Increased pulmonary embolism in patients with COVID-19: a case series and literature review

Abstract

There is some recent evidence that the coronavirus disease 2019 (COVID-19) increases the risk of venous thromboembolism by creating a prothrombotic state. COVID-19 and pulmonary embolism (PE) are both associated with tachypnoea, hypoxemia, dyspnoea, and increased D-dimer. Diagnosis of pulmonary embolism in a patient with COVID-19 compared to an individual without it, using the conventional clinical and biochemical evidence is challenging and somehow impossible. In this study, we reported four male cases affected by COVID-19 and admitted to hospitals in Sanandaj, Iran. The patients were all older adults (ranging between 56 and 95 years of age). Fever, chills, muscle pain, and cough were evident in all the cases. Red blood cell levels were low, and pulmonary embolism was clearly detected on spiral computed tomographic (CT) angiography of the pulmonary circulation of all patients. These cases demonstrated that COVID-19 may lead to pulmonary embolism by causing blood coagulation problems. As COVID-19 continues to cause considerable mortality, more information is emerging which reveals its complicated pathogenicity. In the meantime, venous thromboembolism remains an uncommon finding in patients with COVID-19. It is essential that health care providers perform the necessary diagnostic evaluations and provide appropriate treatment for patients.

Outcomes among heart failure patients hospitalized for acute pulmonary embolism and COVID‐19 infection: Insight from the National Inpatient Sample

“…This significant increase in the in‐hospital mortality among patients with concomitant COVID‐19 infection is likely due to the implicating mechanisms of the SARS‐CoV‐2 virus causing increased risk for developing thrombosis as well as inciting cardiac injury in the setting of massive cytokine release and severe systemic inflammation with subsequent downstream pathophysiological effects. 20 , 21 COVID‐19 infection increases the risk for developing arterial and venous thrombosis due to its procoagulant effect, with acute PE being the most common thrombotic manifestation. 22 Additionally, the mechanisms implicated in COVID‐19 infection causing myocardial injury is through direct damage to the cardiomyocytes, systemic inflammation, and exaggerated cytokine response 23 leading to clinical entities including acute coronary syndrome, myocarditis, and the development or worsening of pre‐existing HF.…”

“…This was concurrent with the findings of our study which showed that concomitant COVID‐19 infection significantly increased the risk for in‐hospital mortality among hospitalized acute PE patients with comorbid HF. This significant increase in the in‐hospital mortality among patients with concomitant COVID‐19 infection is likely due to the implicating mechanisms of the SARS‐CoV‐2 virus causing increased risk for developing thrombosis as well as inciting cardiac injury in the setting of massive cytokine release and severe systemic inflammation with subsequent downstream pathophysiological effects 20,21 . COVID‐19 infection increases the risk for developing arterial and venous thrombosis due to its procoagulant effect, with acute PE being the most common thrombotic manifestation 22 .…”

COVID-19 Associated Pulmonary Thromboembolic Events in Anti-Coagulated Patients: Case Series from a Tertiary Facility in Ghana

“…Diagnosis of PE can pose quite a challenge in COVID-19 patients due to an overlap in respiratory clinical presentations in patients with PE and those with severe COVID-19 [25]. Moreover, researchers have documented a rise in D-dimer levels in patients with severe COVID-19 even in the absence of thromboembolism, with elevated D-dimer levels being a predictor of increased mortality [26,27].…”

Lung Ventilation-Perfusion Scan in COVID-19

“…Case 1. Although COVID-19 infection is associated with the increased risk of pulmonary thromboembolism (PTE), 1,2 COVID-19 pulmonary lesions cause ventilation-perfusion (V/Q) patterns other than PTE. [3][4][5] Here, we have described 6 distinct V/Q patterns in patients with COVID-19 infection.…”