COVID-19 pneumonia: microvascular disease revealed on pulmonary dual-energy computed tomography angiography.

BACKGROUND

Increased prevalence of acute pulmonary embolism in COVID-19 has been reported in few recent studies. Some works have highlighted pathological changes on lung microvasculature with local pulmonary intravascular coagulopathy that may explain pulmonary artery thrombosis found on pulmonary computed tomography (CT) angiography. The objective of our study was to describe lung perfusion disorders assessed by pulmonary dual-energy CT (DECT) angiography in severe COVID-19 patients.

METHODS

This single center retrospective study included 85 consecutive patients with a reverse transcriptase-polymerase chain reaction diagnosis of SARS-CoV-2 who underwent a pulmonary DECT angiography between March 16

RESULTS

Twenty-nine patients (34%) were diagnosed with pulmonary artery thrombosis, mainly segmental (83%). Semi-quantitative analysis revealed parenchymal ischemia in 68% patients of the overall population, with no significant difference regarding absence or presence of pulmonary artery thrombosis (23

CONCLUSIONS

Pulmonary perfusion evaluated by iodine concentration maps shows extreme heterogeneity in COVID-19 patients and lower iodine levels in normal parenchyma. Pulmonary ischemic areas were more frequent and larger in patients with pulmonary artery thrombosis. Pulmonary DECT angiography revealed a significant number of pulmonary ischemic areas even in the absence of visible pulmonary arterial thrombosis. This may reflect microthrombosis associated with COVID-19 pneumonia.

Informations de copyright

2020 Quantitative Imaging in Medicine and Surgery. All rights reserved.

Déclaration de conflit d'intérêts

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/qims-20-708). The authors have no conflicts of interest to declare.