COVID-19 and acute pulmonary embolism: what should be considered to indicate a computed tomography pulmonary angiography scan?

Abstract

The full spectrum of COVID-19 is still emerging, although several studies have highlighted that patients infected with the novel coronavirus can potentially develop a hypercoagulable state. However, several aspects related to the incidence and pathophysiology of the association between COVID-19 and pulmonary embolism are not well established. Here, we present a case of a patient with COVID-19 who developed acute pulmonary embolism. Clinical and laboratory data and findings of non-enhanced CT indicate possibility of acute pulmonary embolism, and support the decision to proceed with computed tomography pulmonary angiography that can objectively identify filling defects in pulmonary arterial branches.

Late acute pulmonary embolism after mild Coronavirus Disease 2019 (COVID-19): a case series

“…Firstly, several studies reported the occurrence of thromboembolic phenomenon in inpatient settings, especially in ICU patients with severe or critical COVID-19 12,13,[24][25][26][27] . Secondly, in a PubMed search for papers concerning thromboembolic events after mild COVID-19 cases, we retrieved only ten articles [14][15][16][17][18][19][20][21][22][23] .…”

“…Moreira et al 23 described a case of a 52-year-old asthmatic man with a 5-day history of fever, myalgia, headache, abdominal pain, cough and dyspnea. There was no need for oxygen supplementation.…”

“…Most of the studies reported thromboembolic events in patients with COVID-19 admitted to the hospital. A PubMed search for articles published up to July 31, 2020 using the following search strategy -("Thrombosis" OR "Embolism" OR "Thromboemb*") AND "COVID-19"found ten articles reporting cases of VTE in patients after mild COVID-19 [14][15][16][17][18][19][20][21][22][23] . Here we describe a case series of five patients with mild COVID-19 that, after an apparent clinical improvement, developed acute pulmonary embolism more than fourteen days after the onset of symptoms.…”

Pulmonary embolism complicating the course of COVID-19 – an underestimated condition?

“…The inflammatory injury of the blood vessel's endothelium by viral direct and cytokine-mediated damage plays a crucial pathogenetic role [10]. Almost all available papers report this coagulopathy in patients with the severe form of SARS-CoV-2 pneumonia and coexisting risk factors for PE [5,[11][12][13]. Recently published results from a prospective French study conducted among 150 critically ill patients in four intensive care units confirmed the high incidence of PE (16.7%) in patients with acute respiratory distress syndrome (ARDS) secondary to COVID-19 despite anticoagulation [5].…”

The reversed halo sign: Considerations in the context of the COVID-19 pandemic

“…These pathological findings have been matched in imaging studies. Chest CT angiography has revealed the presence of pulmonary thrombi, including the formation of pulmonary infarctions [ 10 ]. Pulmonary CT angiography demonstrated acute pulmonary emboli in 32 of 106 (30%; 95% confidence interval, 22–40%) patients with COVID-19 infection [ 11 ].…”