Acute pulmonary embolism in non-hospitalized COVID-19 patients referred to CTPA by emergency department
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Acute pulmonary embolism in non-hospitalized COVID-19 patients referred to CTPA by emergency department Alban Gervaise 1,2
&
Caroline Bouzad 1 & Evelyne Peroux 1 & Carole Helissey 2
Received: 22 April 2020 / Revised: 14 May 2020 / Accepted: 20 May 2020 # European Society of Radiology 2020
Abstract Objectives To evaluate the prevalence of acute pulmonary embolism (APE) in non-hospitalized COVID-19 patients referred to CT pulmonary angiography (CTPA) by the emergency department. Methods From March 14 to April 6, 2020, 72 non-hospitalized patients referred by the emergency department to CTPA for COVID-19 pneumonia were retrospectively identified. Relevant clinical and laboratory data and CT scan findings were collected for each patient. CTPA scans were reviewed by two radiologists to determinate the presence or absence of APE. Clinical classification, lung involvement of COVID-19 pneumonia, and CT total severity score were compared between APE group and non-APE group. Results APE was identified in 13 (18%) CTPA scans. The mean age and D-dimer of patients from the APE group were higher in comparison with those from the non-APE group (74.4 vs. 59.6 years, p = 0.008, and 7.29 vs. 3.29 μg/ml, p = 0.011). There was no significant difference between APE and non-APE groups concerning clinical type, COVID-19 pneumonia lung lesions (ground-glass opacity: 85% vs. 97%; consolidation: 69% vs. 68%; crazy paving: 38% vs. 37%; linear reticulation: 69% vs. 78%), CT severity score (6.3 vs. 7.1, p = 0.365), quality of CTPA (1.8 vs. 2.0, p = 0.518), and pleural effusion (38% vs. 19%, p = 0.146). Conclusions Non-hospitalized patients with COVID-19 pneumonia referred to CT scan by the emergency departments are at risk of APE. The presence of APE was not limited to severe or critical clinical type of COVID-19 pneumonia. Key Points • Acute pulmonary embolism was found in 18% of non-hospitalized COVID-19 patients referred by the emergency department to CTPA. Two (15%) patients had main, four (30%) lobar, and seven (55%) segmental acute pulmonary embolism. • Five of 13 (38%) patients with acute pulmonary embolism had a moderate clinical type. • Severity and radiological features of COVID-19 pneumonia showed no significant difference between patients with or without acute pulmonary embolism. Keywords Pulmonary embolism . CT angiography . Coronavirus . Pneumonia
Abbreviations APE Acute pulmonary embolism COVID-19 Coronavirus disease 19 CTPA Computed tomography pulmonary angiography
GGO RT-PCR
Ground-glass opacity Reverse transcription polymerase chain reaction
Introduction * Alban Gervaise [email protected] 1
Department of Radiology, Military Hospital Begin, 69 Avenue de Paris, 94163 Saint Mande Cedex, France
2
Clinical Research Unit, Military Hospital Begin, Saint Mandé, France
Non-contrast chest CT has been shown to play an important role in the evaluation of COVID-19 pneumonia [1, 2]. Because of its excellent sensitivity in comparison with the RT-PCR test [3–5] and its high specificity in an epidemic context [6], c
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