Title Clinical and computed tomography pulmonary angiogram (CTPA) characteristics of COVID-19 related pulmonary artery thromboembolism
Title (croatian) Kliničke i CTPA karakteristike plućne tromboembolije povezane s COVID-19
Author Ana Kostović
Mentor Krešimir Dolić (mentor)
Committee member Sanja Lovrić Kojundžić (predsjednik povjerenstva)
Committee member Tade Tadić (član povjerenstva)
Committee member Ivana Pavlinac Dodig (član povjerenstva)
Granter University of Split School of Medicine Split
Defense date and country 2022-09-14, Croatia
Scientific / art field, discipline and subdiscipline BIOMEDICINE AND HEALTHCARE Clinical Medical Sciences Radiology
Abstract Objectives: The objective of this study was to evaluate the clinical and computed tomography
pulmonary angiogram characteristics of pulmonary embolism seen in patients hospitalized
because of SARS-CoV-2 infection. Additionally, we intended to describe the distribution of the
pulmonary emboli.
Subjects and methods: This study is based on a retrospective observational study which was
carried out in the Department of Radiology at the University Hospital Split. A sample of 78
patients was chosen who developed pulmonary embolism after being infected with SARS-CoV-
2. CTPAs were analyzed according to location and radiological appearance of PE.
Results: Median age is 71 years and there is a slight male predominance. At least one
comorbidity is present in majority of individuals (n= 64, 82.06%), whereas only 14 (17.94%)
are without comorbidities. The most prevalent comorbidity is hypertension (n= 34, 43.53%) of
PE patients either by itself or together with other diseases, such as diabetes or cardiac disorders.
D-dimer levels are elevated (median 12.51, Q1-Q3 8.00-28.04) and PE is manifested at a
median of 14 (Q1-Q3 11-19.5) days after Covid-19 diagnosis has been made. Unilateral
pulmonary embolism was demonstrated in nearly half of patients who underwent CTPA, mostly
located in one of the segmental or subsegmental branches (n=23,29.49% of total number of PE
patients). In 8 (10.25%) cases PE involved unilaterally two or more of the segmental or
subsegmental branches and typically encompassing areas of Covid-19 inflammation-related CT
changes. In 33 (42.31%) patients the pulmonary tree affection was bilateral and involved
multilobar/multisegmental levels. Branches at all levels and a wide variety of PE locations were
present and were not necessarily linked to inflammatory damage seen on CT. The right lobe of
the lung was more often involved than the opposite lobe.
Conclusion: Our results showed that acute PE is a potential complication of Covid-19 even in
mild forms or late in the course of the disease, when the initial symptoms of SARS-CoV-2
infection have already disappeared. Pulmonary branches of all sizes were affected, primarily
those of smaller diameters and more often in the right lung. PE in Covid-19 patients seems to
be rather an in-situ thrombosis in the lung than a consequence of a deep venous thrombosis,
although an embolic event arising from dee vein thrombosis is possible, especially when
comorbidities are present. There is a difference in the clinical picture of pulmonary infections
between Covid-19 and non-Covid-19 patients. Appearance of the embolism and imaging of the
lungs showed differences between infected and noninfected patients. Due to the infection, lung
infiltrates and ground-glass opacities were seen more often as well as lymph node and vessel
thickening and enlargement. So, beyond the PE, CT scanning shows common morphological patterns, but it must be emphasized that those patterns are not specific for Covid-19 as they can
occur in other viral and non-viral diseases.
Abstract (croatian) Ciljevi: Cilj rada je evaluacija kliničke slike hospitaliziranih pacijenata oboljelih od Covid-19,
te analiza nalaza kompjutorizirane tomografije onih pacijenata s popratnom embolijom pluća.
Materijali i metode: Ovaj se rad prvenstveno temelji na retrospektivnoj opservacijskoj studiji
provedenoj na odjelu za Radiologiju u Kliničko bolničkom Centru u Splitu.
U studiji je bilo uključeno 78 pacijenata koji su u okviru infekcije sa SARS-CoV-2 imali
emboliju pluća kao popratnu komplikaciju.
Rezultati: Medijan starosne dobi je bio 71 godina s laganom prevagom muškog spola. U većini
pacijenata je bio barem jedan komorbiditet (n= 64, 82,06%), samo 14 pacijenata (17,94%) je
bilo bez popratnih oboljenja od kojih je najčešća bila hipertenzija (n= 34, 43,53%) kao jedina
ili s drugim komorbiditetima kao šećerna bolest ili srčana oboljenja. D-dimeri su bili povišeni
(medijan 12,51, Q1-Q3 8,00-28,04) dok se pulmonalna embolija manifestirala s medijanom od
14 (Q1-Q3 11-19,5) dana nakon dijagnoze Covid-19. U skoro polovice pacijenata CTPA je
pokazala jednostranu pulmonalnu emboliju, najčešće lokaliziranu u segmentalnim ili
subsegmentalnim granama (n=23,29,49% od ukupnog broja pacijenata s plućnom embolijom).
U 8 slučajeva (10,25%) embolija je jednostrano obuhvatila dvije ili više segmentalnih ili
subsegmentalnih grana i pri tome u pravilu obuhvaćala plućne areale sa znakovima upale u
CT-u. U 33 pacijenata (42,31%) embolijom su bila pogođena oba plućna krila pri čemu su bile
obuhvaćene multilobarne i multisegmentalne grane raznih veličina s velikom topografskom
varijacijom. Pri tome embolija nije nužno bila povezana s arealima u kojima je CT pokazivao
znakove upalnog procesa.
Zaključci: Naši rezultati pokazuju da je akutna pulmonalna embolija moguća komplikacija kod
Covid-19 čak i u blagim slučajevima te se može manifestirati i u kasnijim stadijima oboljenja
kada početni simptomi već jenjavaju. Pogođene su grane svih veličina, prvenstveno one s malim
promjerom te češće desno plućno krilo. Postoji osnovana sumnja da je pulmonalna embolija u
Covid-19 pacijenata lokalnog uzroka a manje posljedica periferne tromboze, iako je takva
moguća posebice u pacijenata s komorbiditetima. Isto tako se razlikuju karakteristike
pulmonalne embolije kod Covid-19 te općenito slikovni nalazi u CT-u u usporedbi s
pacijentima s drugim infekcijama pluća.
Kod Covid-19 često su prisutni infiltrati te “groundglass” promjene, povećani medijastinalni
limfni čvorovi kao zadebljanje i proširenja pulmonalnih arterija. Osim pulmonalne embolije CT pokazuje morfološke promjene koje ukazuju na prisutnost Covid-19 ali koje nisu specifične za
Covid-19 jer su prisutne i kod pulmonalnih infekcija drugih uzroka.
Keywords
Pulmonary Artery Thromboembolism
CTPA
COVID-19
SARSCoV-2
Keywords (croatian)
Tromboembolija plućne arterije
CTPA
COVID-19
SARSCoV-2
Language english
URN:NBN urn:nbn:hr:171:934247
Study programme Title: Medical Studies in English Study programme type: university Study level: integrated undergraduate and graduate Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
Type of resource Text
File origin Born digital
Access conditions Open access
Terms of use
Created on 2022-09-21 13:17:58