key: cord-0835614-63y32vlp
authors: Le Berre, A.; Marteau, V.; Emmerich, J.; Zins, M.
title: Concomitant acute aortic thrombosis and pulmonary embolism complicating COVID-19 pneumonia
date: 2020-04-16
journal: Diagn Interv Imaging
DOI: 10.1016/j.diii.2020.04.003
sha: 2e5d5f4c99f452c6c57cf4cb57c48515f104b2b6
doc_id: 835614
cord_uid: 63y32vlp

nan

Dear Editor, In the context of the coronavirus health crisis, radiologists are on the front line to raise awareness about severe complications of COVID-19 pneumonia. Cardiovascular complications are known to occur in patients with COVID-19. We present herein a patient with concomitant acute thrombosis of the abdominal aorta and pulmonary embolism, illustrating the hypercoagulable state associated with the disease.

An otherwise healthy 71-year-old man presented with dyspnea, fever and cough that started 2 weeks ago. Computed tomography (CT) examination of the chest performed one hour after admission showed typical features of COVID-19 pneumonia ( Fig. 1 ), later confirmed with real-time polymerase chain reaction test. The patient was admitted and oxygen treatment initiated. On hospital day (HD) 3, oxygen requirements increased. Blood test showed serum Ddimer level of 17280 ng/mL (Normal < 250 ng/mL), prothrombin time of 16 sec and platelets count of 361 × 10 9 /L. Venous Doppler ultrasound revealed thrombosis of right posterior tibial vein. Pulmonary CT angiography confirmed acute pulmonary embolism. As a filling defect was observed within the aorta, additional aortic CT angiography was performed and showed a free-floating thrombus without aortic atherosclerosis. There were no evidences of visceral, hepatic, splenic or renal embolisms on venous phase images. The 12-lead electrocardiogram showed normal sinus rhythm. There was no clinical evidence of acute limb ischemia. Enoxaparin anticoagulation therapy was started with favorable outcome.

Abnormal coagulation parameters, such as elevated D-dimers, have been described and seem to be associated with a higher risk of development of acute respiratory distress syndrome and death in patients with COVID-19 [1] . As in other viral pneumonias, patients with COVID-19 may be at risk of acute pulmonary embolism; however, the prevalence of this association is yet to be determined. This observation is to our knowledge the first to report an acute arterial thrombosis related to COVID-19. This complication may reflect the potential hypercoagulability associated with SARS-CoV-2 infection and raises the question of using early markers of disseminated intravascular coagulation, particularly D-dimer levels, to guide therapy [2] . Letter / Diagnostic and Interventional Imaging xxx (2020) xxx-xxx 

Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia

Disseminated intravascular coagulation in patients with 2019-nCoV pneumonia

All authors attest that they meet the current International Committee of Medical Journal Editors (ICMJE) criteria for Authorship.

None.

The authors declare that they have no competing interest.