key: cord-0800173-w0kkkh17
authors: Nagai, Hiroyuki; Yamamoto, Shinya; Saito, Makoto; Adachi, Eisuke
title: Infiltrative Shadows in COVID-19: Pneumonia or Pulmonary Embolism?
date: 2020-08-12
journal: Intern Med
DOI: 10.2169/internalmedicine.5380-20
sha: c3f4704900c1ee236d545b3256cd326e38678fd5
doc_id: 800173
cord_uid: w0kkkh17

nan

A 56-year-old African-American man was referred to our hospital for the assessment of a fever that had persisted for 14 days. His SpO2 was 88% on ambient air. He did not complain of any symptoms other than a fever. As he had worked in a highly endemic area in Tokyo, a nasopharyngeal swab was taken for SARS-CoV2 reverse transcription polymerase chain reaction (RT-PCR), which was positive. Chest computed tomography (CT) revealed bilateral patchy ground-glass opacities and infiltrative shadows (Picture A). For a further investigation, we performed contrast-enhanced CT, which detected a filling defect at the pulmonary trunk (Picture B). His blood tests revealed an elevated D-dimer level of 29.1 mg/dL. At night on the day of admission, his hypoxemia deteriorated. After two days on intravenous heparin and favipiravir, his symptoms subsided. His D-dimer level decreased promptly but still showed a positive result of 4.6 mg/dL on Day 43. Pulmonary embolus has been reported to be associated with invasive mechanical ventilation (1). Chest CT plays an important role in the management of patients with COVID-19, but consolidation is relatively common in the late second week of COVID-19 (2). Contrastenhanced CT might therefore be a powerful tool for excluding alternate diagnoses or added pathologies.

Acute pulmonary embolism associated with COVID-19 pneumonia detected by pulmonary CT angiography

Time course of lung changes on chest ct during recovery from 2019 novel coronavirus (COVID-19) pneumonia

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