PMC8430448_01
The progression of ALI and COVID-19-associated pneumonia.. A) The clinical presentation of the lower extremities at day 0 of hospitalization. B) The worsening of ALI at day 8. C) The progress of COVID-19-associated pneumonia before referral, at day 1 and day 4 of hospitalization. Left: bilateral infiltrates were observed; middle: bilateral pneumonia was slightly increased; right: an improvement was visible.
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Meanwhile, her right leg was warm, had no necrosis, and exhibited normal sensory and motoric functions ( Figure 1A). A/C< 30, P/C<0,15, while her arterial blood gas analysis (BGA) showed pH 7.42, pCO2 38, pO2 146, HCO3 23.4 and SpO 2 99%. Additionally, her chest X-ray showed bilateral pulmonary infiltrates ( Figure 1C). Additionally, an improvement of the bilateral pulmonary infiltrates on chest X-ray was also observed ( Figure 1C). ALI ( Figure 1B), and was advised to perform computed tomography angiography (CTA) and undergo an above-knee amputation. At day 9, the right lower extremity CTA ( Figure 2) discovered total occlusion due to 6 cm thrombus on right popliteal artery (from 1 cm above right femorotibial joint toward inferior).
The computed tomography angiography (CTA) of the lower extremity.. The CTA revealed an abdominal aortosclerosis with abnormalities on both limbs. Right limb: total occlusion due to 6 cm thrombus on right popliteal artery (from 1 cm above right femorotibial joint toward inferior), right anterior tibial artery received contrast flow from collateral arteries and no contrast flow was seen in right posterior tibial, peroneal and dorsalis pedis arteries. Left limb: total occlusion due to 12.7 cm thrombus on left popliteal artery (from 6 cm above left femorotibial joint toward inferior). No contrast flow was seen in left anterior tibial, posterior tibial, peroneal and dorsalis pedis arteries. (This figure has been edited in Microsoft PowerPoint 2016 to obscure patient's data.)
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ALI ( Figure 1B), and was advised to perform computed tomography angiography (CTA) and undergo an above-knee amputation. At day 9, the right lower extremity CTA ( Figure 2) discovered total occlusion due to 6 cm thrombus on right popliteal artery (from 1 cm above right femorotibial joint toward inferior).
The appearance of left lower limb post amputation.. Two days post-surgery, the patient was safely discharged and followed up regularly for recurring symptoms at the outpatient clinic.
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At day 14, the surgeries (both amputation and thrombectomy) were performed ( Figure 3) and 10 cm thrombus was retrieved in the right femoral artery.