COVID-19 Complicated by Acute Pulmonary Embolism

We report two cases from Wuhan, China, presenting with fever, cough, and dyspnea secondary to COVID-19 (formerly known as 2019 novel coronavirus [2019-nCoV]) pneumonia, confirmed with real-time fluorescence polymerase chain reaction test and presenting with typical findings at CT (1, 2); these cases evolved with respiratory deterioration and elevated serum D-dimer level. Figure 1 illustrates the case of a 57-year-old man admitted to the hospital for 10 days; unenhanced chest CT on day 10 from the onset of fever showed bilateral peripheral ground-glass opacities (Fig 1, A). CT pulmonary angiography performed on day 2 of admission helped diagnose acute pulmonary embolism (Fig 1, B). Figure 2 depicts the case of a 70-year-old man admitted to the hospital for 7 days; unenhanced chest CT on admission showed bilateral ground-glass opacities and consolidation in a peripheral distribution (Fig 2, A). CT pulmonary angiography 6 days after admission confirmed acute pulmonary embolism (Fig 2, B). Acute pulmonary embolism is a cause of clinical deterioration in viral pneumonias (3, 4). As patients with COVID-19 are admitted for treatment and isolation, it is important to follow prophylactic measures for avoiding venous thromboembolism. In this scenario, respiratory deterioration with other clinical evidence of venous thrombosis should raise suspicion for pulmonary embolism.