PDF(Pubmed)
Abstract：
Background: COVID-19 disease is often complicated by respiratory failure, developing through multiple pathophysiological mechanisms, with pulmonary embolism (PE) and microvascular thrombosis as key and frequent components. Newer imaging modalities such as dual-energy computed tomography (DECT) can represent a turning point in the diagnosis and follow-up of suspected PE during COVID-19. Case presentation: A 78-year-old female presented to our internal medicine 3 weeks after initial hospitalization for COVID-19 disease, for recrudescent respiratory failure needing oxygen therapy. A computed tomography (CT) lungs scan showed a typical SARSCoV-2 pneumonia. Over the following 15 days, respiratory function gradually improved. Unexpectedly, after 21 days from symptom onset, the patient started complaining of breath shortening with remarkable desaturation requiring high-flow oxygen ventilation. CT pulmonary angiography and transthoracic echocardiography were negative for signs of PE. Thereby, Dual-energy CT angiography of the lungs (DECT) was performed and detected diffuse peripheral microembolism. After 2 weeks, a second DECT was performed, showing a good response to the anticoagulation regimen, with reduced extent of microembolism and some of the remaining emboli partially recanalized. Discussion: DECT is an emerging diagnostic technique providing both functional and anatomical information. DECT has been reported to produce a much sharper delineation of perfusion defects than pulmonary scintigraphy, using a significantly lower equivalent dose of mSv. We highlight that DECT is particularly useful in SARS-Cov-2 infection, in order to determine the predominant underlying pathophysiology, particularly when respiratory failure prolongs despite improved lung parenchymal radiological findings.
摘要：
背景:COVID-19疾病常并发呼吸衰竭,通过多种病理生理机制发展，肺栓塞（PE）和微血管血栓形成是关键和常见的组成部分。较新的成像方式，如双能量计算机断层扫描(DECT)，可以代表COVID-19期间疑似PE的诊断和随访的转折点。病例介绍：一名78岁女性在因COVID-19疾病初次住院3周后就诊于我们的内科，用于需要氧疗的复发性呼吸衰竭。计算机断层扫描（CT）肺部扫描显示典型的SARSCoV-2肺炎。在接下来的15天里，呼吸功能逐渐改善。出乎意料的是,症状发作21天后，患者开始抱怨呼吸缩短和显著的去饱和,需要高流量氧气通气.CT肺动脉造影和经胸超声心动图检查均未显示PE征象。因此，进行了肺部双能量CT血管造影（DECT）并检测到弥漫性外周微栓塞。2周后,进行了第二次DECT，对抗凝方案反应良好，微栓塞程度降低，部分剩余栓塞部分再通。讨论：DECT是一种新兴的诊断技术，可提供功能和解剖信息。据报道，DECT比肺部闪烁显像产生更清晰的灌注缺陷轮廓，使用显著较低等效剂量的mSv。我们强调DECT在SARS-Cov-2感染中特别有用，为了确定主要的潜在病理生理学，特别是当呼吸衰竭延长，尽管改善肺实质的放射学结果。
