CT Pulmonary Angiographic Findings in COVID-19 patients with desaturation at Saraburi Hospital

Abstract

Introduction: After the pandemic of Coronavirus 2019 (Covid-19), many post-treatment patients suffered from dyspnea and needed oxygen support due to their lung response injury or other complications such as pulmonary embolism. Therefore, computed tomographic pulmonary angiography (CTPA) plays an important role in diagnosis.

Materials and methods: The CTPA findings of Covid-19 patients with dyspnea and desaturation at Saraburi hospital were retrospectively reviewed in the parameters, namely: CT features, distribution, severity, complications, and other findings. The patients who had had CTPA for more than 14 days after symptom-onset were categorized into different responses of lung injury pattern; organizing pneumonia (OP) pattern, acute fibrinous and organizing pneumonia (AFOP) pattern, and diffuse alveolar damage (DAD) pattern. Then correlation between response of lung injury pattern and survival rate was evaluated.

Result: A total 71 studies of CTPA were analyzed (68 patients). The common CT features were fibrosis (85.9%), bronchiectasis (81.6%), and architectural distortion (76.1%), respectively. The complications included barotrauma (14.1%) and pulmonary embolism (7.0%). There were 59 studies categorized into the response of lung injury pattern; 44 OP pattern (73.3%) with 38 alive patients (88.6%) (p= 0.000) and 4 DAD pattern (6.7%) with 3 dead patients (75%) (p=0.036).

Conclusion: CTPA in desaturated Covid-19 pneumonia patients does not only exclude vascular cause e.g. pulmonary embolism, but also gives information of radiographic findings of lung parenchyma according to lung injury response patterns, which possibly correlate with death.