Characteristics of Acute Pulmonary Embolism in Patients With COVID-19 Associated Pneumonia From the City of Wuhan

Abstract

The aim of this study was to describe clinical, imaging, and laboratory features of acute pulmonary embolism (APE) in patients with COVID-19 associated pneumonia. Patients with COVID-19 associated pneumonia who underwent a computed tomography pulmonary artery (CTPA) scan for suspected APE were retrospectively studied. Laboratory data and CTPA images were collected. Imaging characteristics were analyzed descriptively. Laboratory data were analyzed and compared between patients with and without APE. A series of 25 COVID-19 patients who underwent CTPA between January 2020 and February 2020 were enrolled. The median D-dimer level founded in these 25 patients was 6.06 μg/mL (interquartile range [IQR] 1.90-14.31 μg/mL). Ten (40%) patients with APE had a significantly higher level of D-dimer (median, 11.07 μg/mL; IQR, 7.12-21.66 vs median, 2.44 μg/mL; IQR, 1.68-8.34, respectively, P = .003), compared with the 15 (60%) patients without APE. No significant differences in other laboratory data were found between patients with and without APE. Among the 10 patients with APE, 6 (60%) had a bilateral pulmonary embolism, while 4 had a unilateral embolism. The thrombus-prone sites were the right lower lobe (70%), the left upper lobe (60%), both upper lobe (40%) and the right middle lobe (20%). The thrombus was partially or completely absorbed after anticoagulant therapy in 3 patients who underwent a follow-up CTPA. Patients with COVID-19 associated pneumonia have a risk of developing APE during the disease. When the D-dimer level abnormally increases in patients with COVID-19 pneumonia, CTPA should be performed to detect and assess the severity of APE.

Keywords: COVID-19; SAR-CoV-2; pulmonary embolism.

Figure 1.

Serum (D-dimer) levels in 25 patients with COVID-19 pneumonia. (A) D-dimer values for patients without acute pulmonary embolism (APE; n = 15) tested over multiple days. (B) D-dimer values for patients with APE (n = 10) tested over multiple days. Color-coded squares correspond to D-dimer values for different dates. Red arrows indicate patients deceased during treatment.

Figure 2.

A 76-year-old women with severe COVID-2019 pneumonia. (A) Thrombus (arrow) occurred in bilateral lower lobe pulmonary artery on axial computed tomography pulmonary artery (CTPA) image. (B) Axial computed tomography (CT) image showed widely increased density of both lungs, showing a “white lung” appearance, indicating the patient was at the peak stage.

Figure 3.

A 57-year-old man with moderate COVID-19 pneumonia. (A, B) The first computed tomography pulmonary artery (CTPA) examination: thrombus (thick arrow) in left upper lobe pulmonary artery and right lower lobe pulmonary artery. (C, D) Follow-up CTPA examination: corresponding acute pulmonary embolism (APE) lesions (thin arrow) at the same location were absorbed after anticoagulant therapy. (E) The first CTPA images at lung window: axial computed tomography (CT) image showed a little fibrous stripe (arrow), indicating the patient was at absorption stage.