Acute pulmonary embolism in non-hospitalized COVID-19 patients referred to CTPA by emergency department.

Alban Gervaise,Caroline Bouzad,Carole Helissey,Evelyne Peroux

doi:10.1007/s00330-020-06977-5

Alban Gervaise, Caroline Bouzad + Show 2 more

Open Access

https://doi.org/10.1007/s00330-020-06977-5

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Journal: European radiology	Publication Date: Jun 9, 2020
Citations: 92	License type: NO-CC CODE

Affiliation: Hôpital d'Instruction des Armées Bégin

Abstract

ObjectivesTo evaluate the prevalence of acute pulmonary embolism (APE) in non-hospitalized COVID-19 patients referred to CT pulmonary angiography (CTPA) by the emergency department.MethodsFrom March 14 to April 6, 2020, 72 non-hospitalized patients referred by the emergency department to CTPA for COVID-19 pneumonia were retrospectively identified. Relevant clinical and laboratory data and CT scan findings were collected for each patient. CTPA scans were reviewed by two radiologists to determinate the presence or absence of APE. Clinical classification, lung involvement of COVID-19 pneumonia, and CT total severity score were compared between APE group and non-APE group.ResultsAPE was identified in 13 (18%) CTPA scans. The mean age and D-dimer of patients from the APE group were higher in comparison with those from the non-APE group (74.4 vs. 59.6 years, p = 0.008, and 7.29 vs. 3.29 μg/ml, p = 0.011). There was no significant difference between APE and non-APE groups concerning clinical type, COVID-19 pneumonia lung lesions (ground-glass opacity: 85% vs. 97%; consolidation: 69% vs. 68%; crazy paving: 38% vs. 37%; linear reticulation: 69% vs. 78%), CT severity score (6.3 vs. 7.1, p = 0.365), quality of CTPA (1.8 vs. 2.0, p = 0.518), and pleural effusion (38% vs. 19%, p = 0.146).ConclusionsNon-hospitalized patients with COVID-19 pneumonia referred to CT scan by the emergency departments are at risk of APE. The presence of APE was not limited to severe or critical clinical type of COVID-19 pneumonia.Key Points • Acute pulmonary embolism was found in 18% of non-hospitalized COVID-19 patients referred by the emergency department to CTPA. Two (15%) patients had main, four (30%) lobar, and seven (55%) segmental acute pulmonary embolism. • Five of 13 (38%) patients with acute pulmonary embolism had a moderate clinical type. • Severity and radiological features of COVID-19 pneumonia showed no significant difference between patients with or without acute pulmonary embolism.

Highlights

Non-contrast chest CT has been shown to play an important role in the evaluation of COVID-19 pneumonia [1, 2]
Of the 72 patients included in the study, 58 (80%) patients had a positive RT-PCR for SARS-CoV-2, 10 (14%) did not have RT-PCR, and 4 (6%) had a diagnosis based on the typical clinical and radiological presentation of COVID-19 with RT-PCR results negative for SARS-CoV-2
The association between COVID-19 pneumonia and acute pulmonary embolism (APE) has already been described in patients hospitalized with severe to critical clinical type [13,14,15,16,17,18]

Summary

Introduction

Non-contrast chest CT has been shown to play an important role in the evaluation of COVID-19 pneumonia [1, 2]. The place of computed tomography pulmonary angiography (CTPA) in the evaluation of COVID-19 pneumonia remains more limited. It is reserved for patients whose clinical condition has deteriorated in order to search for an acute pulmonary embolism (APE) [2]. Several published studies seem to confirm the association between COVID-19 and APE in hospitalized patients with severe to critical form [13,14,15,16,17,18].

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