Diagnostic Evaluation of Pulmonary Embolism During the COVID-19 Pandemic

Zuckier, Lionel S.; Moadel, Renée M.; Haramati, Linda B.; Freeman, Leonărd M.

doi:10.2967/jnumed.120.245571

Cited by 91 publications

(97 citation statements)

References 4 publications

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“…Since the rapid emergence of the COVID-19 pandemic, diagnostic algorithms for the evaluation of PE which minimize the performance of ventilation studies have been proposed, limiting the potential for aerosolization and exposure of COVID-19 to patients and staff members [ 10 – 13 ]. However, prior societal guidelines have suggested the use of both perfusion and ventilation scans in patients suspected to have PE to reduce the potential risk of false positive results [ 8 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical utility of perfusion (Q)-single-photon emission computed tomography (SPECT)/CT for diagnosing pulmonary embolus (PE) in COVID-19 patients with a moderate to high pre-test probability of PE

Das

Yeh

Schöder

2020

Eur J Nucl Med Mol Imaging

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Purpose We reviewed the clinical utility of perfusion (Q)-single-photon emission computed tomography (SPECT)/CT for diagnosing pulmonary embolus (PE) in patients hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). Methods Following the World Health Organization’s declaration of a global pandemic, our department policy recommended Q-only SPECT/CT for all patients undergoing nuclear medicine evaluation for suspected PE to reduce the risk of aerosolization of respiratory droplets. We performed a retrospective review of sequential patients admitted with COVID-19 imaged with Q-SPECT/CT between March 17, 2020, and June 30, 2020, at Memorial Sloan Kettering Cancer Center. We recorded patient demographics, clinical symptoms, Wells score (to stratify patients according to pre-test probability for PE prior to Q-SPECT/CT), and noted ancillary imaging findings on CT. Results Of the 33 patients imaged with Q-SPECT/CT, 6 patients (3 men, 3 women) had a laboratory confirmed diagnosis of COVID-19 (mean age, 55, ± 11.4 years, range 33–68). All patients had a current diagnosis of malignancy and had a moderate or high pre-test probability for PE (mean Wells score 2.8, range 2–4). Q-SPECT/CT was positive in 4/6 (67%) of patients. Distribution of pulmonary emboli was bilateral and segmental in 75% of patients. Ancillary acute findings on SPECT/CT included bilateral parenchymal ground glass opacities ( n = 5), pleural effusions ( n = 2), and pneumomediastinum ( n = 1). Conclusion Q-SPECT/CT has clinical utility for diagnosing PE in patients with COVID-19 where there is a contraindication for iodinated contrast media and a moderate or high pre-test probability for PE.

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Section: Introductionmentioning

confidence: 99%

Clinical utility of perfusion (Q)-single-photon emission computed tomography (SPECT)/CT for diagnosing pulmonary embolus (PE) in COVID-19 patients with a moderate to high pre-test probability of PE

Das

Yeh

Schöder

2020

Eur J Nucl Med Mol Imaging

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“…COVID-19 is an infectious disease that primarily affects the respiratory system, but it can also cause other complications, such as cardiovascular problems. Although the symptoms of COVID-19 may resemble the symptoms of pulmonary embolism (PE), in some cases, PE may accompany COVID-19 [1]. Lately, cases of acute PE associated with severe COVID-19 infection have been reported.…”

Section: Introductionmentioning

confidence: 99%

Sudden death due to acute pulmonary embolism in a young woman with COVID-19

Polat

ALP

2020

J Thromb Thrombolysis

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Coronavirus disease 2019 (COVID-19) is an infectious disease that primarily affects the respiratory system, but it may cause cardiovascular complications such as thromboembolism. Rarely, pulmonary embolism may be encountered in patients with severe COVID-19 infection, especially in intensive care units. An asymptomatic young case of COVID-19 presenting with sudden death due to acute massive pulmonary embolism has not been previously described. We report a 41-year-old woman presented to emergency department with sudden death during physical activity. She had only history of diabetes mellitus and she was asymptomatic until sudden death. CT pulmonary angiography and chest CT scans revealed acute massive embolism and typical imaging findings of COVID-19 pneumonia, respectively. Interestingly, the patient had no symptoms or signs of infection and also had no risk factors for thromboembolism. COVID-19 infection appears to induce venous thromboembolism, especially pulmonary embolism. The case is remarkable in terms of showing how insidious and life-threatening COVID-19 infection can be.

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“…A potential alternative to ceCT for this indication is perfusion single-photon emission tomography (SPECT) using [ 99m Tc]-labeled macroaggregated albumin (MAA). Due to the high risk of aerosol production associated with ventilation ([ 99m Tc]-labeled aerosols) scans, the Society of Nuclear Medicine of Northern America discouraged the use of classic imaging combination of ventilation-perfusion in patients with COVID-19 in a recent communication by Zuckier et al [7]. Ventilation scans should be omitted in any patient with known or suspected COVID-19 infection; therefore, a chest X-ray based algorithm was proposed, with perfusion only SPECT scans in patients without pulmonary opacities.…”

mentioning

confidence: 99%