Acute Pulmonary Embolism in COVID-19: A Potential Connection between Venous Congestion and Thrombus Distribution
Franck Nevesny,
David C. Rotzinger,
Alexander W. Sauter,
Laura I. Loebelenz,
Lena Schmuelling,
Hatem Alkadhi,
Lukas Ebner,
Andreas Christe,
Alexandra Platon,
Pierre-Alexandre Poletti,
Salah D. Qanadli
Affiliations
Franck Nevesny
Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, 21079 Dijon, France
David C. Rotzinger
Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), 1011 Lausanne, Switzerland
Alexander W. Sauter
Department of Radiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
Laura I. Loebelenz
Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
Lena Schmuelling
Department of Radiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
Hatem Alkadhi
Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, 8006 Zurich, Switzerland
Lukas Ebner
Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
Andreas Christe
Department of Radiology, Division City and County Hospitals, Inselgroup, Bern University Hospital, University of Bern, 3004 Bern, Switzerland
Alexandra Platon
Service of Radiology Division of Clinical Epidemiology Service of Radiology, Geneva University Hospital, 1205 Geneva, Switzerland
Pierre-Alexandre Poletti
Service of Radiology Division of Clinical Epidemiology Service of Radiology, Geneva University Hospital, 1205 Geneva, Switzerland
Salah D. Qanadli
Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), 1011 Lausanne, Switzerland
Background: Vascular abnormalities, including venous congestion (VC) and pulmonary embolism (PE), have been recognized as frequent COVID-19 imaging patterns and proposed as severity markers. However, the underlying pathophysiological mechanisms remain unclear. In this study, we aimed to characterize the relationship between VC, PE distribution, and alveolar opacities (AO). Methods: This multicenter observational registry (clinicaltrials.gov identifier NCT04824313) included 268 patients diagnosed with SARS-CoV-2 infection and subjected to contrast-enhanced CT between March and June 2020. Acute PE was diagnosed in 61 (22.8%) patients, including 17 females (27.9%), at a mean age of 61.7 ± 14.2 years. Demographic, laboratory, and outcome data were retrieved. We analyzed CT images at the segmental level regarding VC (qualitatively and quantitatively [diameter]), AO (semi-quantitatively as absent, 50% involvement), clot location, and distribution related to VC and AO. Segments with vs. without PE were compared. Results: Out of 411 emboli, 82 (20%) were lobar or more proximal and 329 (80%) were segmental or subsegmental. Venous diameters were significantly higher in segments with AO (p = 0.031), unlike arteries (p = 0.138). At the segmental level, 77% of emboli were associated with VC. Overall, PE occurred in 28.2% of segments with AO vs. 21.8% without (p = 0.047). In the absence of VC, however, AO did not affect PE rates (p = 0.94). Conclusions: Vascular changes predominantly affected veins, and most PEs were located in segments with VC. In the absence of VC, AOs were not associated with the PE rate. VC might result from increased flow supported by the hypothesis of pulmonary arteriovenous anastomosis dysregulation as a relevant contributing factor.
