Clinical and computed tomography characteristics of COVID-19 associated acute pulmonary embolism: a different phenotype of thrombotic disease?

Dam, L.F. van; Kroft, L.J.M.; Wal, L.I. van der; Cannegieter, S.C.; Eikenboom, J.; Jonge, E. de; ... ; Klok, F.A. (2020)

Article / Letter to editor

Introduction: COVID-19 infections are associated with a high prevalence of venous thromboembolism, particularly pulmonary embolism (PE). It is suggested that COVID-19 associated PE represents in situ immunothrombosis rather than venous thromboembolism, although the origin of thrombotic lesions in COVID-19 patients remains largely unknown.Methods: In this study, we assessed the clinical and computed tomography (CT) characteristics of PE in 23 consecutive patients with COVID-19 pneumonia and compared these to those of 100 consecutive control patients diagnosed with acute PE before the COVID-19 outbreak. Specifically, RV/LV diameter ratio, pulmonary artery trunk diameter and total thrombus load (according to Qanadli score) were measured and compared.Results: We observed that all thrombotic lesions in COVID-19 patients were found to be in lung parenchyma affected by COVID-19. Also, the thrombus load was lower in COVID-19 patients (Qanadli score -8%, 95% confidence interval [95%CI] -16 to -0.36%) as was the prevalence of the most proximal PE in the main/lobar pulmonary artery (17% versus 47%; -30%, 95%CI -44% to -8.2). Moreover, the mean RV/LV ratio (mean difference -0.23, 95%CI -0.39 to -0.07) and the prevalence of RV/LV ratio > 1.0 (prevalence difference -23%, 95%CI -41 to -0.86%) were lower in the COVID-19 patients.Conclusion: Our findings therefore suggest that the phenotype of COVID-19 associated PE indeed differs from PE in patients without COVID-19, fuelling the discussion on its pathophysiology.

• Pulmonary embolism
• COVID-19
• Computed tomography
• Thrombosis

• All authors: Dam, L.F. van; Kroft, L.J.M.; Wal, L.I. van der; Cannegieter, S.C.; Eikenboom, J.; Jonge, E. de; Huisman, M.V.; Klok, F.A.
• Date: 2020-09-01
• Journal: Thrombosis Research: Vascular Obstruction, Hemorrhage and Hemostasis
• Volume: 193
• Pages: 86 - 89
• DOI: doi:10.1016/j.thromres.2020.06.010
• Link: https://www.sciencedirect.com/science/article/pii/S0049384820302528?via%...