Infiltrative Shadows in COVID-19: Pneumonia or Pulmonary Embolism?

A 56-year-old black man was referred to our hospital for the assessment of a fever that had persisted for 14 days His SpO2 was 88% on ambient air He did not complain of any symptoms other than a fever As he had worked in a highly endemic area in Tokyo, a nasopharyngeal swab was taken for SARS-CoV2 reverse transcription polymerase chain reaction (RT-PCR), which was positive Chest computed to-mography (CT) revealed bilateral patchy ground-glass opaci-ties and infiltrative shadows (Picture 1A) For a further investigation , we performed contrast-enhanced CT, which detected a filling defect at the pulmonary trunk (Picture 1B) His blood tests revealed an elevated D-dimer level of 29 1 mg/dL At night on the day of admission, his hypoxemia deteriorated After two days on intravenous heparin and favipi-ravir, his symptoms subsided His D-dimer level decreased promptly but still showed a positive result of 4 6 mg/dL on Day 43 Pulmonary embolus has been reported to be associated with invasive mechanical ventilation (1) Chest CT plays an important role in the management of patients with COVID-19, but consolidation is relatively common in the late second week of COVID-19 (2) Contrast-enhanced CT might therefore be a powerful tool for excluding alternate diagnoses or added pathologies Ethics Approval Ethics approval for a retrospective analysis of routinely col