Recent data support the existence of a distinctive ‘vascular’ phenotype with the involvement of both pulmonary parenchyma and its circulation in COVID-19 pneumonia. Its prompt identification is important for the accurate management of COVID-19 patients. The aim is to analyse the pro and contra of the different modalities to identify the ‘vascular’ phenotype. Chest computed tomography scan and angiogram may quantify both parenchyma and vascular damage, but the presence of thrombosis of pulmonary microcirculation may be missed. Increased d-dimer concentration confirms a thrombotic state, but it cannot localize the thrombus. An elevation of troponin concentration non-specifically reflects cardiac injury. Echocardiogram and electrocardiogram provide specific signs of right ventricular pressure overload. This is particularly relevant for the ‘vascular’ phenotype, which does not necessarily represent the result of thrombo-embolic venous complications, but more frequently, it is the result of pulmonary microcirculation thrombosis in situ and needs immediate therapeutic action.

中文翻译：

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COVID-19肺炎的表型异质性：血管表型的临床和病理生理学相关性

最近的数据支持在 COVID-19 肺炎中存在一种独特的“血管”表型，涉及肺实质及其循环。其及时识别对于准确管理 COVID-19 患者非常重要。目的是分析不同方式的优缺点，以确定“血管”表型。胸部计算机断层扫描和血管造影可以量化实质和血管损伤，但可能会错过肺微循环血栓形成的存在。d-二聚体浓度增加可确认血栓状态，但不能定位血栓。肌钙蛋白浓度的升高非特异性地反映了心脏损伤。超声心动图和心电图提供右心室压力超负荷的具体迹象。这与“血管”表型尤其相关，“血管”表型不一定代表血栓栓塞性静脉并发症的结果，但更常见的是，它是肺微循环原位血栓形成的结果，需要立即采取治疗措施。