In a 75-year-old Covid-19positive woman hospitalized for severe bilateral pneumonia, CT scan documented bilateral pulmonary embolism associated with extensive groundglass opacifications involving both the lung parenchymas. Acute infections are associated with a transient increased risk of venous thromboembolic events. A COVID-19positive 75-year-old woman, with severe bilateral pneumonia and concomitant acute pulmonary embolism, was hospitalized after 10 days of fever and a recent onset of dyspnoea. She was haemodynamically stable and without strong predisposing risk factors for venous thrombo-embolism. The baseline ECG was normal. A modest leucocytosis was present (11.360/mm) with increased values of C-reactive protein (180 mg/L), troponin I (3240.4 ng/mL), and D-dimer (21 lg/mL). While on oxygen, arterial blood gas revealed a PaO2 of 78.0 mmHg with a PcO2 of 25.1 mmHg and an sO2 of 95.6%. A right basal infiltrate was evident at the chest X-ray, while echocardiographic evaluation showed a dilated and severely hypokinetic right ventricle with a mean derived pulmonary arterial pressure of 60 mmHg. CT scan documented the presence of a bilateral filling defect diagnostic for pulmonary embolism (Panels 1A and B; Supplementary material online Video 1), associated with extensive ground-glass opacifications involving both the lung parenchymas with predominant consolidation in the posterior basal segment of the left lower lobe (Panels 1C and D; Supplementary material online Video 2). Lower-limb compression ultrasonography was negative. Based on these findings, treatment with low molecular weight heparin, lopinavir/ritonavir, and hydroxychloroquine was started. In conclusion, the absence of major predisposing factors in this case of diffuse bilateral COVID-19 pneumonia seems to confirm the role of severe infections as a precipitant factor for acute venous thrombo-embolism and the causal relationship.

中文翻译：

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急性肺栓塞和 COVID-19 肺炎：随机关联？

在一名因严重双侧肺炎住院的 75 岁 Covid-19 阳性女性中，CT 扫描记录了双侧肺栓塞，并伴有涉及双肺实质的广泛磨玻璃混浊。急性感染与静脉血栓栓塞事件的风险暂时增加有关。一名 COVID-19 阳性的 75 岁女性患有严重的双侧肺炎并伴有急性肺栓塞，在发烧 10 天和最近出现呼吸困难后住院。她血流动力学稳定，没有明显的静脉血栓栓塞诱发危险因素。基线心电图正常。存在适度的白细胞增多 (11.360/mm)，C 反应蛋白 (180 mg/L)、肌钙蛋白 I (3240.4 ng/mL) 和 D-二聚体 (21 lg/mL) 值升高。吸氧时，动脉血气显示 PaO2 为 78。0 mmHg，PcO2 为 25.1 mmHg，sO2 为 95.6%。胸部 X 光检查显示右侧基底浸润明显，而超声心动图评估显示右心室扩张且运动严重减退，平均衍生肺动脉压为 60 mmHg。CT 扫描记录了诊断肺栓塞的双侧充盈缺损的存在（图 1A 和 B；在线补充材料视频 1），与广泛的磨玻璃混浊相关，涉及两个肺实质，左侧后基底段主要为实变下叶（图 1C 和 D；补充材料在线视频 2）。下肢加压超声检查呈阴性。基于这些发现，开始使用低分子量肝素、洛匹那韦/利托那韦和羟氯喹进行治疗。综上所述，