Vincent Jounieaux1, Damien Basille2, Osama Abou-Arab3, Marie-Pierre Guillaumont4, Claire Andrejak2, Yazine Mahjoub3, Daniel Oscar Rodenstein5. 1. Pneumology Department, University Hospital Centre, Amiens, France. jounieaux.vincent@chu-amiens.fr. 2. Pneumology Department, University Hospital Centre, Amiens, France. 3. Cardiac, Thoracic-vascular and Respiratory Intensive Care Unit, Department of Anesthesia and Critical Care, University Hospital Centre, Amiens, France. 4. Transversal Cardiology Department, University Hospital Centre, Amiens, France. 5. Pneumology Department, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
Abstract
BACKGROUND: SARS-CoV-2 virus which targets the pulmonary vasculature is supposed to induce an intrapulmonary right to left shunt with an increased pulmonary blood flow. Such vascular injury is difficult to observe because it is hidden by the concomitant lung injury. We report here what may be, to the best of our knowledge, the first case of a pure Covid-19 related Acute Vascular Distress Syndrome (AVDS). CASE PRESENTATION: A 43-year-old physician, tested positive for Covid-19, was addressed to the emergency unit for severe dyspnoea and dizziness. Explorations were non informative with only a doubt regarding a sub-segmental pulmonary embolism (no ground-glass lesions or consolidations related to Covid-19 disease). Dyspnoea persisted despite anticoagulation therapy and normal pulmonary function tests. Contrast-enhanced transthoracic echocardiography was performed which revealed a moderate late right-to-left shunt. CONCLUSIONS: This case report highlights the crucial importance of the vascular component of the viral disease. The intrapulmonary shunt induced by Covid-19 which remains unrecognized because generally hidden by the concomitant lung injury, can persist for a long time. Contrast-enhanced transthoracic echocardiography is the most appropriate test to propose in case of persistent dyspnoea in Covid-19 patients.
BACKGROUND:SARS-CoV-2 virus which targets the pulmonary vasculature is supposed to induce an intrapulmonary right to left shunt with an increased pulmonary blood flow. Such vascular injury is difficult to observe because it is hidden by the concomitant lung injury. We report here what may be, to the best of our knowledge, the first case of a pure Covid-19 related Acute Vascular Distress Syndrome (AVDS). CASE PRESENTATION: A 43-year-old physician, tested positive for Covid-19, was addressed to the emergency unit for severe dyspnoea and dizziness. Explorations were non informative with only a doubt regarding a sub-segmental pulmonary embolism (no ground-glass lesions or consolidations related to Covid-19 disease). Dyspnoea persisted despite anticoagulation therapy and normal pulmonary function tests. Contrast-enhanced transthoracic echocardiography was performed which revealed a moderate late right-to-left shunt. CONCLUSIONS: This case report highlights the crucial importance of the vascular component of the viral disease. The intrapulmonary shunt induced by Covid-19 which remains unrecognized because generally hidden by the concomitant lung injury, can persist for a long time. Contrast-enhanced transthoracic echocardiography is the most appropriate test to propose in case of persistent dyspnoea in Covid-19patients.
Authors: Francisco J González-Ruiz; Emmanuel A Lazcano-Díaz; Luis A Baeza Herrera; Montserrat Villalobos-Pedroza; Enma L Toledo Alemán; Miriam G Zuñiga-Salcedo; Camelia Cruz-Rodríguez; Alexandra López-Polanco; Abraham Torres-Pulido; Alejandro Sierra-González de Cossio; Luis A Cota Apodaca; Daniel Manzur-Sandoval Journal: Ann Med Surg (Lond) Date: 2022-05-17
Authors: Vincent Jounieaux; Damien Basille; Bénédicte Toublanc; Claire Andrejak; Daniel Oscar Rodenstein; Yazine Mahjoub Journal: Front Med (Lausanne) Date: 2021-11-30