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Dead space shunt lungs9/16/2023 ![]() ![]() Intussusceptive angiogenesis is a highly dynamic morphogenetic process involving circulating angiogenic cells, endothelial progenitor cells or monocytes observed in numerous organs of fatal COVID-19 cases (lung, heart, brain or placenta) as well as in, for example, fibrosing interstitial lung diseases and malignant neoplasms.Ī) Cinematic rendering of a hierarchical phase-contrast tomography (HiP-CT) study from a 78-year-old male patient who succumbed to COVID-19 highlights the spatial heterogeneity of the affected lung parenchyma. ![]() Moreover, this septal micro-ischaemia was accompanied by a periseptal thickening and pronounced dilatation and expansion of the bronchial circulation plexus by opening of intrapulmonary bronchopulmonary shunts and “Sperrarterien” (specialised blockade arteries of the bronchial circulation), and an excessive blood vessel neoformation by intussusceptive angiogenesis, especially in the interlobular septae ( figure 1d–g). We observed a distinct, mosaic-like consolidation of individual secondary pulmonary lobules based on microvascular occlusion and secondary lobular micro-ischaemia, reflecting the increased alveolar dead space described by H arbut et al. In a recent study, we were able to demonstrate the involvement of the secondary pulmonary lobules in the fatal trajectory of COVID-19 using ultra-high resolution synchrotron radiation based hierarchical phase-contrast tomography (HiP-CT) ( figure 1a–c). Although COVID-19 related hypoxaemia is characterised by preserved oxygen saturation, a ventilation–perfusion mismatch and increased alveolar ventilation/perfusion ratio heterogeneity, the underlying morphological evidence of this physiological enigma has not been fully understood. We are grateful for them sharing their valuable functional blood and alveolar gas exchange data, pointing out a significant alveolar dead space of nearly 30% in recovered COVID-19 patients, suggesting a persistent pulmonary vascular pathology. describing the role of intrapulmonary shunting and alveolar dead space in patients with acute COVID-19 pneumonitis. With the greatest interest we read the paper by H arbut et al. ![]()
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