{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T17:53:34Z","timestamp":1789149214678,"version":"build-2803163510"},"reference-count":36,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2021,4,8]],"date-time":"2021-04-08T00:00:00Z","timestamp":1617840000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Globally, at the time of writing (20 March 2021), 121.759.109 confirmed COVID-19 cases have been reported to the WHO, including 2.690.731 deaths. Globally, on 18 March 2021, a total of 364.184.603 vaccine doses have been administered. In Italy, 3.306.711 confirmed COVID-19 cases with 103.855 deaths have been reported to WHO. In Italy, on 9 March 2021, a total of 6.634.450 vaccine doses have been administered. On 15 March 2021, Italian Medicines Agency (AIFA) decided to temporarily suspend the use of the AstraZeneca COVID-19 vaccine throughout the country as a precaution, pending the rulings of the European Medicines Agency (EMA). This decision was taken in line with similar measures adopted by other European countries due to the death of vaccinated people. On 18 March 2021, EMA\u2019s safety committee concluded its preliminary review about thromboembolic events in people vaccinated with COVID-19 Vaccine AstraZeneca at its extraordinary meeting, confirming the benefits of the vaccine continue to outweigh the risk of side effects, however, the vaccine may be associated with very rare cases of blood clots associated with thrombocytopenia, i.e., low levels of blood platelets with or without bleeding, including rare cases of cerebral venous thrombosis (CVT). We report the case of a 54-year-old woman who developed disseminated intravascular coagulation (DIC) with multi-district thrombosis 12 days after the AstraZeneca COVID-19 vaccine administration. A brain computed tomography (CT) scan showed multiple subacute intra-axial hemorrhages in atypical locations, including the right frontal and the temporal lobes. A plain old balloon angioplasty (POBA) of the right coronary artery was performed, without stent implantation, with restoration of distal flow, but with persistence of extensive thrombosis of the vessel. A successive thorax angio-CT added the findings of multiple contrast filling defects with multi-vessel involvement: at the level of the left upper lobe segmental branches, of left interlobar artery, of the right middle lobe segmental branches and of the right interlobar artery. A brain magnetic resonance imaging (MRI) in the same day showed the presence of an acute basilar thrombosis associated with the superior sagittal sinus thrombosis. An abdomen angio-CT showed filling defects at the level of left portal branch and at the level of right suprahepatic vein. Bilaterally, it was adrenal hemorrhage and blood in the pelvis. An evaluation of coagulation factors did not show genetic alterations so as the nasopharyngeal swab ruled out a COVID-19 infection. The patient died after 5 days of hospitalization in intensive care.<\/jats:p>","DOI":"10.3390\/jpm11040285","type":"journal-article","created":{"date-parts":[[2021,4,8]],"date-time":"2021-04-08T11:58:45Z","timestamp":1617883125000},"page":"285","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":76,"title":["A Rare Case of Cerebral Venous Thrombosis and Disseminated Intravascular Coagulation Temporally Associated to the COVID-19 Vaccine Administration"],"prefix":"10.3390","volume":"11","author":[{"given":"Vincenzo","family":"D\u2019Agostino","sequence":"first","affiliation":[{"name":"Neuroradiology Unit, PO Ospedale del Mare, ASL NA1, via Enrico Russo, 80147 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ferdinando","family":"Caranci","sequence":"additional","affiliation":[{"name":"Department of Medicine of Precision, School of Medicine, \u201cLuigi Vanvitelli\u201d University of Campania, 80147 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7904-1563","authenticated-orcid":false,"given":"Alberto","family":"Negro","sequence":"additional","affiliation":[{"name":"Neuroradiology Unit, PO Ospedale del Mare, ASL NA1, via Enrico Russo, 80147 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria","family":"Piscitelli","sequence":"additional","affiliation":[{"name":"Neuroradiology Unit, PO Ospedale del Mare, ASL NA1, via Enrico Russo, 80147 