• Arch. Bronconeumol. · Jan 2021

    Observational Study

    Blue Lungs in Covid-19 Patients: A Step beyond the Diagnosis of Pulmonary Thromboembolism using MDCT with Iodine Mapping.

    • Virginia Pérez Dueñas, María Allona Krauel, Emilio Agrela Rojas, Maria Teresa Ramírez Prieto, Laura Díez Izquierdo, Ulpiano López de la Guardia, and Isabel Torres Sánchez.
    • Servicio de Radiología, HM Hospitales, Hospital Universitario HM Sanchinarro, Madrid, España. Electronic address: vperez@hmhospitales.com.
    • Arch. Bronconeumol. 2021 Jan 1; 57 Suppl 1: 35-46.

    ObjectiveTo evaluate the diagnostic capacity of pulmonary angiography with multidetector computed tomography (MDCT) and iodine mapping in the diagnosis of pulmonary thromboembolism (PTE) in patients with Covid-19 disease.MethodsRetrospective observational study of 81 consecutive patients admitted with Covid-19 respiratory infection who underwent MDCT for clinical suspicion of PTE (sudden dyspnea, chest pain, hemoptysis, severe respiratory failure (SRF) not corrected with high O2 flow) and/or raised D-dimer.ResultsOf the 81 patients studied [64 (79.01%) men], acute PTE was identified in 22 (27.16%), bilaterally in 13 (59.09%), and 13 (59,09%) showed areas of hypoperfusion. Of the 59 (72.83%) patients without PTE, hypoperfusion was observed in 41 (69.49%) (attributable in one case to pulmonary emphysema). In 18 (22.2%) of the total number of patients, neither PTE nor hypoperfusion were seen. A crazy paving pattern is a risk factor for developing PTE (OR 1.94; 95% CI 0.28-13.57), as are consolidations (OR 1.44; 95% CI 0.24-8.48) and septal thickening/bronchiectasis (OR 1.47; 95% CI 0.12-17.81). Patients with O2-refractory SRF showed a 6.36-fold higher risk for hypoperfusion on the iodine map.ConclusionBy adding the functional image to the anatomical image, pulmonary angiography with MDCT and iodine mapping can demonstrate not only PTE in main, lobar and segmental arteries, but also the presence of hypoperfusion in distal vessels. This makes it a highly useful tool for the accurate diagnosis and therapeutic orientation of patients with Covid-19 lung involvement.Copyright © 2020 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

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