الفهرس 
RADIOLOGICAL LUNG ANATOMYOnly 14 pages are availabe for public view
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Abstract
COVID-19 is a highly infectious disease that has been spreading widely worldwide. It has been associated with thrombotic complications, pulmonary embolism has been arising as one of these complications that needs early diagnosis and management.
Our study aimed to discuss the prevalence of pulmonary embolism in Egyptian population who have COVID-19 pneumonia using CT pulmonary angiography.
This was a retrospective study done at Ain Shams University Hospitals that included 50 patients who were diagnosed with COVID-19 pneumonia either by PCR or by HRCT criteria and were clinically suspected to have acute pulmonary embolism.
It revealed high prevalence of acute pulmonary embolism in patients with COVID-19 (22 %), being more common in males, and associated with high D-dimer levels. These results should raise the importance of using contrast enhanced CT rather than routine non contrast CT in suspected patients. It also pointed to the site of embolism to be in segmental branches, which means that it is likely of thrombotic origin rather than embolic.
CONCLUSION
Pulmonary embolism is a relatively common complication during COVID-19 pandemic, and it is associated with high D-dimer levels.
This is one of the thrombotic complications of this disease which needs early recognition and management.
STUDY LIMITATIONS
Our study had several limitations. First, the number of patients included was small. Second, certain medical or biological data were not available due to the retrospective nature of our study. Third, our study did not include a control group to compare the prevalence of acute pulmonary embolism in a group of patients with COVID-19 pneumonia versus other types of pneumonia.
STRENGTHS & CLINICAL IMPLICATIONS
Our study has some strengths including the involvement of patients from the emergency department ED and regular ward, which are both underrepresented in available studies, adding valuable information to the expanding COVID-19 literature.
This study findings may have some relevant implications for clinicians: pulmonary thromboembolism is a highly probable clinical entity in COVID-19 patients, and clinicians should consider all COVID-19 patients at risk of venous thromboembolism, especially in the presence of deterioration of symptoms and high D-dimer levels, also including a CTPA scan in the diagnostic assessment of such individuals. The early recognition of PE risk factors can help physicians to start full-dose, anticoagulation therapy.
RECOMMENDATIONS
• We recommend conducting other multi-centric studies with larger sample size to assess the presence of other risk factors of pulmonary embolism in COVID-19 pneumonia to support therapeutic indications of starting the anti-coagulant therapy, and to better define the target population.
• Also involving artificial intelligence in the diagnosis of pulmonary embolism in COVID-19 patients as a tool to reduce radiologists’ workload, streamline workflow, improve diagnostic accuracy, and facilitate resource allocation.
• Early prediction of the occurrence of pulmonary embolism helps in recognizing the risky patients and early managing such complication, hence identification of early signs of PE is important as dilated vessel sign in HRCT.
• Also, the use of ECG gated CT pulmonary angiography in high-risk patients can increase the rate of detection of segmental and subsegmental emboli.
• Nowadays in the era of COVID-19, CORADS classification represents a significant predictor of developing acute PE, so it is important to identify the CORADS classification of each patient and accordingly recognizing the risk and probability of developing PE.