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernardino","family":"Tuccillo","sequence":"additional","affiliation":[{"name":"Cardiology Unit, PO Ospedale del Mare, ASL NA1, via Enrico Russo, 80147 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrizio","family":"Fasano","sequence":"additional","affiliation":[{"name":"Neuroradiology Unit, PO Ospedale del Mare, ASL NA1, via Enrico Russo, 80147 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Sirabella","sequence":"additional","affiliation":[{"name":"Neuroradiology Unit, PO Ospedale del Mare, ASL NA1, via Enrico Russo, 80147 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ines","family":"Marano","sequence":"additional","affiliation":[{"name":"Radiology Unit, PO Ospedale del Mare, ASL NA1, via Enrico Russo, 80147 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenza","family":"Granata","sequence":"additional","affiliation":[{"name":"Division of Radiology, \u201cIstituto Nazionale Tumori IRCCS Fondazione Pascale\u2014IRCCS di Napoli\u201d, I-80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Grassi","sequence":"additional","affiliation":[{"name":"Department of Medicine of Precision, School of Medicine, \u201cLuigi Vanvitelli\u201d University of Campania, 80147 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Pupo","sequence":"additional","affiliation":[{"name":"Department of Medicine of Precision, School of Medicine, \u201cLuigi Vanvitelli\u201d University of Campania, 80147 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0566-3199","authenticated-orcid":false,"given":"Roberto","family":"Grassi","sequence":"additional","affiliation":[{"name":"Department of Medicine of Precision, School of Medicine, \u201cLuigi Vanvitelli\u201d University of Campania, 80147 Naples, Italy"},{"name":"Cardiology Unit, PO Ospedale del Mare, ASL NA1, via Enrico Russo, 80147 Naples, Italy"},{"name":"Radiology Unit, PO Ospedale del Mare, ASL NA1, via Enrico Russo, 80147 Naples, Italy"},{"name":"Division of Radiology, \u201cIstituto Nazionale Tumori IRCCS Fondazione Pascale\u2014IRCCS di Napoli\u201d, I-80131 Naples, Italy"},{"name":"Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,4,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Granata, V., Fusco, R., Izzo, F., Setola, V., Coppola, M., Grassi, R., Reginelli, A., Cappabianca, S., Grassi, R., and Petrillo, A. (2021). Covid-19 infection in cancer patients: The management in a diagnostic unit. Radiol. Oncol.","DOI":"10.2478\/raon-2021-0010"},{"key":"ref_2","unstructured":"World Health Organization (WHO) (2021, March 10). Available online: https:\/\/www.who.int\/emergencies\/diseases\/novel-coronavirus-2019\/events-as-they-happen."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Chaudhary, S., Benzaquen, S., Woo, J.G., Rubinstein, J., Matta, A., Albano, J., De Joy, R., Lo, K.B., and Patarroyo-Aponte, G. (2021). Clinical Characteristics, Respiratory Mechanics and Outcomes in Critically Ill Subjects with COVID-19 Infection in an Underserved Urban Population. Respir. Care.","DOI":"10.4187\/respcare.08319"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"9","DOI":"10.2147\/TCRM.S280079","article-title":"Clinical Features for Severely and Critically Ill Patients with COVID-19 in Shandong: A Retrospective Cohort Study","volume":"17","author":"Zhou","year":"2021","journal-title":"Ther. Clin. Risk Manag."},{"key":"ref_5","first-page":"572","article-title":"Plasmapheresis with corticosteroids and antiviral: A life-saving treatment for severe cases of Covid 19","volume":"11","author":"Bagherzade","year":"2020","journal-title":"Casp. J. Intern. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1056\/NEJMoa2035389","article-title":"COVE Study Group. Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine","volume":"384","author":"Baden","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2603","DOI":"10.1056\/NEJMoa2034577","article-title":"C4591001 Clinical Trial Group. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine","volume":"383","author":"Polack","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/S0140-6736(20)32661-1","article-title":"Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: An interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK","volume":"397","author":"Voysey","year":"2021","journal-title":"Lancet"},{"key":"ref_9","unstructured":"(2021, March 10). Covid-19-Situazione in Italia, Available online: http:\/\/www.salute.gov.it\/portale\/nuovocoronavirus\/dettaglioContenutiNuovoCoronavirus.jsp?area=nuovoCoronavirus&id=5351&lingua=italiano&menu=vuoto."