Role of CT angiography in detecting acute pulmonary embolism associated with COVID-19 pneumonia

Abstract

Purpose Recently coronavirus disease (COVID-19) caused a global pandemic, characterized by acute respiratory distress syndrome (ARDS). The aim of our study was to detect pulmonary embolism (PE) in patients with severe form of COVID-19 infection using pulmonary CT angiography, and its associations with clinical and laboratory parameters. Methods From March to December 2020, we performed a prospective monocentric study collecting data from 374 consecutive patients with confirmed SARS-CoV-2 infection, using real-time reverse-transcriptase polymerase-chain-reaction (rRT-PCR) assay of nasopharyngeal swab specimens. We subsequently selected patients with at least two of the following inclusion criteria: (1) severe acute respiratory symptoms (such as dyspnea, persistent cough, fever > 37.5 °C, fatigue, etc.); (2) arterial oxygen saturation ≤ 93% at rest; (3) elevated D-dimer (≥ 500 ng/mL) and C-reactive protein levels (≥ 0.50 mg/dL); and (4) presence of comorbidities. A total of 63/374 (17%) patients met the inclusion criteria and underwent CT angiography during intravenous injection of iodinated contrast agent (Iomeprol 400 mgI/mL). Statistical analysis was performed using Wilcoxon rank-sum and Chi-square tests. Results About, 26/60 patients (40%) were found positive for PE at chest CT angiography. In these patients, D-dimer and CRP values were significantly higher, while a reduction in SaO2 < 93% was more common than in patients without PE (P < 0.001). Median time between illness onset and CT scan was significantly longer (15 days; P < 0.001) in patients with PE. These were more likely to be admitted to the Intensive Care Unit (19/26 vs. 11/34 patients; P < 0.001) and required mechanical ventilation more frequently than those without PE (15/26 patients vs. 9/34 patients; P < 0.001). Vascular enlargement was significantly more frequent in patients with PE than in those without (P = 0.041). Conclusions Our results pointed out that patients affected by severe clinical features of COVID-19 associated with comorbidities and significant increase of D-dimer levels developed acute mono- or bi-lateral pulmonary embolism in 40% of cases. Therefore, the use of CT angiography rather than non-contrast CT should be considered in these patients, allowing a better evaluation, that can help the management and improve the outcomes.

Acute Pulmonary Embolism in COVID-19: A Potential Connection between Venous Congestion and Thrombus Distribution

“…Previous reports concluded that PE was more frequent in patients presenting VC [ 34 ]. Nonetheless, our study is the first to look into the detailed configuration of PE regarding AO and VC, providing new insights into possible underlying mechanisms.…”

Imaging Severity COVID-19 Assessment in Vaccinated and Unvaccinated Patients: Comparison of the Different Variants in a High Volume Italian Reference Center

“…Data from these countries have proven the benefit of a booster dose in reducing symptomatic infection and offering a significant decrease in critical outcomes [ 49 , 50 , 51 , 52 , 53 , 54 ]. Moreover, the protection level offered by previous SARS-CoV-2 infection, both in terms of infection and disease severity and, therefore, of outcome, is still unclear [ 55 , 56 , 57 , 58 , 59 , 60 , 61 ]. In this scenario, the main essential element leading to the evolution of SARS-CoV-2 infection is the interaction with the host’s immune system.…”

Acute Pulmonary Embolism: Prognostic Role of Computed Tomography Pulmonary Angiography (CTPA)

“…Moreover, in the study by Masselli et al, 26/60 (40%) patients with SARS-CoV-2 were found to be positive for PE at CTPA. In these patients, the probability of being admitted to the intensive care unit was higher than those who did not have PE (19/26 vs. 11/34 patients) and more frequently required mechanical ventilation (15/26 patients vs. 9/34 patients) [45] (Figure 4). and leukocytes, and later thrombin generation and widespread fibrin deposition, are related to the increased risk of thromboembolic events in SARS-CoV2 infection [43,44].…”