CT imaging of pulmonary embolism in patients with COVID-19 pneumonia: a retrospective analysis.

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.

• Authors: Irene Espallargas, Juan José Rodríguez Sevilla, Diego Agustín Rodríguez Chiaradía, Antonio Salar, Guillem Casamayor, Judit Villar-Garcia, Anna Rodó-Pin, Salvatore Marsico, Santiago Carbullanca, Diego Ramal, Luis Alexander Del Carpio, Ángel Gayete, José María Maiques, Flavio Zuccarino
• Journal: European radiology (Eur Radiol) Vol. 31 Issue 4 Pg. 1915-1922 (Apr 2021) ISSN: 1432-1084 [Electronic] Germany
• PMID: 32964337 (Publication Type: Journal Article)

Topics

• COVID-19
• Humans
• Pulmonary Embolism (diagnostic imaging)
• Retrospective Studies
• SARS-CoV-2
• Tomography, X-Ray Computed