},{"key":"ref_10","unstructured":"(2021, March 10). Available online: https:\/\/www.aifa.gov.it\/."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Granata, V., Fusco, R., Setola, S.V., Galdiero, R., Picone, C., Izzo, F., D\u2019Aniello, R., Miele, V., Grassi, R., and Grassi, R. (2021). Lymphadenopathy after BNT162b2 Covid-19 Vaccine: Preliminary Ultrasound Findings. Biology, 10.","DOI":"10.3390\/biology10030214"},{"key":"ref_12","unstructured":"(2021, March 10). COVID-19 Vaccine AstraZeneca: Benefits Still Outweigh the Risks Despite Possible Link to Rare Blood Clots with Low Blood Platelets. Available online: https:\/\/www.ema.europa.eu\/en\/news\/covid-19-vaccine-astrazeneca-benefits-still-outweigh-risks-despite-possible-link-rare-blood-clots."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1001\/jamainternmed.2020.0994","article-title":"Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China","volume":"180","author":"Wu","year":"2020","journal-title":"JAMA Intern. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1055\/s-0040-1715456","article-title":"COVID-19 and Venous Thromboembolism: A Meta-analysis of Literature Studies","volume":"46","author":"Ambrosino","year":"2020","journal-title":"Semin. Thromb. Hemost."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"E186","DOI":"10.1148\/radiol.2020201544","article-title":"Acute Pulmonary Embolism Associated with COVID-19 Pneumonia Detected with Pulmonary CT Angiography","volume":"296","author":"Grillet","year":"2020","journal-title":"Radiology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1007\/s11547-020-01195-x","article-title":"Artificial intelligence to codify lung CT in Covid-19 patients","volume":"125","author":"Belfiore","year":"2020","journal-title":"Radiol. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1007\/s11547-020-01202-1","article-title":"Radiographic severity index in COVID-19 pneumonia: Relationship to age and sex in 783 Italian patients","volume":"125","author":"Borghesi","year":"2020","journal-title":"Radiol. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1007\/s11547-020-01200-3","article-title":"COVID-19 outbreak in Italy: Experimental chest X-ray scoring system for quantifying and monitoring disease progression","volume":"125","author":"Borghesi","year":"2020","journal-title":"Radiol. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1007\/s11547-020-01203-0","article-title":"It\u2019s not over until it\u2019s over: The chameleonic behavior of COVID-19 over a six-day period","volume":"125","author":"Fichera","year":"2020","journal-title":"Radiol. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1007\/s11547-020-01197-9","article-title":"Use of CT and artificial intelligence in suspected or COVID-19 positive patients: Statement of the Italian Society of Medical and Interventional Radiology","volume":"125","author":"Neri","year":"2020","journal-title":"Radiol. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1007\/s11547-020-01179-x","article-title":"Proposal of a low-dose, long-pitch, dual-source chest CT protocol on third-generation dual-source CT using a tin filter for spectral shaping at 100 kVp for CoronaVirus Disease 2019 (COVID-19) patients: A feasibility study","volume":"125","author":"Agostini","year":"2020","journal-title":"Radiol. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1007\/s11547-020-01178-y","article-title":"Facing the COVID-19 emergency: We can and we do","volume":"125","author":"Giovagnoni","year":"2020","journal-title":"Radiol. Med."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Grassi, R., Fusc, R., Belfiore, M.P., Montanelli, A., Patelli, G., Urraro, F., Petrillo, A., Granata, V., Sacco, P., and Mazzei, M.A. (2020). Cappabianca S. Coronavirus disease 2019 (COVID-19) in Italy: Features on chest computed tomography using a structured report system. Sci Rep., 10, Erratum in Sci. Rep. 2021, 11, 4231.","DOI":"10.1038\/s41598-020-73788-5"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1007\/s11547-020-01236-5","article-title":"The lung ultrasound: Facts or artifacts? In the era of COVID-19 outbreak","volume":"125","author":"Notaro","year":"2020","journal-title":"Radiol. Med."