A Case of Severe COVID-19 Who Developed Acute Pulmonary Embolism and Mediastinal Emphysema

A man in his fifties visited another hospital with fever and cough. The patient was diagnosed as having coronavirus disease 2019 (COVID-19) on the basis of the results of a reverse transcription polymerase chain reaction (RT-PCR) test. Chest CT revealed multiple ground-glass opacities in both the lower lobes. Subsequently, the patient developed dyspnea and was initiated on oxygen supplementation via a nasal cannula. Chest CT showed rapid progression of the ground-glass opacities and consolidation in both lower lung lobes,and the patient was started on treatment with favipiravir. At this stage, he was transferred to our hospital for intensive care. Two days after he was transferred, the condition progressed to acute respiratory failure,necessitating mechanical ventilation. The serum D-dimer levels were significantly increased (115μg/mL). In addition to exacerbation of the primary lung disease, we diagnosed the patient as also having acute pulmonary embolism and mediastinal emphysema on the basis of the findings on a CT obtained after intravenous administration of contrast material, and he was started on therapy with an anticoagulant. He became hypotensive and required norepinephrine and vasopressin, and also developed severe acute kidney injury. His lung condition gradually improved, and on day 12 after he was intubated, he was successfully weaned from mechanical ventilation. We have presented a report of this case owing to the extremely rapid progression of the disease in this patient.