Clin Pract Cases Emerg Med. 2020 Aug;4(3):299-303. doi: 10.5811/cpcem.2020.7.48174.
INTRODUCTION: There is recent evidence that coronavirus disease 2019 (COVID-19) infection results in a prothrombotic state that may increase the risk of venous thromboembolism. Both COVID-19 infection and pulmonary emboli can present with dyspnoea, tachypnoea, hypoxaemia and an elevated D-dimer. Identifying a pulmonary embolus in a patient with COVID-19 and differentiating it from the typical clinical and biochemical features of COVID-19 is challenging.
CASE REPORTS: We report four cases, and reviewed two further cases in the literature, of a pulmonary embolus in patients who presented to the emergency department with COVID-19 and no other risk factor for a pulmonary embolus.
CONCLUSION: We identified a series of atypical features that should raise suspicion for a pulmonary embolus: pleuritic chest pain; haemoptysis; atrial fibrillation; tachycardia; hypotension; late onset deterioration; evidence of right heart strain; or a disproportionally elevated D-dimer in comparison to ferritin.