In Situ Pulmonary Arterial Thrombosis: Literature Review and Clinical Significance of a Distinct Entity

被引:11
作者
Baranga, Latika [1 ]
Khanuja, Simrandeep [2 ]
Scott, Jinel A. [1 ]
Provancha, Ian [1 ]
Gosselin, Marc [3 ]
Walsh, James [1 ]
Arancibia, Rosa [2 ]
Bruno, Michael A. [4 ]
Waite, Stephen [1 ]
机构
[1] SUNY Downstate Hlth Sci Univ, Dept Radiol, 450 Clarkson Ave, Brooklyn, NY 11203 USA
[2] SUNY Downstate Hlth Sci Univ, Div Pulm & Crit Care Med, Dept Med, Brooklyn, NY USA
[3] Vis Radiol, Dallas, TX USA
[4] Penn State Milton S Hershey Med Ctr, Sect Emergency Radiol, Dept Radiol & Med, Hershey, PA USA
关键词
COVID-19; infections; in situ thrombosis; pulmonary embolism; trauma; RESPIRATORY-DISTRESS-SYNDROME; DIFFUSE ALVEOLAR DAMAGE; DEEP VENOUS THROMBOSIS; COMMON FEMORAL VEIN; RISK-FACTORS; TRAUMA PATIENTS; EMBOLISM; HYPERTENSION; CT; THROMBOEMBOLISM;
D O I
10.2214/AJR.23.28996
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
Filling defects identified in the pulmonary arterial tree are commonly presumed to represent an embolic phenomenon originating from thrombi formed in remote veins, particularly lower-extremity deep venous thrombosis (DVT). However, accumulating evidence supports an underappreciated cause for pulmonary arterial thrombosis (PAT), namely, de novo thrombogenesis-whereby thrombosis arises within the pulmonary arteries in the absence of DVT. Although historically underrecognized, in situ PAT has become of heightened importance with the emergence of SARS-CoV-2 infection. In situ PAT is attributed to endothelial dysfunction, systemic inflammation, and acute lung injury and has been described in a range of conditions including COVID-19, trauma, acute chest syndrome in sickle cell disease, pulmonary infections, and severe pulmonary arterial hypertension. The distinction between pulmonary embolism and in situ PAT may have important implications regarding management decisions and clinical outcomes. In this review, we summarize the pathophysiology, imaging appearances, and management of in situ PAT in various clinical situations. This understanding will promote optimal tailored treatment strategies for this increasingly recognized entity.
引用
收藏
页码:57 / 68
页数:12
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