Chronic Thromboembolic Pulmonary Hypertension (CTEPH): A Review of Another Sequel of Severe Post-Covid-19 Pneumonia

Abstract

The spectrum of pulmonary parenchymal and vascular pathologies related to the COVID-19 have emerged. There is evidence of a specific susceptibility related to thrombotic microangiopathy in situ and a complex immune-inflammatory cascade, especially in the pulmonary vascular bed. The potential to lead to transient or self-correcting sequelae of pulmonary vascular injury will only become apparent with longer-term follow-up. In this review, we aimed to present the findings in a group of patients with severe pneumonia due to covid-19 complicated by acute pe documented by chest angiography, who during a follow-up of more than 3 months with oral anticoagulant met clinical, hemodynamic, and imaging criteria of chronic thromboembolic pulmonary hypertension. We present a brief review of the epidemiology, pathophysiology, clinical findings, comorbidities, treatment, and imaging findings of chronic thromboembolic pulmonary hypertension as a sequel of severe post-covid-19 pneumonia; and compared and discussed these findings with similar reports from the medical literature.

FIG 1

The proportion of patients with PE that developed CTEPH in the context of severe pneumonia due to COVID-19.

FIG 2

(A) Perfusion lung scan q shows multiple bilateral segmental and right lobar defects. (B) chest radiograph with predominantly left bilateral opacities. (C) Coronal CT angiography with filling defects in the left lobar and right segmental artery. (D) flotation catheter in pulmonary artery with the hemodynamic report of case 1 in Table 2.

FIG 3

(A) perfusion lung scan q shows multiple segmental defects. (B) chest radiograph with left opacity. (C) chest angiotomography axial section with intraluminal defect from the main right pulmonary artery extends to the inferior lobar and middle lobar arteries. Left pulmonary artery, with intraluminal defect at the level of the bifurcation toward the upper, and lower lobar with involvement of the segmental ones. (D) flotation catheter in the pulmonary artery and the hemodynamic report of case 2 in Table 2.

FIG 4

(A) perfusion lung scan q shows multiple bilateral segmental defects. (B) chest radiograph with cardiomegaly and predominantly left bilateral infiltrate. (C) axial CT angiography with filling defects in the right basal segmental artery. (D) flotation catheter in the pulmonary artery, and the hemodynamic report of case 3 in Table 2.