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Vascular abnormalities in patients with COVID-19 pneumonia

Elias El-Haddad, Najib Pascal Chalhoub, Mohammad Rida, Samer Abi-Khalil, Tonine Younan, Sami Slaba, Soha Haddad-Zebouni

Purpose: Describe CT findings in patients with COVID-19 pneumonia, focusing on the vascular aspects, during the novel coronavirus pandemic.

Materials and methods: In this prospective single-institutional study we included patients admitted to the emergency department between March 1 and April 4, 2020 with a SARS-CoV-2 pneumonia. We report findings on chest CT from 59 patients (35 men, 24 women, mean age 52.54 years).

Results: Among the symptoms found: fever (78%), cough (42.4%), dyspnea (39%) and headache (6.8%). Initial reverse transcriptase polymerase chain reaction (RT-PCR) was positive in 81.4%, becoming positive on retesting. Intensive care unit (ICU) admission rate was 23.7%. A total of 59 scans were obtained, describing distribution: left (8.7%) right (32.6%) or bilateral (58.7%) with the most common localization being the right lower lobe (84.8%). Findings included focal ground glass opacities (GGO) (10.9%) or multiple GGO (89.1%), consolidation (37%), crazy paving (32.6%), reversed halo sign (17.4%) and traction bronchiectasis (76.1%).

We reported vascular aspects such as enlargement (78.3%), irregularities (58.7%) and distortion (58.7%). A severity score based on lung involvement was estimated over a score of 25 with a mean of 6.4 (range: 0 to 22) and it was correlated with age (p<0.05). Other correlations included abnormal CT findings and male sex (p=0.001). Vascular angulation and traction were correlated with multifocal GGO, traction bronchiectasis, crazy paving, reversed halo sign and male sex (p<0.05).

Conclusion: Those signs can raise the possibility of concomitant vasculitis in patients with COVID-19 pneumonias.