Cegolon, L.

Einollahi, B.

Ghahderijani, B.H.

Izadi, M.

Jafari, A.

Jafari, R.

Javanbakht, M.

Kashaki, M.

Otoukesh, B.

Saadat, S.H.

eprints Iran University of Medical Sciences

CARDIOVASCULAR FLASHLIGHT doi:10.1093/eurheartj/ehaa402Online publish-ahead-of-print 6 May 2020....................................................................................................................................................Large saddle pulmonary embolism in a woman infected by COVID-19pneumoniaRamezan Jafari1,2, Luca Cegolon3,4, Atefeh Jafari5, Mandana Kashaki6, Babak Otoukesh7,8, Bahareh HeshmatGhahderijani9, Morteza Izadi2, Seyed Hassan Saadat10,11, Behzad Einollahi11, and Mohammad Javanbakht11*1Department of Radiology, Baqiyatallah University of Medical Sciences, Tehran, Iran; 2Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran;3Local Health Unit N. 2 ‘Marca Trevigiana’ Public Health Department, Treviso, Italy; 4Institute for Maternal & Child Health, IRCCS ‘Burlo Garofolo’, Trieste, Italy;5Department of Clinical Pharmacy, School of Pharmacy, Guilan University of Medical Sciences, Rasht, Iran; 6Shahid Akbarabadi Clinical Research Development Unit(ShACRDU), Iran University of Medical Sciences (IUMS), Tehran, Iran; 7Bone and Joint Reconstruction Research Center, Iran University of Medical Sciences, Tehran, Iran;8Department of Orthopedic and Traumatology, Universit€atsklinikum Bonn, Bonn, Germany; 9MD, Radiologist; 10Behavioral Science Research Center, Lifestyle Institute,Baqiyatallah University of Medical Sciences, Tehran, Iran; and 11Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran* Corresponding author: Email: mhmjvbt81@yahoo.comA 50-year-old woman was admittedto the Accident & Emergencydepartment of Baqiyatallah hospitalin Tehran (Iran), with symptoms offever, dyspnoea, dry cough, andfatigue for the past 4 days.At physical examination, she hadenhanced body temperature(38.1 C), a heart rate of 100 b.p.m.,a respiratory rate of 22 breaths/min,and O2 saturation of 92%. Laboratory tests revealed an increasedwhite blood cell count (WBC ¼13.5  103/lL), increased platelets(PLT ¼ 475 103/lL), polynuclear(80%); partial thromboplastin time(PTT¼ 5 s), PTLab/INRLab (¼1.31 s);prothrombin test (PT ¼ 18.2 s); andD-dimer (10 ng/mL). Further ele-vated values were found for C-reac-tive protein (CRP ¼ 30.3 mg/L),erythrocyte sedimentation rate(ESR ¼ 57 mm/h); serum glutamic-pyruvic transaminase (SGPT ¼ 108lL); lactate dehydrogenase (LDH ¼983lL); and amylase serum (278lL). Reverse transcription–PCR forCOVID-19 was positive and thepatient was given oxygen andtreated with hydroxychloroquine,dimenhydrinate, and naproxen.On day 2 after admission, a chest CT scan without contrast evidenced bilateral diffuse multiple patchy and subpleural consolidations withleft pleural effusion—radiological findings consistent with COVID-19 pneumonia (Panel A). On day 3 following admission, the patient sud-denly developed severe dyspnoea, with O2 saturation decreasing to 74%. A chest computed tomography angiography (CTA) was per-formed, which revealed a large saddle pulmonary embolism in the main pulmonary artery (MPA), right pulmonary artery (RPA), and leftpulmonary artery (LPA) (Panel B). From day 3 of hospitalization, the patient received anticoagulation therapy with heparin and antithrom-botic treatment.The patient remained in hospital for a further 7 days before being discharged in stable condition, with O2 saturation increased to 98%,body temperature of 37.2 C, negative PCR, and normal laboratory tests.Published on behalf of the European Society of Cardiology. All rights reserved. VC The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.Cardiovascular flashlight 2133Downloaded from https://academic.oup.com/eurheartj/article/41/22/2133/5831089 by Tehran University of Medical Science user on 20 September 2020

Large saddle pulmonary embolism in a woman infected by COVID-19 pneumonia

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Large saddle pulmonary embolism in a woman infected by COVID-19 pneumonia

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