Diagnosis of pulmonary embolism in patients with viral pneumonia using multislice spiral computed tomographic angiography
Authors: Kalinina Ekaterina P. , Belova Irina B. 
Published: July 2024

BACKGROUND: Viral pneumonia represents a significant and potentially life-threatening complication of coronavirus infection. It can result in a range of adverse outcomes, including pulmonary embolism. However, the prevalence of pulmonary embolism in these patients remains poorly understood. Multispiral computed tomographic angiography offers a valuable tool for studying the unique characteristics of radiation diagnostics in this disease and identifying specific signs of this complication.
AIM: The aim of this study is to improve the diagnosis of pulmonary embolism in patients with SARS-CoV-2 virus-induced pneumonia using multispiral computed tomographic angiography.
MATERIALS AND METHODS: A retrospective review of medical records and multispiral computed tomographic angiography data from 200 patients with viral pneumonia (COVID-19) who were treated between May 25, 2021, and October 15, 2021, for suspected pulmonary embolism based on laboratory findings was conducted.
RESULTS: Of the total number of patients (58.5% female, 41.5% male), the majority were aged between 60 and 69 years. Pulmonary embolism was confirmed in 42 patients, which constituted 21% of the total number. This group included 36% males and 62% females. When the localization of thromboemboli was assessed, it was found that 64.3% of cases had a peripheral localization, 24% of cases had thromboemboli at the level of lobular branches, 7.1% of cases had thromboemboli in the main arteries and pulmonary trunk, and 4.6% of cases had thromboemboli in the pulmonary trunk. In the assessment of pulmonary perfusion disorders, the majority of patients exhibited a degree of severity classified as I (78.6%), with a smaller proportion classified as III or IV (11.9% and 9.5%, respectively). A statistical analysis of the incidence of pulmonary embolism in patients with varying degrees of pneumonia severity revealed that in over half of the cases, the condition was confirmed in patients with minimal pulmonary parenchyma lesions. Specifically, 22 (52.4%) patients exhibited this pattern. The second part accounted for 16.6% of cases with critical severity of pneumonia, 16.7% with moderate severity, 11.9% with significant severity, and only 2.4% of cases with regression of inflammatory infiltration. Among patients with pulmonary embolism, pneumonia was in the advanced stage in 35.7% of cases, the peak stage in 33.3%, the incomplete stage in 21.4%, the early stage in 7.2%, and the resolution stage in 2.4%. However, when comparing the severity and stage of pneumonia in patients with confirmed and unconfirmed pulmonary embolism, no statistically significant differences between these parameters were found (p 0.05).
CONCLUSIONS: Among patients with suspected pulmonary embolism and viral pneumonia, 21% had a confirmed diagnosis. Of these, 64.3% had a peripheral localization of thromboemboli, 78.6% had grade I impairment of pulmonary perfusion, and most cases were in the advanced (35.7%) and peak (33.3%) stages of pneumonia. There was no correlation between the incidence of pulmonary embolism, severity, and stage of viral pneumonia.