Case report of SARS Co-V2 infection, acute pulmonary embolism, and right ventricular thrombus

Vervaat, Fabienne E; Houthuizen, Patrick

BACKGROUND: COVID-19 is a novel disease that has been associated with changes in haemostasis and increased risk of thrombosis, especially in patients who are critically ill. CASE SUMMARY: a 71-year-old patient presented to the emergency department with acute respiratory failure. The patient had been discharged from the hospital 1 day before, after apparent recovery of a proven COVID-19 infection. Relevant medical history reports polycythemia vera. The diagnostic work-up included a CT-scan of the thorax, revealing bilateral sub-segmental pulmonary embolism. An echocardiogram showed a dilated right ventricle with poor systolic function and a large multi-lobar thrombus. Forty-eight hours after initiation of treatment with therapeutic anticoagulation the thrombus was no longer seen on the echocardiogram. DISCUSSION: This case confirms the high risk of thrombosis in COVID-19 infection as has been described in recent literature. It demonstrates the severity of the coagulopathy given the presence of both bilateral sub-segmental pulmonary embolism and right ventricular thrombus, despite treatment with prophylactic anticoagulation. Remarkable in this case is the fact that the patient had a myeloproliferative neoplasm (polycythaemia vera). This is associated with an increased risk of thrombosis, especially in the presence of erythrocytosis, leucocytosis, and/or inflammation.