Purpose

Patients hospitalized for infection with SARS-CoV-2 typically present with pneumonia. The respiratory failure is frequently complicated by pulmonary embolism in segmental pulmonary arteries. The distribution of pulmonary embolism in regard to lung parenchymal opacifications has not been investigated yet.

Methods

All patients with COVID-19 treated at a medical intensive care unit between March 8th and April 15th, 2020 undergoing computed tomography pulmonary angiography (CTPA) were included. All CTPA were assessed by two radiologists independently in respect to parenchymal changes and pulmonary embolism on a lung segment basis.

Results

Out of 22 patients with severe COVID-19 treated within the observed time period, 16 (age 60.4 ± 10.2 years, 6 female SAPS2 score 49.2 ± 13.9) underwent CT. A total of 288 lung segment were analyzed. Thrombi were detectable in 9/16 (56.3%) patients, with 4.4 ± 2.9 segments occluded per patient and 40/288 (13.9%) segments affected in the whole cohort. Patients with thrombi had significantly worse segmental opacifications in CT (p < 0.05) and all thrombi were located in opacitated segments. There was no correlation between d-dimer level and number of occluded segmental arteries.

Conclusions

Thrombi in segmental pulmonary arteries are common in COVID-19 and are located in opacitated lung segments. This might suggest local clot formation.

中文翻译：

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肺动脉血栓与 SARS-CoV2 诱导的 ARDS 中的混​​浊位于同一位置。

目的

因感染 SARS-CoV-2 而住院的患者通常会出现肺炎。呼吸衰竭常因肺动脉节段性肺栓塞而并发。尚未研究肺栓塞与肺实质混浊的分布。

方法

包括 2020 年 3 月 8 日至 4 月 15 日期间在医疗重症监护室接受计算机断层扫描肺血管造影 (CTPA) 治疗的所有 COVID-19 患者。所有 CTPA 均由两名放射科医生独立评估肺段的实质变化和肺栓塞。

结果

在观察时间段内接受治疗的 22 名重症 COVID-19 患者中，16 名（年龄 60.4 ± 10.2 岁，6 名女性 SAPS2 评分 49.2 ± 13.9）接受了 CT。共分析了 288 个肺段。9/16 (56.3%) 名患者可检测到血栓，每名患者有 4.4 ± 2.9 个节段闭塞，整个队列有 40/288 (13.9%) 个节段受到影响。血栓患者在 CT 中的节段性混浊明显更差（p < 0.05），所有血栓均位于混浊节段。d-二聚体水平与闭塞的节段动脉数量之间没有相关性。

结论

节段性肺动脉血栓在 COVID-19 中很常见，并且位于混浊的肺段中。这可能表明局部凝块形成。