Department of Radiology, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy; Post-Graduate School of Radiology, University of Milano-Bicocca, Monza, Italy.
Department of Radiology, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy.
Eur J Radiol. 2021 Apr;137:109613. doi: 10.1016/j.ejrad.2021.109613. Epub 2021 Feb 24.
Pulmonary embolism (PE) in COVID-19 patients can play a key role in precipitating clinical conditions. We aimed to evaluate PE distribution on CTA and to investigate any possible association with D-dimer (DD), pulmonary stage of disease and prognosis.
COVID-19 patients of two affiliated Hospitals, undergone a CTA examination for PE suspicion, were retrospectively enrolled. Comorbidities, laboratory tests and clinical outcomes (hospitalization, discharge, death) were assessed. A parenchymal stage (early, progressive, peak, absorption) for lung involvement was assigned.
A cohort of 114 patients (mean age 61 years; 26.3 % females) with severe COVID-19 pneumonia were evaluated. At last follow-up 25 (21.9 %) were hospitalized, 72 (63.2 %) discharged, 17 (14.9 %) dead. Eighty-eight patients (77.2 %) had at least one comorbidity, being cardiovascular ones the most frequent (44.7 %). CTA revealed PE in 65 patients (57 %), with concomitant pulmonary trunk and/or main arteries involvement in 16.9 %. PE defects were ubiquitous in 18.5 % of cases. The predominant parenchymal stages were the progressive (24.6 %) and peak (67.7 %). DD levels showed a significant correlation with PE occurrence and extent in pulmonary branches, despite anticoagulant therapies; trend of correlation with pulmonary stages was also noted.
PE is a frequent complication in severe COVID-19 patients, particularly during central parenchymal stages and despite ongoing anticoagulant therapy. CTA and DD levels play a crucial role in the assessment of suspected PE, despite anticoagulant therapies, along with proper information about lung involvement extent.
COVID-19 患者中的肺栓塞（PE）可能在引发临床病症方面发挥关键作用。我们旨在评估 CTA 上的 PE 分布，并研究其与 D-二聚体（DD）、肺部疾病阶段和预后之间的任何可能关联。
回顾性纳入在两家附属医院因疑似 PE 而行 CTA 检查的 COVID-19 患者。评估了合并症、实验室检查和临床结局（住院、出院、死亡）。对肺部受累的实质阶段（早期、进展、高峰、吸收）进行了赋值。
评估了 114 例严重 COVID-19 肺炎患者的队列（平均年龄 61 岁；26.3%为女性）。在最后一次随访时，25 例（21.9%）住院，72 例（63.2%）出院，17 例（14.9%）死亡。88 例（77.2%）至少有一种合并症，其中心血管合并症最常见（44.7%）。CTA 显示 65 例（57%）患者存在 PE，其中 16.9%患者伴有肺总干和/或主肺动脉受累。18.5%的病例中存在广泛的 PE 缺损。最常见的实质阶段是进展期（24.6%）和高峰期（67.7%）。尽管进行了抗凝治疗，但 DD 水平与肺分支中 PE 的发生和程度呈显著相关；也观察到与肺部阶段的相关性趋势。
PE 是严重 COVID-19 患者的常见并发症，尤其是在中央实质阶段，尽管进行了抗凝治疗。CTA 和 DD 水平在疑似 PE 的评估中发挥着重要作用，尽管进行了抗凝治疗，但也需要了解肺部受累程度的相关信息。
