Dyspnea in COVID-19: not just pneumonia

We present five cases of patients affected by severe SARS-CoV-2 pneumonia (COVID-19) complicated by acute pulmonary embolism (APE). The clinical presentation, D-dimer levels, and the time of appearance of the acute pulmonary embolism were different in every single case. First case was a 46-year-old man affected by bilateral pneumonia COVID-19 with a high D-dimer serum value on the first day of hospitalization. Computed tomography pulmonary angiography (CTPA) showed bilateral pulmonary embolism. Second case was a 51-year-old man affected by acute respiratory failure from bilateral pneumonia-COVID-19 with a significant and sudden increase of D-dimer levels on the twelfth day of illness, CTPA showed widespread bilateral embolism. Third case was a 62-year-old man affected by acute respiratory failure due to COVID-19 with persistently low D-dimer values but with HRCT evidence of vascular dilatation that is characteristic for the presence of thrombosis. The CTPA practiced subsequently ascertained the presence of diffuse segmental embolism. Fourth case was a 35year-old woman, with respiratory failure and severe dyspnea due to COVID-19. No elevation of D-dimer levels. Blood gas analysis (BGA) showed middle hypoxemia and normocapnia; on fifth day she performed CT angiography for persistent dyspnea and chest pain, that documented bilateral pulmonary embolism. Finally, fifth case was a 47 years old man, affected by acute respiratory failure due to bilateral pneumonia COVID-19 related, and normal D-dimer levels. CT angiography showed bilateral pulmonary embolism.