Pulmonary embolism in coronavirus disease-19 (COVID-19): rational and stepwise use of clinical data and imaging in its d
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Pulmonary embolism in coronavirus disease‑19 (COVID‑19): rational and stepwise use of clinical data and imaging in its diagnosis Arshed Hussain Parry1 · Abdul Haseeb Wani2 · Mudasira Yaseen3 Received: 4 June 2020 / Accepted: 17 July 2020 © Italian Association of Nuclear Medicine and Molecular Imaging 2020
Main body Our knowledge about the broad repertoire of manifestations of coronavirus-19 (COVID-19) is expeditiously evolving. The preliminary data indicate that patients of COVID-19 are at high risk for developing pulmonary embolism (PE) which is a potentially fatal complication. The reported incidence of PE has been pegged at 23–30% in severe COVID-19 pneumonia [1]. Postmortem examination of lungs has also proved PE in severe COVID-19 pneumonia [2]. Occurrence of PE has been reported previously in several infections. This is thought to be a consequence of hypercoagulable state which is triggered by systemic inflammatory response, endothelial dysfunction, and hypoxia. Prolonged immobilization of severely ill patients may also contribute to PE. Higher levels of D-dimer, fibrinogen, and degradation products of fibrinogen in COVID-19 have been reported with higher frequency compared to control group suggesting hypercoagulable state in COVID-19 [3]. Diagnosis of PE in COVID-19 is essential but challenging. Clinical symptoms and signs of PE are non-specific. Raised D-dimer levels, reported in severe COVID-19, are insensitive and non-specific to diagnose PE. Elevated D-dimer levels can be seen in COVID-19 even in the * Arshed Hussain Parry [email protected] Abdul Haseeb Wani [email protected] Mudasira Yaseen [email protected] 1
Department of Radiodiagnosis, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu & Kashmir, India
2
Department of Radiodiagnosis, Government Medical College, Srinagar, Jammu & Kashmir, India
3
Department of Anesthesiology and Critical Care Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu & Kashmir, India
absence of PE. Two widely applied diagnostic modalities of chest radiography and non-contrast computed tomography (CT) of lungs in COVID-19 are also non-specific and cannot be relied upon to establish a diagnosis of PE. Among the imaging modalities, CT angiography (CTA) has the potential to conclusively confirm or refute the diagnosis of PE. Most of the published data until date on PE in COVID-19 pneumonia has primarily focused on and used CTA to arrive at the diagnosis. However, the use of CTA for diagnosis of PE may not be logistically feasible in every centre in the current pandemic for a multitude of reasons. First, it requires administration of iodinated contrast material which might be contraindicated in patients with acute kidney injury and contrast allergy. Acute kidney injury has been reported in COVID-19. Cheng et al. reported proteinuria and hematuria in admitted patients of COVID-19 with a frequency of 43.9 and 26.7%, respectively [4]. They also reported elevated creatinine and reduced glomerular filtratio
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