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. 2020 May 6:ehaa402. doi: 10.1093/eurheartj/ehaa402

Large saddle pulmonary embolism in a woman infected by COVID-19 pneumonia

Ramezan Jafari e1,e2, Luca Cegolon e3,e4, Atefeh Jafari e5, Mandana Kashaki e6, Babak Otoukesh e7,e8, Bahareh Heshmat Ghahderijani e9, Morteza Izadi e2, Seyed Hassan Saadat e10,e11, Behzad Einollahi e11, Mohammad Javanbakht e11,
PMCID: PMC7239188  PMID: 32374381

A 50-year-old woman was admitted to the Accident & Emergency department of Baqiyatallah hospital in Tehran (Iran), with symptoms of fever, dyspnoea, dry cough, and fatigue for the past 4 days.

At physical examination, she had enhanced body temperature (38.1 °C), a heart rate of 100 b.p.m., a respiratory rate of 22 breaths/min, and O2 saturation of 92%. Laboratory tests revealed an increased white blood cell count (WBC = 13.5 × 103/μL), increased platelets (PLT = 475× 103/μL), polynuclear (80%); partial thromboplastin time (PTT = 5 s), PTLab/INRLab (=1.31 s); prothrombin test (PT = 18.2 s); and D-dimer (10 ng/mL). Further elevated values were found for C-reactive protein (CRP = 30.3 mg/L), erythrocyte sedimentation rate (ESR = 57 mm/h); serum glutamic-pyruvic transaminase (SGPT = 108 μL); lactate dehydrogenase (LDH = 983μL); and amylase serum (278 μL). Reverse transcription–PCR for COVID-19 was positive and the patient was given oxygen and treated with hydroxychloroquine, dimenhydrinate, and naproxen.

graphic file with name ehaa402f1.jpg

On day 2 after admission, a chest CT scan without contrast evidenced bilateral diffuse multiple patchy and subpleural consolidations with left pleural effusion—radiological findings consistent with COVID-19 pneumonia (Panel A). On day 3 following admission, the patient suddenly developed severe dyspnoea, with O2 saturation decreasing to 74%. A chest computed tomography angiography (CTA) was performed, which revealed a large saddle pulmonary embolism in the main pulmonary artery (MPA), right pulmonary artery (RPA), and left pulmonary artery (LPA) (Panel B). From day 3 of hospitalization, the patient received anticoagulation therapy with heparin and antithrombotic treatment.

The patient remained in hospital for a further 7 days before being discharged in stable condition, with O2 saturation increased to 98%, body temperature of 37.2 °C, negative PCR, and normal laboratory tests.


Articles from European Heart Journal are provided here courtesy of Oxford University Press

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