Pulmonary thromboembolic disease in COVID-19 patients on CT pulmonary angiography – Prevalence, pattern of disease and relationship to D-dimer

•Prevalence of pulmonary thromboembolic disease (PTE) is 38 % in COVID-19 patients who underwent CTPA.•Patients with more severe COVID-19 changes are more likely to have PTE.•Majority of PTE is observed within smaller pulmonary vessels (75 %) and lungs demonstrated COVID-19 changes (72 %).•Subsegmen...

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Published in:European journal of radiology 2020-11, Vol.132, p.109336-109336, Article 109336
Main Authors: Ooi, M.W.X., Rajai, A., Patel, R., Gerova, N., Godhamgaonkar, V., Liong, S.Y.
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Betacoronavirus
Computed Tomography Angiography - methods
Coronavirus
Coronavirus Infections - complications
Coronavirus Infections - metabolism
COVID-19
Female
Fibrin Fibrinogen Degradation Products - metabolism
Humans
Male
Middle Aged
Pandemics
Pneumonia, Viral - complications
Pneumonia, Viral - metabolism
Prevalence
Pulmonary Artery - diagnostic imaging
Pulmonary embolism
Pulmonary Embolism - complications
Pulmonary Embolism - diagnostic imaging
Pulmonary Embolism - metabolism
Retrospective Studies
SARS-CoV-2
Sensitivity and Specificity
Severity of Illness Index
Thromboembolism
Young Adult
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Summary:•Prevalence of pulmonary thromboembolic disease (PTE) is 38 % in COVID-19 patients who underwent CTPA.•Patients with more severe COVID-19 changes are more likely to have PTE.•Majority of PTE is observed within smaller pulmonary vessels (75 %) and lungs demonstrated COVID-19 changes (72 %).•Subsegmental vessels should be scrutinized for presence of PTE.•D-dimer values may have potential in guiding anticoagulation therapy and evaluating prognosis in these patients. To define the prevalence of pulmonary thromboembolic (PTE) disease diagnosed on CT pulmonary angiography (CTPA) in COVID-19 patients. To assess distribution of PTE and to evaluate for association between severity of COVID-19 disease, D-dimer values and incidence of PTE. Patients with diagnosis of COVID-19 presenting to 5 different hospitals across Greater Manchester between 1st March 2020 and 30th April 2020 who had CTPA were included. CTPA images were evaluated for presence of PTE, distribution of PTE (in small and/or large vessels) and distribution of PTE within lungs with or without COVID-19 CT changes. Severity of COVID lung changes were graded. D-dimer values within 72 h of CTPA were obtained. Statistical analyses were performed to evaluate for any significant association between variables. p values of ≤0.05 were regarded as statistically significant. A total of 974 patients presented across five hospital sites with COVID-19 infection. Eighty-four (n = 84) COVID-19 patients underwent CTPA. Of these, 38 % (32/84) had PTE. PTE was seen in small vessels in 75 % (24/32) and in lungs demonstrating COVID-19 changes in 72 % (23/32). 84 % (27/32) of PTE positive patients had disease severity of moderate or higher score (p = 0.005). D-dimer values were significantly higher (p ≤ 0.001) in PTE patients, median value in PTE group was 6441mcg/L (range 219-90925). A D-dimer cut off value of 2247mcg/L provides sensitivity of 0.72 and specificity of 0.74. There is increased prevalence of PTE in patients with moderate to severe COVID-19 disease. D-dimer values may have potential in guiding anticoagulation therapy and prognostication.
ISSN:0720-048X
1872-7727
DOI:10.1016/j.ejrad.2020.109336