Volume 26, Number 8—August 2020
Research Letter
Pulmonary Embolism and Increased Levels of D-Dimer in Patients with Coronavirus Disease
Daniel O. Griffin
, Alexandra Jensen, Mushmoom Khan, Jessica Chin, Kelly Chin, Jennifer Saad, Ryan Parnell, Christopher Awwad, and Darshan Patel
, Alexandra Jensen, Mushmoom Khan, Jessica Chin, Kelly Chin, Jennifer Saad, Ryan Parnell, Christopher Awwad, and Darshan Patel
Table
Characteristics of pulmonary embolism seen by CTA and increased levels of
| Characteristic | Case-patient |
||
|---|---|---|---|
| 1 | 2 | 3 | |
| Age, y |
52 |
60 |
68 |
| Risk factors |
Allergic rhinitis, asthma |
Chronic bronchitis, history of ovarian cancer, and history of provoked DVT |
Hypertension, diabetes mellitus type 2 |
| Smoking status | Former | Never | Never |
| BMI, kg/m2 | 27.0 | 27.4 | 23.7 |
| Creatinine clearance, mL/min |
116 |
127.4 |
64 |
| Day of symptoms, baseline/CTA | 12/18 | 8/18 | 14/22 |
| O2 saturation, baseline/CTA | 52% on RA/98% on NRB | 92% on NC/91% on NC | 94% on NRB/93% on NRB |
| 2,283/9,698 | 221/2,563 | 33,318/1,554 | |
| Ferritin, μg/L, baseline/CTA | 2,283/1,050 | 1,276/1,176 | 2,797/1,282 |
| CRP, mg/L, baseline/CTA | 32.30/0.42 | 11.89/0.66 | 8.88/0.25 |
| Procalcitonin, ng/mL, baseline/CTA | 0.19/0.05 | 0.05/0.13 | 0.23/NA |
| LDH, U/L, baseline/CTA | 567/467 | 448/637 | 824/616 |
| Neutrophil:lymphocyte ratio, baseline/CTA |
10.58/11.75 |
6.6/7.5 |
7.67/14.99 |
| ISTH score, day of CTA | >5 | >5 | >5 |
| VTE prevention | Enoxaparin, 40 mg 2×/d | Enoxaparin, 40 mg 2×/d | Enoxaparin, 40 mg/d |
| IMPROV score | 0 | 3 | 1 |
| Doses of tocilizumab | 1 | 1 | 1 |
| Methylprednisolone duration, d | 8 | 5 | 5 |
| Hydroxychloroquine duration, d |
5 |
5 |
5 |
| CTA read | Bilateral PE; filling defects most pronounced in the right lobar pulmonary artery extending to the first-order branches of the right lower lobe pulmonary artery; additional small filling defect identified within the right upper lobe, right middle lobe, and lingular pulmonary artery branches; diffuse scattered bilateral ground-glass opacities with areas of consolidation compatible with reported viral pneumonia COVID-19 | Multiple bilateral segmental and subsegmental PE with suggestion of cardiac strain; bilateral scattered, predominantly peripheral ground-glass opacities with some interlobular septal thickening consistent with given history of COVID-19 pneumonia | Central filling defects compatible with acute pulmonary embolism in several segmental and subsegmental pulmonary arteries in the right upper lobe, right lower lobe, and left lower lobe; diffuse bilateral ground-glass opacities unchanged from previous imaging |
*BMI, body mass index; COVID-19, coronavirus disease; CRP, C-reactive protein; CTA, computed tomography angiogram; DVT, deep vein thrombosis; IMPROV, International Medical Prevention on Venous Thrombosis; ISTH, International Society of Thrombosis and Haemostasis; LDH, lactate dehydrogenase; NA, not available; NC, nasal cannula; NRB, nonrebreather; PE, pulmonary embolus; RA, room air; RLL, right lower lobe; VTE, venous thromboembolism.
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