CT imaging of pulmonary embolism in patients with COVID-19 pneumonia: a retrospective analysis
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CT imaging of pulmonary embolism in patients with COVID-19 pneumonia: a retrospective analysis Irene Espallargas 1,2 & Juan José Rodríguez Sevilla 3 & Diego Agustín Rodríguez Chiaradía 4,5,6,7 & Antonio Salar 3,5 & Guillem Casamayor 8 & Judit Villar-Garcia 9,5 & Anna Rodó-Pin 4,5,6,7 & Salvatore Marsico 1 & Santiago Carbullanca 1 & Diego Ramal 1 & Luis Alexander del Carpio 1 & Ángel Gayete 1 & José María Maiques 1 & Flavio Zuccarino 1,10 Received: 24 April 2020 / Revised: 8 September 2020 / Accepted: 15 September 2020 # European Society of Radiology 2020
Abstract Objectives To describe imaging and laboratory findings of confirmed PE diagnosed in COVID-19 patients and to evaluate the characteristics of COVID-19 patients with clinical PE suspicion. Characteristics of patients with COVID-19 and PE suspicion who required admission to the intensive care unit (ICU) were also analysed. Methods A retrospective study from March 18, 2020, until April 11, 2020. Inclusion criteria were patients with suspected PE and positive real-time reverse-transcription polymerase chain reaction (RT-PCR) for SARS-CoV-2. Exclusion criteria were negative or inconclusive RT-PCR and other chest CT indications. CTPA features were evaluated and severity scores, presence, and localisation of PE were reported. D-dimer and IL-6 determinations, ICU admission, and previous antithrombotic treatment were registered. Results Forty-seven PE suspicions with confirmed COVID-19 underwent CTPA. Sixteen patients were diagnosed with PE with a predominant segmental distribution. Statistically significant differences were found in the highest D-dimer determination in patients with PE and ICU admission regarding elevated IL-6 values. Conclusion PE in COVID-19 patients in our series might predominantly affect segmental arteries and the right lung. Results suggest that the higher the D-dimer concentration, the greater the likelihood of PE. Both assumptions should be assessed in future studies with a larger sample size. Key Points • On CT pulmonary angiography, pulmonary embolism in COVID-19 patients seems to be predominantly distributed in segmental arteries of the right lung, an assumption that needs to be approached in future research. • Only the highest intraindividual determination of D-dimer from admission to CT scan seems to differentiate patients with pulmonary embolism from patients with a negative CTPA. However, interindividual variability calls for future studies to establish cut-off values in COVID-19 patients. • Further studies with larger sample sizes are needed to determine whether the presence of PE could increase the risk of intensive care unit (ICU) admission in COVID-19 patients.
* Irene Espallargas [email protected] 1
Department of Radiology, Hospital del Mar, Passeig Maritim 23-25, 08003 Barcelona, Spain
2
Department of Radiology, Hospital Germans Trias i Pujol, Carretera de Canyet S/N, 08916 Badalona, Spain
3
Department of Hematology, Hospital del Mar, Passeig Maritim 23-25, 08003 Barcelona, Spain
4
Pulmonology Department,
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