Pulmonary embolism in COVID-19: Clinical characteristics and cardiac implications

Am J Emerg Med. 2020 Oct;38(10):2142-2146. doi: 10.1016/j.ajem.2020.07.054. Epub 2020 Jul 24.


Background: The thrombogenic potential of Covid-19 is increasingly recognised. We aim to assess the characteristics of COVID-19 patients diagnosed with pulmonary embolism (PE).

Methods: We conducted a single centre, retrospective observational cohort study of COVID-19 patients admitted between 1st March and 30th April 2020 subsequently diagnosed with PE following computed tomography pulmonary angiogram (CTPA). Patient demographics, comorbidities, presenting complaints and inpatient investigations were recorded.

Results: We identified 15 COVID-19 patients diagnosed with PE (median age = 58 years [IQR = 23], 87% male). 2 died (13%), both male patients >70 years. Most common symptoms were dyspnoea (N = 10, 67%) and fever (N = 7, 47%). 12 (80%) reported 7 days or more of non-resolving symptoms prior to admission. 7 (47%) required continuous positive airway pressure (CPAP), 2 (13%) of which were subsequently intubated. All patients had significantly raised D-dimer levels, lactate dehydrogenase (LDH), C-reactive protein (CRP), ferritin and prothrombin times. The distribution of PEs correlated with the pattern of consolidation observed on CTPA in 9 (60%) patients; the majority being peripheral or subsegmental (N = 14, 93%) and only 1 central PE. 10 (67%) had an abnormal resting electrocardiogram (ECG), the commonest finding being sinus tachycardia. 6 (40%) who underwent transthoracic echocardiography (TTE) had structurally and functionally normal right hearts.

Conclusion: Our study suggests that patients who demonstrate acute deterioration, a protracted course of illness with non-resolving symptoms, worsening dyspnoea, persistent oxygen requirements or significantly raised D-dimer levels should be investigated for PE, particularly in the context of COVID-19 infection. TTE and to a lesser degree the ECG are unreliable predictors of PE within this context.

Keywords: COVID-19; Coagulopathy; Coronavirus; Pulmonary embolism; Venous thromboembolism.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • COVID-19 / complications*
  • COVID-19 / physiopathology
  • Cohort Studies
  • Computed Tomography Angiography
  • Female
  • Fibrin Fibrinogen Degradation Products / metabolism
  • Humans
  • Male
  • Middle Aged
  • Pandemics
  • Pulmonary Embolism / diagnostic imaging
  • Pulmonary Embolism / etiology*
  • Retrospective Studies
  • SARS-CoV-2
  • Severity of Illness Index


  • Fibrin Fibrinogen Degradation Products
  • fibrin fragment D