Pulmonary Thromboembolism in COVID-19: Initial Experience from India
Published: September 1, 2020 | DOI: https://doi.org/10.7860/JCDR/2020/45723.13987
Shekhar Kunal, Harnish Bhatia, Sohan Kumar Sharma, Shashi Mohan Sharma, Sudhir Bhandari
1. Senior Resident, Department of Cardiology, SMS Medical College, Jaipur, Rajasthan, India.
2. Senior Resident, Department of Cardiology, SMS Medical College, Jaipur, Rajasthan, India.
3. Associate Professor, Department of Cardiology, SMS Medical College, Jaipur, Rajasthan, India.
4. Senior Professor and Head, Department of Cardiology, SMS Medical College, Jaipur, Rajasthan, India.
5. Senior Professor, Department of Medicine, SMS Medical College, Jaipur, Rajasthan, India.
Correspondence
Dr. Sohan Kumar Sharma,
SMS Medical College, Jaipur, Rajasthan, India.
E-mail: drsohansharma@yahoo.com
Pulmonary thromboembolic complications are increasingly being recognised in Coronavirus Disease 2019 (COVID-19) infections. Most of the cases of Pulmonary Embolism (PE) are often missed in presence of non-specific symptoms. The present report is about a 90-year-old COVID-19 positive male, asymptomatic on presentation, with no prior co-morbidities who developed acute onset shortness of breath along with elevated D-dimer levels four days post admission. Subsequently, a Computed Tomography Pulmonary Angiogram (CTPA) was done which revealed segmental and sub-segmental thromboembolism in upper and middle lobar branches of right pulmonary artery along with bilateral lower lobe ground-glass opacities consistent with COVID-19 pneumonia. As the patient was haemodynamically stable, he was managed conservatively on low molecular weight heparin and subsequently discharged on oral anti-coagulants. This report highlights the need for prompt evaluation of symptoms such as dyspnoea in COVID-19 patients and to rule out thromboembolic complications in them. In resource limited countries such as India with most of the COVID-19 centres having limited access to CT scans, triaging patients based on clinical suspicion and serially rising D-dimer levels may help identify those with thromboembolic complications.
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