COVID-19 Presenting as Acute Bilateral Submassive Pulmonary Embolism in a Young Healthy Female

Abstract

Similar symptoms, signs, and laboratory abnormalities between coronavirus disease 2019 (COVID-19) and pulmonary embolism (PE) creates a diagnostic challenge to every physician, and emerging data show an association between COVID-19, hypercoagulable state, and venous thromboembolism. We present a rare case of COVID-19 presented as bilateral sub-massive PE. A 28-year-old COVID-19 positive female with no significant past medical history presented with a dry cough and shortness of breath for three days. Initial laboratory test showed elevated D-dimer, electrocardiogram (EKG) showed right axis deviation, right ventricular strain pattern, and S(I) Q(III) T(III) pattern, and echocardiogram (ECHO) showed right ventricular dysfunction. Those two bedside tests directed the urgency of chest CT angiography that showed bilateral sub-massive PE. Since EKG finding of S(I) Q(III) T(III) pattern and right ventricular strain, and ECHO finding of right ventricular dysfunction are well described in PE but not in COVID-19, these bedside diagnostic tools can help identify COVID-19 patients with underlining PEs.