COVID-19后并发症:一例险些漏诊的肺栓塞病例

A. Jamil, A. Syeda, V. Shyam
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引用次数: 1

摘要

目前已经确定COVID-19感染与高凝血症有关,特别是在严重呼吸道疾病和较高程度炎症的患者中。我们提出一个不寻常的病例肺栓塞(PE)与不典型症状的COVID-19幸存者。病例报告:一名47岁非裔美国人,非吸烟女性,有高血压和病态肥胖史,突然出现头晕伴恶心和呕吐。在出现症状之前,病人的健康状况与往常一样。她把她的头晕描述为一种房间旋转的感觉。对系统的审查是正常的。她没有急性窘迫,生命体征在正常范围内,室内空气氧饱和度为98%。身体检查,包括迪克斯-霍尔派克操作,没有什么特别的。实验室检查和心电图正常。头部和颈部的CT血管造影未发现任何脑缺血,然而,它揭示了有关PE的发现。胸部CT血管造影显示双侧栓子伴充盈缺损,证实PE。超声心动图正常。患者没有任何PE的危险因素,如近期固定、旅行、手术、使用口服避孕药或激素治疗、恶性肿瘤和个人或家族血栓栓塞性疾病史。值得注意的是,六个月前,她被检测出COVID-19阳性,症状轻微,不需要住院治疗。入院期间COVID-19检测为阴性,但未获得d -二聚体。在没有任何其他合理的头晕病因的情况下,她的症状归因于非典型PE的表现。她接受肝素治疗,出院时口服阿哌沙班抗凝治疗一年。讨论:虽然提出了几种假设,但COVID-19感染高凝性的确切发病机制尚不清楚。到目前为止,报道的作为COVID-19感染并发症的PE病例出现在发病后六周内。我们的患者在感染后6个月出现双侧PE,在没有其他PE危险因素的情况下,并不严重到需要住院治疗。最近的研究表明,BMI大于30 kg / m²的患者,如我们的患者,有更大的倾向发展PE,但在严重疾病的情况下。医生应该认识到这一临床实体,并对既往感染COVID-19的患者的PE具有高度的怀疑指数,无论其时间和疾病严重程度如何,特别是像本例患者这样具有非典型表现的患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Post COVID-19 Complication: A Near Miss Case of Pulmonary Embolism
Introduction:It is now well established that COVID-19 infection is associated with hypercoagulability especially in those with severe respiratory disease and higher degree of inflammation. We present an unusual case of pulmonary embolism (PE) with atypical symptoms in a COVID-19 survivor.Case Report:A 47-year-old African-American, non-smoker female with a history of hypertension and morbid obesity presented with sudden onset of dizziness associated with nausea and vomiting. The patient was in her usual state of health prior to the onset of symptoms. She described her dizziness as a sensation of room spinning. Review of systems was otherwise normal. She was in no acute distress, vital signs were within normal limits and oxygen saturation was 98% on room air. Physical examination including the Dix-Hallpike maneuver was unremarkable. Laboratory investigations and EKG were normal. A CT angiography of the head and neck did not reveal any cerebral ischemia, however, it disclosed findings concerning PE. A CT angiography of the chest demonstrated bilateral emboli with filling defects confirming PE. Echocardiogram was normal. The patient did not have any risk factors for PE like recent immobilization, travel, surgery, use of oral contraceptives or hormonal therapy, malignancy and personal or family history of thromboembolic disorders. Of note, six months ago she was tested positive for COVID-19 with mild symptoms which did not require hospitalization. COVID-19 test during this admission was negative, but D-dimer was not obtained. In the absence of any other plausible etiology of dizziness, her symptoms were attributed to atypical presentation of PE. She was treated with heparin and discharged on oral anticoagulation therapy with apixaban for one year. Discussion:Although there are several proposed hypotheses, the exact pathogenesis of hypercoagulability in COVID-19 infection is unclear. Thus far, the reported cases of PE as a complication of COVID-19 infection presented within six weeks of disease onset. Our patient developed bilateral PE six months post infection, which was not severe enough to require hospitalization, in the absence of any other risk factors for PE. More recent studies suggest that patients with a BMI greater than 30 kg per meter square, like our patient, have a greater propensity to develop PE but in the setting of severe disease. Physicians should be cognizant of this clinical entity and have a high index of suspicion for PE in patients with prior COVID-19 infection irrespective of the timeline and disease severity especially in those with atypical presentation like our patient.
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