Clinical and Imaging Findings in COVID-19 Patients Complicated by Pulmonary Embolism

Abstract

All the authors have no conflicts of interest to disclose. AcknowledgementWe thank Sudhakar, Pipavath in University of Washington for his valuable contribution in editing the manuscript. AbstractObjective: To describe clinical, and imaging findings including the evolution pattern in COVID-19 pneumonia complicated by pulmonary embolism (PE). Methods:Eleven of 1453 patients with a probable diagnosis of COVID-19 pneumonia were retrospectively selected for the presence of PE. Clinical and laboratory data were recorded. All cross-sectional CT imaging was qualitatively scored for the first 28 days after onset of symptoms. Results:Of 24 patients underwent CTA-PE, 11 were confirmed with PE. All 11 patients developed acute respiratory distress syndrome (ARDS). The pulmonary emboli were most common in segmental and subsegmental pulmonary arteries. We observed an evolution pattern of predominant findings with ground-glass opacities (GGO) to GGO with crazy paving in 3 patients, then to consolidation with linear densities, or to reticulation in 9 patients. Lung cysts or traction bronchiectasis could be seen from day 5 to 9 after symptoms and reticulation, subpleural curvilinear lines were more common from day 20. The pulmonary opacities were predominantly peripheral in distribution with relative sparing of nondependent lungs. The severity of . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) : medRxiv preprint lung involvement was high with an average score of 9.7 in the first phase, 18 in the second phase plateauing in the next two phases, with a slight decrease to 16.9 in the late phase. Conclusion:The incidence of PE among suspected patients in COVID-19 was high. The pulmonary emboli were most common in segmental and subsegmental pulmonary arteries. Our study suggests PE may occur with increased frequency in the ARDS subgroup. The evolution of radiographic abnormalities showed a general pattern, but are also unique with more extensive lung injury and specific imaging features, which may due to the exist of ARDS in these patients.

The Incidence of Acute Pulmonary Embolism with COVID-19 Pneumonia in Saudi Arabia: A retrospective single-center study

“…PE, in our study, was most frequently observed in the subsegmental and segmental pulmonary arteries, or both (75%), whereas the remaining cases were distributed between multisegmented, lobar, and massive PE. This finding agrees with previous studies that reported that PE in COVID-19 is more typically identified in the peripheral parts of the lungs [ 34 – 39 ], which is compatible with the observation of microthrombi formation [ 38 , 39 ]. These sites also tend to conform to the most typical COVID-19 opacity distribution [ 38 ]; however, other studies have also reported massive PE among COVID-19 patients [ 27 , 40 ].…”

Radiological manifestations of COVID-19: key points for the physician

“…It is these same inflammatory cytokines that initiate the formation of a pro-coagulopathic state (Levi et al, 2020). This cascading effect may explain why Li et al (2020a) found an increase in pulmonary embolism rates in those who are critically ill with COVID-19 disease. There is also evidence of perfusion defects as a result of pulmonary microthrombi (Fogarty et al, 2020), described as a 'pulmonary vasculopathy'.…”