Findings of Acute Pulmonary Embolism in COVID-19 Patients

Background: Elevated level of D-dimer was reported in some patients with COVID-19 pneumonia on admission, especially in severe COVID-19 patients. However, it was still unknown this abnormality was associated with acute pulmonary embolism (APE). This study aimed to uncover the findings of APE diagnosed by computed tomography pulmonary angiography (CTPA) in COVID-19 patients. Methods: This study retrospectively analyzed the results of COVID-19 patients who were admitted to out hospital and had undergone CTPA scans due to suspected APE and other clinical concerns. Relevant laboratory data and radiology images were collected for each patient. All diagnostic findings in laboratory data and CTPA features were confirmed according to clinical diagnostic criteria. Findings: 1008 patients with COVID-19 pneumonia were hospitalized in our institution between January 2020 and February 2020. And 25 patients confirmed COVID-19 pneumonia who also underwent CTPA scans were enrolled. The median of D-dimer for the 25 patients was 6•06ug/ml (IQR, 1•90-14•31ug/ml). 10 patients were APE positive as presented on CTPA and the median D-dimer level was 11•07ug/ml (IQR, 7•12-21•66); 15 patients were APE negative and median D-dimer levels was 2•44ug/ml (IQR, 1•68-8•34). There is a significant difference (P < 0 . 05) between the two groups. Lymphopenia (lymphocyte count, median 0•81×10 9 /L, IQR, 0•55-1•05×10 9 /L) mostly occurred in 19 patients (76%). Serum CRP and B-type BNP frequently increased with a decline of Albumin and PaO 2 among 25 patients, however no significant differences in laboratory data but D-dimer were found between these two groups. APE in the 10 patients was found dominantly located in small branches of the pulmonary artery. Thrombus was partly or completely absorbed after anticoagulant therapy in 3 patients who underwent a follow-up CTPA. Interpretation: Patients with COVID-19 pneumonia are at risk of APE. When D-dimer remarkable increases, CTPA facilitates the diagnosis of APE and assesses its change during the course. Special attention needs to be paid to the danger of APE associated with COVID-19 infection.Funding Statement: There was no funding source for this study.Declaration of Interests: The authors declare no competing interests.Ethics Approval Statement: This study was approved by the Ethics of Committees of The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology The need for patient informed consent was waived because of its retrospective nature.