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Rapidly growing evidence has now shown a high incidence of venous thrombosis in patients with severe acute respiratory syndrome secondary to novel coronavirus 2, a disease now named COVID-19. Accumulating case reports and series have also shown a higher prevalence of arterial thrombosis in these patients as well. Although the pathophysiology remains unknown but likely multifactorial – including endotheliitis from direct viral damage and an underlying hyper-inflammatory state, arterial and venous thrombosis occurrence does not appear to be linked with underlying classic risk factors for venous thromboembolism and may present in healthy patients without significant comorbidities. We present a case of a 22-year-old healthy patient with COVID-19 who developed a pulmonary embolism with a pulmonary infarction, a complication that results from arterial and venous thrombosis of the pulmonary vascular supply resulting in tissue necrosis.

Background: Ventilator-induced Barotrauma is a complication of intubation that is associated with high driving pressures and positive end-expiratory pressure use. We attempt to determine the incidence of barotrauma in intubated patients with SARS-CoV-2 infection. Methods: Retrospective observation case series of patients with SARS-CoV-2 infection who were intubated in the ICU. Data were collected for a total of 3 months from electronic health records on patient's age, sex, BMI, incidence of barotrauma, total length of intubation and outcome. Results: Ninteen out of the 100 included patients developed barotrauma as defined by radiographic evidence of pneumothorax, pneumomediastinum or subcutaneous emphysema. The average BMI of patients with barotrauma was 32.06 kg/m2 with an average age of 56.84 years and 9 patients being classified as obese (BMI ≥30 kg/m2). Fourteen out of 19 patients (73%) with barotrauma were intubated for 10 or more days with a median of 16.52 days. The overall mortality rate was noted to be 92% amongst intubated patients. Conclusion: Rate of barotrauma in COVID-19 intubated patients was noted to be 19% in our study, which is on par with the rate of ventilator-induced barotrauma with the previous SARS virus-associated ARDS, and higher than that of the general population with ARDS. Patients who developed barotrauma were also noted to be intubated for a significantly longer duration (16.52 days) as compared to their non-barotrauma counterparts. These findings suggest a need for more data and randomized studies to establish appropriate ventilator management strategies for patients with lung injury associated with COVID-19. [ABSTRACT FROM AUTHOR]

Naloxone-induced noncardiogenic pulmonary edema is a rare but reported entity that can occur following naloxone use in the reversal of opioid overdose. Proposed mechanisms include an adrenergic crisis secondary to catecholamine surge which causes more volume shift to pulmonary vasculature, subsequently leading to pulmonary edema. It appears to be more common when higher doses of naloxone are used. We present a case of a patient with opioid overdose came with altered mental status developed early features of pulmonary edema following the administration of multiple doses of naloxone. She responded well with the administration of diuretics and oxygen supplementation. Her oxygen requirements improved and didn't require mechanical ventilation. [ABSTRACT FROM AUTHOR]

Patients with injection drug use can have nonthrombotic pulmonary emboli (NTPE) of foreign insoluble particles that are either parts of the equipment used or mixed with the drug as an additive. These foreign particles can become a nidus for infection and inflammation. We present a case of a 31-year-old man with active intravenous drug use who initially presented with signs and symptoms of pleurisy and was found to have NTPE of septic refractile crystalline material as seen on bronchial wash and brush biopsy. We believe our patient likely had embolism of either crack particles, needle fragments or cotton-wool fragments that led to a localized inflammatory reaction and infection. This highlights the importance of obtaining detailed history and diagnostic workup. Once the diagnoses of bacterial endocarditis and thrombophlebitis are ruled out with blood cultures, transthoracic echocardiogram, trans -esophageal echocardiogram and/or CT scan (depending on the suspicion), NTPE should be considered and bronchoscopy with bronchoalveolar lavage with biopsy should be performed. [ABSTRACT FROM AUTHOR]

E-cigarette or vaping has become an increasingly popular alternative to smoking tobacco. In September 2019 multiple cases of confirmed E-cigarette or vaping product use associated lung injury were published. However, there is limited knowledge regarding the pathologic mechanism of this condition. We performed a systematic literature review in PubMed and EMBASE aiming to obtain additional clinical data on confirmed E-cigarette or vaping product use associated lung injury cases with lung biopsy results. With this information we hope to determine whether this condition is related to a histopathological pattern of acute lung injury instead of lipid deposits. Seven articles were reviewed and a total of 27 cases were included. Imaging findings predominantly showed presence of diffuse bilateral ground glass opacities. A majority of patients had complete resolution of the disease. The most common histopathological pattern was organizing pneumonia present in almost half of the patients. Other frequently occurring patterns included diffuse alveolar damage and acute fibrinous pneumonitis; lipoid pneumonia was found in one case. The underlying pathophysiological mechanism in E-cigarette or vaping product use associated lung injury is most likely acute lung injury related to direct inhalant-mediated parenchymal inflammation. • Majority of cases with confirmed EVALI had diffuse bilateral ground glass opacities pattern. • Diffuse ground glass opacities are more associated with typical patterns (organizing pneumonia and diffuse alveolar damage). • Histological patterns are more consistent with acute lung injury than lipids deposition. • Damage to the lung parenchyma appears to be more related to direct inhaled toxin and/or thermal injury. • Variation of the pathologic findings could be secondary to the different types of possible noxious agents. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Clinical manifestations are diverse and can vary from mild respiratory symptoms to severe hypoxic respiratory failure. In severe cases, infection can cause gastrointestinal, renal, cardiac, neurological and haematological complications and result in multi-organ failure. There are very few reports of parapneumonic effusion in patients with COVID-19. We describe two patients with COVID-19 who had loculated empyema and discuss the clinical course and therapeutic options., Learning Points: The clinical manifestations of COVID-19 vary from mild to severe disease and can result in multi-organ failure.Pleural empyema is usually treated with a combination of antibiotics and surgical drainage of the pleural cavity., Competing Interests: Conflict of interests: The authors declare there are no competing interests., (© EFIM 2021.)

COVID-19 has been repeatedly related to a variety of extra-pulmonary manifestations since its emergence. COVID-19-positive patients have been shown to develop neurological deficits, deep venous thrombosis, acute kidney injury, acute hepatic injury, and myocarditis, among other conditions. The mechanism of some of these injuries remains unclear, but one factor that has been revealed is hypercoagulability. A hypercoagulable state, whether secondary to dysfunctional coagulation cascades or microvascular angiopathy, has been reported in the literature in COVID-19 patients. We present a case of a patient diagnosed with COVID-19 presented with venous thromboembolism and then shortly developed innumerable strokes., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Younes et al.)

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the disease it causes, coronavirus disease 2019 (COVID-19), continue to have socioeconomic as well as health implications worldwide. The virus has already led to over 200,000 deaths in the United States alone. This is most likely secondary to quick respiratory deterioration seen in patients inflicted with the virus. In other words, the heightened inflammatory response leads to major organ system damage, which leads to rapid decompensation of the patient's clinical condition. Interestingly enough, some patients present with both the novel virus as well as a superimposed bacterial infection that further complicates the management of the disease. We present a case of a patient with a positive polymerase chain reaction (PCR) test for SARS-CoV-2 as well as a pneumococcal urine antigen; he was treated with both appropriate antibiotics as well as dexamethasone and remdesivir for pneumonia and novel virus, respectively. The patient's hypoxemia continued to worsen with appropriate means of oxygenation and eventually led to cardiac arrest., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Elkattawy et al.)