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Case report
Case of right ventricular and aortic thrombi in a patient with severe COVID-19
  1. Henrietta Afari1,
  2. Leben Tefera2 and
  3. Rachel P Rosovsky3
  1. 1Hospital Medicine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
  2. 2Harrington Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
  3. 3Department of Hematology, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Henrietta Afari; hafari{at}partners.org

Abstract

Emerging evidence suggests that novel COVID-19 is associated with increased prothrombotic state and risk of thromboembolic complications, particularly in severe disease. COVID-19 is known to predispose to both venous and arterial thrombotic disease. We describe a case of a 61-year-old woman with history of type II diabetes, hypertension and hyperlipidaemia who presented with dry cough and acute abdominal pain. She was found to have a significantly elevated D-dimer, prompting imaging that showed thrombi in her right ventricle and aorta. She had rapid clinical deterioration and eventually required tissue plasminogen activator with subsequent durable clinical improvement. This case highlights a rare co-occurrence of venous and arterial thrombi in a patient with severe COVID-19. Further studies are needed to clarify the molecular mechanism of COVID-19 coagulopathy, the utility of D-dimer to predict and stratify risk of thrombosis in COVID-19, and the use of fibrinolytic therapy in patients with COVID-19.

  • COVID-19
  • haematology (incl blood transfusion)
  • venous thromboembolism

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/bcr-2020-240745

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    Footnotes

    • Contributors All authors were involved in clinical care of patient who is the subject of this case report. HA performed preliminary data collection and writing. LT and RPR provided critical editing and additional input for the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.