Persistent respiratory failure after SARS-CoV-2 infection: The role of dual energy computed tomography. A case report.
Radiol Case Rep
; 17(9): 3179-3184, 2022 Sep.
Article
in English
| MEDLINE | ID: covidwho-1907703
ABSTRACT
Background:
COVID-19 disease is often complicated by respiratory failure, developing through multiple pathophysiological mechanisms, with pulmonary embolism (PE) and microvascular thrombosis as key and frequent components. Newer imaging modalities such as dual-energy computed tomography (DECT) can represent a turning point in the diagnosis and follow-up of suspected PE during COVID-19. Case presentation A 78-year-old female presented to our internal medicine 3 weeks after initial hospitalization for COVID-19 disease, for recrudescent respiratory failure needing oxygen therapy. A computed tomography (CT) lungs scan showed a typical SARSCoV-2 pneumonia. Over the following 15 days, respiratory function gradually improved. Unexpectedly, after 21 days from symptom onset, the patient started complaining of breath shortening with remarkable desaturation requiring high-flow oxygen ventilation. CT pulmonary angiography and transthoracic echocardiography were negative for signs of PE. Thereby, Dual-energy CT angiography of the lungs (DECT) was performed and detected diffuse peripheral microembolism. After 2 weeks, a second DECT was performed, showing a good response to the anticoagulation regimen, with reduced extent of microembolism and some of the remaining emboli partially recanalized.Discussion:
DECT is an emerging diagnostic technique providing both functional and anatomical information. DECT has been reported to produce a much sharper delineation of perfusion defects than pulmonary scintigraphy, using a significantly lower equivalent dose of mSv. We highlight that DECT is particularly useful in SARS-Cov-2 infection, in order to determine the predominant underlying pathophysiology, particularly when respiratory failure prolongs despite improved lung parenchymal radiological findings.
ACE, angiotensin converting enzyme; CT, computed tomography; CTPA, CT pulmonary angiography; Case report; DECT, dual-energy computed tomography; Dual energy CT (DECT); ED, emergency department; LMWH, low molecular weight heparin; PE, pulmonary embolism; PPS, pulmonary perfusion scintigraphy; Persistent respiratory failure; Pulmonary microembolism; SARS-COV-2; TTE, trans-thoracic echocardiography; vWF, von Willebrand factor
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Type of study:
Case report
/
Cohort study
/
Prognostic study
Topics:
Long Covid
Language:
English
Journal:
Radiol Case Rep
Year:
2022
Document Type:
Article
Affiliation country:
J.radcr.2022.05.031
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