A rare case of co-occurrence of pulmonary embolism and left ventricular thrombus in a patient with COVID-19

Abstract

The global pandemic of severe acute respiratory syndrome coronavirus 2 has caused significant morbidity and mortality, not only causing devastating lung injury but also has an enormous effect on the cardiovascular system. The hypercoagulable state associated with coronavirus 2019 plays a major role in the disease manifestation. Venous thromboembolism including pulmonary embolism remains the most common thrombotic manifestation of the disease as compared to arterial thrombosis. Nonetheless, the co-occurrence of both venous and arterial thrombosis in a coronavirus 2019 patient, to our knowledge, has rarely been reported. Herein, we are presenting a case of co-occurrence of left ventricular thrombosis with pulmonary embolism in the setting of coronavirus 2019 with successful treatment with apixaban.

Keywords: Coronavirus 2019; coagulopathy; left ventricular thrombus; pulmonary embolism; severe acute respiratory syndrome coronavirus 2.

Figure 1.

Chest X-ray showed multifocal opacities bilaterally.

Figure 2.

CT angiogram of the chest showed right upper lobe segmental and subsegmental emboli.

Figure 3.

Echocardiogram revealed a large thrombus of a diameter of 3 cm in the apical region of the left ventricle.

Figure 4.

Echocardiogram 3 months prior to his presentation with no signs of left ventricular thrombus.

Figure 5.

Repeated echocardiogram after 6 weeks post discharge which showed a significant reduction in the size of the left ventricular thrombus from 3 cm to 1 cm.