Abstract
BackgroundTo evaluate chest-computed-tomography (CT) scans in coronavirus-disease-2019 (COVID-19) patients for signs of organizing pneumonia (OP) and microinfarction as surrogate for microscopic thromboembolic events.MethodsReal-time polymerase-chain-reaction (RT-PCR)-confirmed COVID-19 patients undergoing chest-CT (non-enhanced, enhanced, pulmonary-angiography [CT-PA]) from March-April 2020 were retrospectively included (COVID-19-cohort). As control-groups served 175 patients from 2020 (cohort-2020) and 157 patients from 2019 (cohort-2019) undergoing CT-PA for pulmonary embolism (PE) during the respective time frame at our institution. Two independent readers assessed for presence and location of PE in all three cohorts. In COVID-19 patients additionally parenchymal changes typical of COVID-19 pneumonia, infarct pneumonia and OP were assessed. Inter-reader agreement and prevalence of PE in different cohorts were calculated.ResultsFrom 68 COVID-19 patients (42 female [61.8%], median age 59 years [range 32–89]) undergoing chest-CT 38 obtained CT-PA. Inter-reader-agreement was good (k = 0.781). On CT-PA, 13.2% of COVID-19 patients presented with PE whereas in the control-groups prevalence of PE was 9.1% and 8.9%, respectively (p = 0.452). Up to 50% of COVID-19 patients showed changes typical for OP. 21.1% of COVID-19 patients suspected with PE showed subpleural wedge-shaped consolidation resembling infarct pneumonia, while only 13.2% showed visible filling defects of the pulmonary artery branches on CT-PA.ConclusionDespite the reported hypercoagulability in critically ill patients with COVID-19, we did not encounter higher prevalence of PE in our patient cohort compared to the control cohorts. However, patients with suspected PE showed a higher prevalence of lung changes, resembling patterns of infarct pneumonia or OP and CT-signs of pulmonary-artery hypertension.
Highlights
Recent observations suggest that respiratory failure in novel coronavirus disease 2019 (COVID19) is not driven by the development of acute respiratory distress syndrome alone, but that microvascular thrombotic processes may play a role [1]
On CT pulmonary angiography (CT-PA), 13.2% of COVID-19 patients presented with pulmonary embolism (PE) whereas in the control-groups prevalence of PE was 9.1% and 8.9%, respectively (p = 0.452)
Up to 50% of COVID-19 patients showed changes typical for organizing pneumonia (OP). 21.1% of COVID-19 patients suspected with PE showed
Summary
Recent observations suggest that respiratory failure in novel coronavirus disease 2019 (COVID19) is not driven by the development of acute respiratory distress syndrome alone, but that microvascular thrombotic processes may play a role [1]. This may have important consequences for the diagnostic and therapeutic management of these patients. Various studies in patients with COVID-19 have shown a very strong association between increased D-dimer levels and severe disease/poor prognosis [1]. To evaluate chest-computed-tomography (CT) scans in coronavirus-disease-2019 (COVID19) patients for signs of organizing pneumonia (OP) and microinfarction as surrogate for microscopic thromboembolic events
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