Pulmonary Embolism and Giant Cavitary Lesion Developing After COVID-19 Pneumonia

Abstract

Introduction: The clinical manifestations of the worldwide pandemic, which began in mainland China in December 2019, were very similar to viral pneumonia and defined as Coronavirus disease 2019 (COVID-19). Complications such as acute respiratory distress syndrome (ARDS), acute cardiac tissue damage, secondary infections, isolated coagulopathy and pulmonary embolism have been reported with COVID-19 disease.

Clinical findings: A 79-year-old woman admitted to the emergency room (ER) had complaints of fever and cough. The patient was admitted to the ER with the suspicion of COVID-19. Samples were collected with a nasopharyngeal swab and confirmed as COVID-19. In addition, a chest CT examination was performed. In the first evaluation after admittance, the D-dimer value was measured as 450 μg/L. In the follow-up of the patient, on the 18th day, increased respiratory distress and high D-dimer level (7893 μg/L) were detected in the laboratory findings.

Outcomes: A chest CT scan had ground-glass opacities compatible with COVID-19 pneumonia. A giant cavitary lesion was detected following the development of pulmonary embolism after COVID-19 disease.

Conclusions: In rare cases of COVID-19 cavitation development may occur after pulmonary infarction. In addition, it should be remembered that emphysema, giant bulla and pneumothorax may develop in COVID-19 pneumonia cases undergoing HFNC oxygen therapy. We present a case of a giant cavitary lesion that developed following a COVID-19-related pulmonary embolism.

Keywords: COVID-19; SARS-Cov-2; cavitation, d-dimer; coronavirus infections/complications; lung diseases; pulmonary embolism.

Figure 1

Axial CT angiography scan of the chest shows bilateral filling defects (white arrows) in both pulmonary arteries, representing thrombi.

Figure 2

CT scans of 79-year-old woman who presented with fever and cough. A (Day 1) normal lung parenchyma, B (Day 18) small air cyst with ground-glass opacities and C (Day 25) giant cavitary lesion in the right upper lobe.