COVID-19 and pulmonary embolism: Do not forget the association!

A 32-year-old man was admitted to the emergency department with a history of headache, fever, chills, dry cough, and fatigue. Chest computed tomography (CT) revealed predominantly peripheral consolidations involving all pulmonary lobes. These opacities were more exuberant in the peripheral upper segment of the left lower lobe (Figure 1 A, black arrow). Real-time polymerase chain reaction confirmed SARS-CoV-2 infection. An increase in blood D-dimer levels raised the suspicion of pulmonary thromboembolism, which was confirmed by CT pulmonary angiography (Figure 1B and C, white arrows).

FIGURE 1:
(A) Chest computed tomography, pulmonary window, axial, showing small areas of consolidation in the peripheral upper segment of the left lower lobe (black arrow), a typical finding in patients with COVID-19 pneumonia; (B and C) axial chest computed tomography with contrast in the mediastinal window. Large filling defects adherent to the walls of both the left and right main pulmonary arteries before their bifurcation (white arrows), an appearance compatible with pulmonary thromboembolism.

In December 2019, a novel viral pneumonia (subsequently named coronavirus disease [COVID-19] pneumonia) emerged in Wuhan, China^1,2. The main CT findings associated with COVID-19 pneumonia are bilateral, subpleural, ground-glass opacities with ill-defined margins, and a slight predominance in the right lower lobe, which includes predominantly peripheral ground-glass opacities, a crazy-paving pattern, and/or consolidation with air bronchograms of the middle and lower lung regions, usually with bilateral and multilobar involvement^1,2. Abnormal CT pulmonary findings can be detected in asymptomatic patients and lung lesions can appear within 1-3 weeks of the onset of symptoms, peaking at around two weeks after onset^1,2. Patients with diagnosed COVID-19 may also have acute pulmonary embolism³. In COVID-19 patients with raised D-dimer levels on admission or sudden clinical worsening, CT pulmonary angiography should be conducted. Although the etiology of pulmonary embolism associated with COVID-19 is still unclear³, adequate and accurate diagnosis can guide the appropriate treatment.

ACKNOWLEDGMENTS

We offer our deepest thanks to the institutions that provided technical support for the development and implementation of this study.

REFERENCES

• ¹
  Muniz BC, Milito MA, Marchiori E. COVID-19 - Computed tomography findings in two patients in Petrópolis, Rio de Janeiro, Brazil. Rev Soc Bras Med Trop. 2020;53:e20200147. doi: 10.1590/0037-8682-0147-2020.
  » https://doi.org/10.1590/0037-8682-0147-2020
• ²
  Moreira BL, Brotto MPA, Marchiori E. Chest radiography and computed tomography findings from a Brazilian patient with COVID-19 pneumonia. Rev Soc Bras Med Trop . 2020;53:e20200134. doi: 10.1590/0037-8682-0134-2020.
  » https://doi.org/10.1590/0037-8682-0134-2020
• ³
  Rotzinger DC, Beigelman-Aubry C, von Garnier C, Qanadli SD. Pulmonary embolism in patients with COVID-19: time to change the paradigm of computed tomography. Thromb Res. 2020;190:58-9. doi: 10.1016/j.thromres.2020.04.011.
  » https://doi.org/10.1016/j.thromres.2020.04.011

Publication Dates

• Publication in this collection
  08 June 2020
• Date of issue
  2020

History

• Received
  25 May 2020
• Accepted
  29 May 2020