COVID-19 has a wide range of clinical presentations from asymptomatic cases to severe respiratory distress, multi-organ dysfunction, and death. Pulmonary embolism (PE) is the most feared and severe spectrum of venous thromboembolism (VTE). We present a case of healthy 25-year-old nonsmoking pregnant woman (gravid 2, no history of abortion/miscarriage) underwent an elective caesarean section at 39 weeks of gestation after uneventful pregnancy, whom afterwards exhibit clinical presentation of pulmonary embolism (PE) overlapping with severe COVID-19 pneumonia. The diagnosis was made based on severe oxygen desaturation, McConnel sign finding on POCUS and elevated d-dimer level (34.19 mcg/mL). Alteplase and low-molecular-weight heparin were used, immediately obtained clinical improvement. We should be warned about high or extremely elevated D-Dimer measurements and severe oxygen desaturation, as possible risk markers of severe COVID-19 pneumonia in patients with high clinical suspicion of PE. Thrombolysis could be an effective and safe therapy for PE in ARDS COVID-19 patients. Furthermore, we underline that POCUS, despite its inherent limitations, could be a flexible diagnostic and management tool in refractory ARDS due to COVID-19.
Key words: COVID-19, SARS-CoV-2, Pulmonary Embolism, Thrombolytic Therapy, Postpartum Period, Point-of-Care Ultrasound
|
