Thrombosis of the vasa vasorum of the large and medium size pulmonary artery and vein leads to pulmonary thromboembolism in COVID-19

The vasa vasorum of the large pulmonary vessels is involved in the pathology of COVID-19. This specialized microvasculature plays a major role in the biology and pathology of the pulmonary vessel walls. We have evidence that thrombosis of the vasa vasorum of the large and medium-sized pulmonary vessels during severe COVID-19 causes ischemia and subsequent death of the pulmonary vasculature endothelium. Subsequent release of thrombi from the vasa interna into the pulmonary circulation and pulmonary embolism generated at the ischemic pulmonary vascular endothelium site, are the central pathophysiological mechanisms in COVID-19 responsible for pulmonary thromboembolism. The thrombosis of the vasa vasorum of the large and medium-sized pulmonary vessels is an internal event leading to pulmonary thromboembolism in COVID-19.

Keywords
COVID-19; Pulmonary Embolism; Vasa Vasorum; Thromboembolism

Authorship

Hubert Daisley

performed the autopsies

photography

manuscript's completion

General Hospital, San Fernando, Trinidad and TobagoGeneral HospitalTrinidad and TobagoSan Fernando, Trinidad and TobagoGeneral Hospital, San Fernando, Trinidad and Tobago

https://orcid.org/0000-0002-7337-8050

Oneka Acco

compiled data

creation of the manuscript

The University of the West Indies, Mona, JamaicaThe University of the West IndiesJamaicaMona, JamaicaThe University of the West Indies, Mona, Jamaica

https://orcid.org/0000-0003-0758-8129

Martina Daisley

compiled data

creation of the manuscript

Princess Alexandra Hospital, The Valley, AnguillaPrincess Alexandra HospitalAnguillaThe Valley, AnguillaPrincess Alexandra Hospital, The Valley, Anguilla

https://orcid.org/0000-0001-9785-3648

Dennecia George

took the photograph

manuscript's completion

Scarborough General Hospital, Signal Hill, Trinidad and TobagoScarborough General HospitalTrinidad and TobagoSignal Hill, Trinidad and TobagoScarborough General Hospital, Signal Hill, Trinidad and Tobago

https://orcid.org/0009-0003-0905-4240

Lilly Paul

data collection

creation of the manuscript

The University of the West Indies, Mona, JamaicaThe University of the West IndiesJamaicaMona, JamaicaThe University of the West Indies, Mona, Jamaica

https://orcid.org/0000-0002-9061-9565

Errol James

creation of the manuscript

Beacon Plastic and Cosmetic Surgery, Woodbrook, Port of Spain, Trinidad and TobagoBeacon Plastic and Cosmetic SurgeryTrinidad and TobagoWoodbrook, Port of Spain, Trinidad and TobagoBeacon Plastic and Cosmetic Surgery, Woodbrook, Port of Spain, Trinidad and Tobago

https://orcid.org/0000-0002-7084-612X

Arlene Rampersad

data collection

photography

General Hospital, San Fernando, Trinidad and TobagoGeneral HospitalTrinidad and TobagoSan Fernando, Trinidad and TobagoGeneral Hospital, San Fernando, Trinidad and Tobago

https://orcid.org/0000-0002-4112-753X

Farhaana Narinesingh

data collection

manuscript creation

General Hospital, San Fernando, Trinidad and TobagoGeneral HospitalTrinidad and TobagoSan Fernando, Trinidad and TobagoGeneral Hospital, San Fernando, Trinidad and Tobago

https://orcid.org/0000-0002-4998-4616

Ornella Humphrey

data collection

General Hospital, San Fernando, Trinidad and TobagoGeneral HospitalTrinidad and TobagoSan Fernando, Trinidad and TobagoGeneral Hospital, San Fernando, Trinidad and Tobago

https://orcid.org/0000-0001-9016-4655

Johann Daisley

completion of the manuscript

https://orcid.org/0000-0003-2344-7991

Melissa Nathan

collection of data

The University of the West Indies, St Augustine, Trinidad and TobagoThe University of the West IndiesTrinidad and TobagoSt Augustine, Trinidad and TobagoThe University of the West Indies, St Augustine, Trinidad and Tobago

https://orcid.org/0000-0002-3452-4334

Conflict of interest: None.

