-263. https://doi.org/10.1016/j.pulmoe.2020.07.013Graziani A., Domenicali M., Zanframundo G., Palmese F., Caroli B., Graziani, L. Pulmonary artery thrombosis in COVID-19 patients. Pulmonology, 2021, vol. 27, no. 3, pp. 261-263. https://doi.org/10.1016/j.pulmoe.2020.07.013Kho J., Ioannou A., Van den Abbeele K., Mandal A.K.J., Missouris C.G. Pulmonary embolism in COVID-19: Clinical characteristics and cardiac implications. // Am J Emerg Med. – 2020. – Vol. 38, № 10. – P. 2142-2146. https://doi.org/10.1016/j.ajem.2020.07.054Kho J., Ioannou A., van den Abbeele K., Mandal A.K.J., Missouris C.G. Pulmonary embolism in COVID-19: Clinical characteristics and cardiac implications. Am. J. Emerg. Med., 2020, vol. 38, no. 10, pp. 2142-2146. https://doi.org/10.1016/j.ajem.2020.07.054Klok F.A., Kruip M.J.H.A., van der Meer N.J.M., Arbous M.S., Gommers D.A.M.P.J., Kant K.M., Kaptein F.H.J., van Paassen J., Stals M.A.M., Huisman M.V., Endeman H. Incidence of thrombotic complications in critically ill ICU patients with COVID-19 // Thromb Res. – 2020. – Vol. 191. – P. 145-147. https://doi.org/10.1016/j.thromres.2020.04.013Klok F.A., Kruip M.J.H.A., van der Meer N.J.M., Arbous M.S., Gommers D.A.M.P.J., Kant K.M., Kaptein F.H.J., van Paassen J., Stals M.A.M., Huisman M.V., Endeman H. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res., 2020, vol. 191, pp. 145-147. https://doi.org/10.1016/j.thromres.2020.04.013Lodigiani C., Iapichino G., Carenzo L., Cecconi M., Ferrazzi P., Sebastian T., Kucher N., Studt J.D., Sacco C., Bertuzzi A., Sandri M.T., Barco S; Humanitas COVID-19 Task Force. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy // Thromb Res. – 2020. – Vol. 191. – P. 9-14. https://doi.org/10.1016/j.thromres.2020.04.024Lodigiani C., Iapichino G., Carenzo L., Cecconi M., Ferrazzi P., Sebastian T., Kucher N., Studt J.D., Sacco C., Bertuzzi A., Sandri M.T., Barco S; Humanitas COVID-19 Task Force. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thromb Res., 2020, vol. 191, pp. 9-14. https://doi.org/10.1016/j.thromres.2020.04.024Miró Ò., Jiménez S., Mebazaa A., Freund, Y., Burillo-Putze, G., Martín, A., Martín-Sánchez F.J., García-Lamberechts E.J., Alquézar-Arbé A., Jacob J., Llorens P., Piñera P., Gil V., Guardiola J., Cardozo C., Mòdol Deltell J.M., Tost J., Aguirre Tejedo A., Palau-Vendrell A., LLauger García L., Adroher Muñoz M., Del Arco Galán C., Agudo Villa T., López-Laguna N., López Díez M.P., Beddar Chaib F., Quero Motto E., González Tejera M., Ponce M.C., González Del Castillo J; Spanish Investigators on Emergency Situations TeAm (SIESTA) network. Pulmonary embolism in patients with COVID-19: incidence, risk factors, clinical characteristics, and outcome // Eur Heart J. – 2021. – Vol. 24, № 33. – P. 3127-3142. https://doi.org/10.1093/eurheartj/ehab314Miró Ò., Jiménez S., Mebazaa A., Freund, Y., Burillo-Putze, G., Martín, A., Martín-Sánchez F.J., García-Lamberechts E.J., Alquézar-Arbé A., Jacob J., Llorens P., Piñera P., Gil V., Guardiola J., Cardozo C., Mòdol Deltell J.M., Tost J., Aguirre Tejedo A., Palau-Vendrell A., LLauger García L., Adroher Muñoz M., Del Arco Galán C., Agudo Villa T., López-Laguna N., López Díez M.P., Beddar Chaib F., Quero Motto E., González Tejera M., Ponce M.C., González Del Castillo J; Spanish Investigators on Emergency Situations TeAm (SIESTA) network. Pulmonary embolism in patients with COVID-19: incidence, risk factors, clinical characteristics, and outcome. Eur. Heart J., 2021, vol. 24, no. 33, pp. 3127-3142. https://doi.org/10.1093/eurheartj/ehab314Mueller-Peltzer K., Krauss T., Benndorf M., Lang C.N., Bamberg F., Bode C., Duerschmied D., Staudacher D.L., Zotzmann V. Pulmonary artery thrombi are co-located with opacifications in SARS-CoV2 induced ARDS // Respir Med. – 2020. – Vol. 172. – Р.106135. https://doi.org/10.1016/j.rmed.2020.106135Mueller-Peltzer K., Krauss T., Benndorf M., Lang C.N., Bamberg F., Bode C., Duerschmied D., Staudacher D.L., Zotzmann V. Pulmonary artery thrombi are co-located with opacifications in SARS-CoV2 induced ARDS. Respir. Med., 2020, vol. 172, pp. 106135. https://doi.org/10.1016/j.rmed.2020.106135Nichols L. Pulmonary arterial thrombosis in COVID-19 with fatal outcome // Annals of internal medicine. – 2021. – Vol. 174, № 1. – Р.139. https://doi.org/10.7326/L20-1275Nichols