Acute Pulmonary Thromboembolism in the Context of Outing Restrictions during COVID-19 Pandemic

Abstract

COVID-19 has spread around the world rapidly. Outing restrictions are performed globally to prevent the further spread of infection. A healthy 49-year-old man was taken in the ambulance due to severe dyspnea. For the previous 10 days, he had been performing remote work at home mainly in a sitting position due to the outing restrictions for the prevention of COVID-19 spread. On admission, his blood pressure was low and could not be measured by automated sphygmomanometer, heart rate was 127 bpm, and oxygen saturation was 98% with oxygenation of 10L/min by a mask with a reservoir. Admission blood tests demonstrated markedly elevated D-dimer of 4.13μg/mL and NT-proBNP of 6973 pg/mL. Echocardiography demonstrated dilatation of the right ventricle and D-shaped deformity of the left ventricle without wall motion abnormality. We started continuous intravenous norepinephrine and dobutamine due to the pre-shock status, and chest computed tomography revealed pulmonary thromboembolism (PTE) from the bilateral main pulmonary arteries to the subsegmental arteries. We introduced extracorporeal membrane oxygenation and performed surgical embolectomy. After the surgery, his vital signs and circulation stabilized. Twenty days after the surgery, he was discharged from our hospital without any physical impediment. Since he had no apparent genetic factors for thrombotic disorder, long-term sitting at home during remote work could have contributed to the thrombus formation leading to PTE. Regardless of whether individuals are infected by COVID-19, we must be alert for thromboembolism in the context of outing restrictions during the pandemic.