Correspondence Hubert Daisley General Hospital Independence Avenue, San Fernando, Trinidad and Tobago, West Indies Phone: +1 (868) 399-0188 profhdjr@aol.com

SCIMAGO INSTITUTIONS RANKINGS

General Hospital, San Fernando, Trinidad and TobagoGeneral HospitalTrinidad and TobagoSan Fernando, Trinidad and TobagoGeneral Hospital, San Fernando, Trinidad and Tobago

The University of the West Indies, Mona, JamaicaThe University of the West IndiesJamaicaMona, JamaicaThe University of the West Indies, Mona, Jamaica

Princess Alexandra Hospital, The Valley, AnguillaPrincess Alexandra HospitalAnguillaThe Valley, AnguillaPrincess Alexandra Hospital, The Valley, Anguilla

Figures

Figures (3)

Thumbnail

Figure 1
Photomicrograph of the lung. A – thrombosis of the vasa interna (black arrow) of a pulmonary vein in COVID-19 (H&E 10x20); B – thrombosis of the vasa interna (black arrow) of a pulmonary artery with thrombosis of the pulmonary artery, in COVID-19(H&E 10x20); C – thrombosis of the vasa externa (black arrow) and fibrin thrombus within the lumen in COVID-19&E 10x20); D – thrombosis of a medium size pulmonary artery with thrombosis of its vasa interna (black arrow) and new thrombus formation within the lumen (blue arrow) in COVID-19 (H&E 10x20).

Thumbnail

Figure 2
Photomicrograph of the lung. A – multiple vasa interna thrombosis (black arrows) in the wall of a pulmonary artery, and fibrin thrombus in its lumen of the pulmonary artery (green arrow) in COVID-19 (H&E 10x20); B – thrombosis of arterioles (black arrows) and capillaries (blue arrow) of the lungs in COVID-19 (H&E 10x20); C – thrombi in the vasa vasorum interna (black arrows) and fibrin thrombus in the lumen of the pulmonary artery, COVID-19 (H&E 10x20); D – thrombosis of venule (black arrow) in COVID-19 (H&E 10x20).

Thumbnail

Figure 3
Photomicrograph of the lung. A – thrombosis of vasa interna of pulmonary vein in COVID-19 (black arrow)(H&E 10x20); B – thrombosis of the vasa interna (black arrow) of a pulmonary artery in COVID-19 and prostate cancer. There is also pulmonary hemorrhage (H&E 10x40); C – thrombosis of vasa interna (black arrow) of pulmonary artery in COVID-19 with impending embolism (H&E 10x40); D – thrombosis of vasa interna (black arrow) of the pulmonary artery in COVID-19 with impending embolism (H&E 10x40).

Figure 1 Photomicrograph of the lung. A – thrombosis of the vasa interna (black arrow) of a pulmonary vein in COVID-19 (H&E 10x20); B – thrombosis of the vasa interna (black arrow) of a pulmonary artery with thrombosis of the pulmonary artery, in COVID-19(H&E 10x20); C – thrombosis of the vasa externa (black arrow) and fibrin thrombus within the lumen in COVID-19&E 10x20); D – thrombosis of a medium size pulmonary artery with thrombosis of its vasa interna (black arrow) and new thrombus formation within the lumen (blue arrow) in COVID-19 (H&E 10x20).

Figure 2 Photomicrograph of the lung. A – multiple vasa interna thrombosis (black arrows) in the wall of a pulmonary artery, and fibrin thrombus in its lumen of the pulmonary artery (green arrow) in COVID-19 (H&E 10x20); B – thrombosis of arterioles (black arrows) and capillaries (blue arrow) of the lungs in COVID-19 (H&E 10x20); C – thrombi in the vasa vasorum interna (black arrows) and fibrin thrombus in the lumen of the pulmonary artery, COVID-19 (H&E 10x20); D – thrombosis of venule (black arrow) in COVID-19 (H&E 10x20).

Figure 3 Photomicrograph of the lung. A – thrombosis of vasa interna of pulmonary vein in COVID-19 (black arrow)(H&E 10x20); B – thrombosis of the vasa interna (black arrow) of a pulmonary artery in COVID-19 and prostate cancer. There is also pulmonary hemorrhage (H&E 10x40); C – thrombosis of vasa interna (black arrow) of pulmonary artery in COVID-19 with impending embolism (H&E 10x40); D – thrombosis of vasa interna (black arrow) of the pulmonary artery in COVID-19 with impending embolism (H&E 10x40).

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E-mail: autopsy.hu@gmail.com

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Métricas

Thrombosis of the vasa vasorum of the large and medium size pulmonary artery and vein leads to pulmonary thromboembolism in COVID-19

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[1] Conflict of interest: None.