Research on COVID-19, the cause of a rapidly worsening pandemic, has led to the observation of laboratory derangements such as a propensity towards a hypercoagulable state. However, there are currently no reports on the incidence of pulmonary venous thrombosis in the setting of COVID-19. We report a case in which follow-up chest CT scans revealed an expansile filling defect in a branch of the right inferior pulmonary vein, which is consistent with pulmonary venous thrombosis. Our objective was to provide insight into an uncommon sequela of COVID-19 and consequently garner increased clinical suspicion for pulmonary VTE during hospitalization.

A 45-year-old woman presented to the emergency department on the morning after Thanksgiving with sudden, severe, constant epigastric pain that migrated to the right upper quadrant as well as subjective fever and emesis since the previous evening. She reported a failure to pass stool or flatus since the onset of symptoms. She denied hematochezia, melena, or hematemesis. Her medical history was significant for heavy smoking, reflux, and surgical procedures including a right inguinal hernia repair, total abdominal hysterectomy, and bilateral salpingooopherectomy, all more than 5 years prior. On examination, she had a distended and tympanic abdomen with tenderness, guarding, and rebound in the epigastrium and right upper quadrant. Vital signs and standard laboratory test results were unremarkable.An upright abdominal plain radiograph showed a distended, thickened stomach and multiple dilated loops of small bowel with air-fluid levels. Contrast-enhanced computed tomography demonstrated a focal area of mixed fat density involving the distal small bowel concerning for a lead point with adjacent mesenteric fat stranding (Figure 1). The scan also revealed multiple bilateral lung nodules.The patient was subsequently taken to the operating room for exploratory laparotomy and found to have an obstruction in the distal ileum. VideoCoronal view A Transverse view B Figure 1. Computed tomography of abdomen. A, Coronal view demonstrating obstructing intraluminal lesion (arrowhead). B, Transverse view demonstrating obstructing intraluminal lesion (arrowhead). WHAT IS YOUR DIAGNOSIS? A. Metastatic lung cancer B. Small-bowel intussusception secondary to pelvic adhesions C. Phytobezoar D. Endometriosis Clinical Review & Education