L. Pulmonary arterial thrombosis in COVID-19 with fatal outcome. Annals of Internal Medicine, 2021, vol. 174, no. 1, pp. 139. https://doi.org/10.7326/L20-1275Remy-Jardin M., Duthoit L., Perez T., Felloni P., Faivre J.B., Fry S., Bautin N., Chenivesse C., Remy J., Duhamel A. Assessment of pulmonary arterial circulation 3 months after hospitalization for SARS-CoV-2 pneumonia: Dual-energy CT (DECT) angiographic study in 55 patients // EClinicalMedicine. – 2021. – Vol. 34. – Р.100778. https://doi.org/110.1016/j.eclinm.2021.100778Remy-Jardin M., Duthoit L., Perez T., Felloni P., Faivre J.B., Fry S., Bautin N., Chenivesse C., Remy J., Duhamel A. Assessment of pulmonary arterial circulation 3 months after hospitalization for SARS-CoV-2 pneumonia: Dual-energy CT (DECT) angiographic study in 55 patients. EClinicalMedicine, 2021, vol. 34, pp. 100778. https://doi.org/110.1016/j.eclinm.2021.100778Roncon L., Zuin M., Barco S., Valerio L., Zuliani G., Zonzin P., Konstantinides S.V. Incidence of acute pulmonary embolism in COVID-19 patients: Systematic review and meta-analysis // Eur J Intern Med. – 2020. – Vol. 82. – P. 29-37. https://doi.org/10.1016/j.ejim.2020.09.006Roncon L., Zuin M., Barco S., Valerio L., Zuliani G., Zonzin P., Konstantinides S.V. Incidence of acute pulmonary embolism in COVID-19 patients: Systematic review and meta-analysis. Eur. J. Intern. Med., 2020, vol. 82, pp. 29-37. https://doi.org/10.1016/j.ejim.2020.09.006Sakr Y., Giovini M., Leone M., Pizzilli G., Kortgen A., Bauer M., Tonetti T., Duclos G., Zieleskiewicz L., Buschbeck S., Ranieri V.M., Antonucci E. Pulmonary embolism in patients with coronavirus disease-2019 (COVID-19) pneumonia: a narrative review // Annals of intensive care. – 2020. – Vol.10. – Р. 124. https://doi.org/10.1186/s13613-020-00741-0.Sakr Y., Giovini M., Leone M., Pizzilli G., Kortgen A., Bauer M., Tonetti T., Duclos G., Zieleskiewicz L., Buschbeck S., Ranieri V.M., Antonucci E. Pulmonary embolism in patients with coronavirus disease-2019 (COVID-19) pneumonia: a narrative review. Annals of Intensive Care, 2020, vol. 10, pp. 124. https://doi.org/10.1186/s13613-020-00741-0.Suh Y.J., Hong H., Ohana M., Bompard F., Revel M.P., Valle C., Gervaise A., Poissy J., Susen S., Hékimian G., Artifoni M., Periard D., Contou D., Delaloye J., Sanchez B., Fang C., Garzillo G., Robbie H., Yoon S.H. Pulmonary embolism and deep vein thrombosis in COVID-19: a systematic review and meta-analysis// Radiology. – 2021. – Vol. 298, № 2. – Р. E70-E80. https://doi.org/10.1148/radiol.2020203557Suh Y.J., Hong H., Ohana M., Bompard F., Revel M.P., Valle C., Gervaise A., Poissy J., Susen S., Hékimian G., Artifoni M., Periard D., Contou D., Delaloye J., Sanchez B., Fang C., Garzillo G., Robbie H., Yoon S.H. Pulmonary embolism and deep vein thrombosis in COVID-19: a systematic review and meta-analysis. Radiology, 2021, vol. 298, no. 2, pp. E70-E80. https://doi.org/10.1148/radiol.2020203557van Dam L.F., Kroft L.J.M., van der Wal L.I., Cannegieter S.C., Eikenboom J., de Jonge E., Huisman M.V., Klok F.A. Clinical and computed tomography characteristics of COVID-19 associated acute pulmonary embolism: a different phenotype of thrombotic disease? // Thromb Res. – 2020. – Vol. 193. – P. 86-89. https://doi.org/10.1016/j.thromres.2020.06.010Van Dam L.F., Kroft L.J.M., van der Wal L.I., Cannegieter S.C., Eikenboom J., de Jonge E., Huisman M.V., Klok F.A. Clinical and computed tomography characteristics of COVID-19 associated acute pulmonary embolism: a different phenotype of thrombotic disease? Thromb. Res., 2020, vol. 193, pp. 86-89. https://doi.org/10.1016/j.thromres.2020.06.010Zanframundo G., Graziani A., Barbara C., Francesco P., Teresa M.M., Cristian C., Pierluigi G., Ludovico D. Resolution of pulmonary artery thrombosis in patients with moderate COVID-19 disease // J Community Hosp Intern Med Perspect. – 2021. – Vol. 11, № 4 – P. 470-472. https://doi.org/110.1080/20009666.2021.1921908Zanframundo G., Graziani A., Barbara C., Francesco P., Teresa M.M., Cristian C., Pierluigi G., Ludovico D. Resolution of pulmonary artery thrombosis in patients with moderate COVID-19 disease. J. Community Hosp. Intern. Med. Perspect., 2021, vol. 11, no. 4, pp. 470-472. https://doi.org/1 10.1080/20009666.2021.1921908

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