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Reginelli, A., Grassi, R., Feragalli, B., Belfiore, M., Montanelli, A., Patelli, G., La Porta, M., Urraro, F., Fusco, R., and Granata, V. (2021). Coronavirus Disease 2019 (COVID-19) in Italy: Double Reading of Chest CT Examination. Biology, 10.","DOI":"10.3390\/biology10020089"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Grassi, R., Belfiore, M.P., Montanelli, A., Patelli, G., Urraro, F., Giacobbe, G., Fusco, R., Granata, V., Petrillo, A., and Sacco, P. (2020). COVID-19 pneumonia: Computer-aided quantification of healthy lung parenchyma, emphysema, ground glass and consolidation on chest computed tomography (CT). Radiol. Med.","DOI":"10.1007\/s11547-020-01305-9"},{"key":"ref_27","first-page":"1","article-title":"Use of the COVID-19 Reporting and Data System (CO-RADS) classification and chest computed tomography involvement score (CT-IS) in COVID-19 pneumonia","volume":"12","author":"Aslan","year":"2021","journal-title":"Radiol. Med."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Ierardi, A.M., Gaibazzi, N., Tuttolomondo, D., Fusco, S., La Mura, V., Peyvandi, F., Aliberti, S., Blasi, F., Cozzi, D., and Carrafiello, G. (2021). Deep vein thrombosis in COVID-19 patients in general wards: Prevalence and association with clinical and laboratory variables. Radiol. Med., 1\u20137.","DOI":"10.1007\/s11547-020-01312-w"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Ippolito, D., Giandola, T., Maino, C., Pecorelli, A., Capodaglio, C., Ragusi, M., Porta, M., Gandola, D., Masetto, A., and Drago, S. (2021). Acute pulmonary embolism in hospitalized patients with SARS-CoV-2-related pneumonia: Multicentric experience from Italian endemic area. Radiol. Med., 1\u201310.","DOI":"10.1007\/s11547-020-01328-2"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Moroni, C., Cozzi, D., Albanesi, M., Cavigli, E., Bindi, A., Luvar\u00e0, S., Busoni, S., Mazzoni, L.N., Grifoni, S., and Nazerian, P. (2021). Chest X-ray in the emergency department during COVID-19 pandemic descending phase in Italy: Correlation with patients\u2019 outcome. Radiol. Med., 1\u20138.","DOI":"10.1007\/s11547-020-01327-3"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Cereser, L., Girometti, R., Da Re, J., Marchesini, F., Como, G., and Zuiani, C. (2021). Inter-reader agreement of high-resolution computed tomography findings in patients with COVID-19 pneumonia: A multi-reader study. Radiol. Med., 1\u20138.","DOI":"10.1007\/s11547-020-01320-w"},{"key":"ref_32","unstructured":"(2021, March 10). Disseminated IntravascularCoagulation (DIC). Available online: https:\/\/www.esicm.org\/wp-content\/uploads\/2020\/04\/Disseminated-Intravascular-Coagulation-_.pdf."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1056\/NEJM199908193410807","article-title":"Disseminated intravascular coagulation","volume":"341","author":"Levi","year":"1999","journal-title":"N. Engl. J. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1111\/ijlh.12830","article-title":"Pathogenesis and diagnosis of disseminated intravascular coagulation","volume":"40","author":"Levi","year":"2018","journal-title":"Int. J. Lab. Hematol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s12032-020-01359-9","article-title":"Delta-radiomics increases multicentre reproducibility: A phantom study","volume":"37","author":"Nardone","year":"2020","journal-title":"Med. Oncol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2019\/7683648","article-title":"Looking for Lepidic Component inside Invasive Adenocarcinomas Appearing as CT Solid Solitary Pulmonary Nodules (SPNs): CT Morpho-Densitometric Features and 18-FDG PET Findings","volume":"2019","author":"Reginelli","year":"2019","journal-title":"BioMed Res. Int."}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/11\/4\/285\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T13:34:26Z","timestamp":1760362466000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/11\/4\/285"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,8]]},"references-count":36,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,4]]}},"alternative-id":["jpm11040285"],"URL":"https:\/\/doi.org\/10.3390\/jpm11040285","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,8]]}}}