Acute pulmonary embolism in non-hospitalized COVID-19 patients referred to CTPA by emergency department

Eur Radiol. 2020 Nov;30(11):6170-6177. doi: 10.1007/s00330-020-06977-5. Epub 2020 Jun 9.


Objectives: To evaluate the prevalence of acute pulmonary embolism (APE) in non-hospitalized COVID-19 patients referred to CT pulmonary angiography (CTPA) by the emergency department.

Methods: From March 14 to April 6, 2020, 72 non-hospitalized patients referred by the emergency department to CTPA for COVID-19 pneumonia were retrospectively identified. Relevant clinical and laboratory data and CT scan findings were collected for each patient. CTPA scans were reviewed by two radiologists to determinate the presence or absence of APE. Clinical classification, lung involvement of COVID-19 pneumonia, and CT total severity score were compared between APE group and non-APE group.

Results: APE was identified in 13 (18%) CTPA scans. The mean age and D-dimer of patients from the APE group were higher in comparison with those from the non-APE group (74.4 vs. 59.6 years, p = 0.008, and 7.29 vs. 3.29 μg/ml, p = 0.011). There was no significant difference between APE and non-APE groups concerning clinical type, COVID-19 pneumonia lung lesions (ground-glass opacity: 85% vs. 97%; consolidation: 69% vs. 68%; crazy paving: 38% vs. 37%; linear reticulation: 69% vs. 78%), CT severity score (6.3 vs. 7.1, p = 0.365), quality of CTPA (1.8 vs. 2.0, p = 0.518), and pleural effusion (38% vs. 19%, p = 0.146).

Conclusions: Non-hospitalized patients with COVID-19 pneumonia referred to CT scan by the emergency departments are at risk of APE. The presence of APE was not limited to severe or critical clinical type of COVID-19 pneumonia.

Key points: • Acute pulmonary embolism was found in 18% of non-hospitalized COVID-19 patients referred by the emergency department to CTPA. Two (15%) patients had main, four (30%) lobar, and seven (55%) segmental acute pulmonary embolism. • Five of 13 (38%) patients with acute pulmonary embolism had a moderate clinical type. • Severity and radiological features of COVID-19 pneumonia showed no significant difference between patients with or without acute pulmonary embolism.

Keywords: CT angiography; Coronavirus; Pneumonia; Pulmonary embolism.

MeSH terms

  • Acute Disease
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Betacoronavirus*
  • COVID-19
  • Causality
  • Comorbidity
  • Computed Tomography Angiography / methods*
  • Coronavirus Infections / epidemiology*
  • Emergency Service, Hospital*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Outpatients / statistics & numerical data
  • Pandemics
  • Pneumonia, Viral / epidemiology*
  • Pulmonary Artery / diagnostic imaging
  • Pulmonary Embolism / diagnostic imaging*
  • Pulmonary Embolism / epidemiology*
  • Referral and Consultation / statistics & numerical data*
  • Retrospective Studies
  • SARS-CoV-2
  • Young Adult