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COVID-19 and Pulmonary Emboli: A Case Series and Literature Review

  • Author(s): Greenan-Barrett, James
  • Perera, Adrian
  • et al.
Creative Commons 'BY' version 4.0 license
Abstract

Introduction: There is recent evidence that coronavirus disease 2019 (COVID-19) infection results in a prothrombotic state that may increase the risk of venous thromboembolism. Both COVID-19 infection and pulmonary emboli can present with dyspnoea, tachypnoea, hypoxaemia and an elevated D-dimer. Identifying a pulmonary embolus in a patient with COVID-19 and differentiating it from the typical clinical and biochemical features of COVID-19 is challenging.

Case Reports: We report four cases, and reviewed two further cases in the literature, of a pulmonary embolus in patients who presented to the emergency department with COVID-19 and no other risk factor for a pulmonary embolus.

Conclusion: We identified a series of atypical features that should raise suspicion for a pulmonary embolus: pleuritic chest pain; haemoptysis; atrial fibrillation; tachycardia; hypotension; late onset deterioration; evidence of right heart strain; or a disproportionally elevated D-dimer in comparison to ferritin.

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