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Covid‐19 pneumonia and pulmonary embolism

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Synchronous presentation of COVID‐19 pneumonia and pulmonary embolism
Farid Poursadegh, Najmeh Davoudian, Mahnaz Mozdourian, Fahimeh Abdollahi

First published: 27 January 2021, https://doi.org/10.1002/ccr3.3870


Simultaneous diagnosis of COVID‐19 pneumonia and pulmonary embolism without any deep vein thrombosis nor predisposing hypercoagulable states was observed. Therefore, patients with COVID‐19 pneumonia who suffer from worsening of the clinical respiratory symptoms, after the beginning of the treatment, should be evaluated for pulmonary embolism using CT angiography, if safe.



Previous studies evidenced that SARS‐CoV‐2 stimulates the coagulation pathway, resulting in abnormal coagulation parameters and endothelial dysfunction. These make the important factor of increased D‐dimer level a poor prognostic factor for patients with COVID‐19.10, 11 Also, the biopsy examination of patients who died with the diagnosis of COVID‐19 has revealed histomorphologically diffuse alveolar damage confirming the COVID‐19–induced coagulopathy.

In our case, as a patient with COVID‐19 presented with pulmonary embolism without any previous predisposing hypercoagulable risk factor, the level of protein C and protein S had decreased with a considerable rise in D‐dimer. In another study by Panigada et. al., opposite results have been reported. By assessing 24 COVID‐19 patients in the intensive care unit, they have reported an increase in the level of protein C and a marginal decrease in the level of protein S.

The kinetics and robustness of the immune response to COVID‐19 are yet to be known. Recent studies show that respiratory failure in COVID‐19 patients is not only caused by respiratory distress but also microscopic clot formation processes. This finding may be a clue to a better understanding of the treatment of these patients. There is a strong relationship between the levels of D‐dimer molecule and disease progression and CT scan findings in these patients, which indicates the cause of venous clots in them.

Some studies also show that there is not a direct relationship between D‐dimer levels and disease severity. Accordingly, imaging studies have confirmed that COVID‐19 syndrome is an inflammatory, clotting‐inflammatory process that negatively affects lung function, and in later stages, affects other organs in the body.

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