Hemoptysis in COVID-19 pulmonary embolism patient: a case report

Rika Bur; Meutia Gebrina; Muhammad Maulana Wildani; Bayu Bijaksana Rumondor; Yarmaniani Miliati Muchtar; Suprohaita Rusdi Talib; Febby Elvanesa Sandra Dewi; Gita Maria

doi:10.15562/bmj.v12i3.4767

Hemoptysis in COVID-19 pulmonary embolism patient: a case report

Rika Bur ,

Meutia Gebrina ,

Muhammad Maulana Wildani ,

Bayu Bijaksana Rumondor ,

Yarmaniani Miliati Muchtar ,

Suprohaita Rusdi Talib ,

Febby Elvanesa Sandra Dewi ,

Gita Maria ,

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DOI: https://doi.org/10.15562/bmj.v12i3.4767 |
Published: 2023-11-07

Abstract

Link of video abstract: https://youtu.be/LsOAYx2sZmw

Background: Coronavirus disease 2019 (COVID-19) is related to hypercoagulability and venous thromboembolism (VTE). The overlapping symptoms of COVID-19 linked to acute respiratory distress syndrome (ARDS) and COVID-19 with concomitant pulmonary embolism (PE) provide a diagnostic difficulty for emergency physicians. This case study aims to evaluate the hemoptysis in COVID-19 pulmonary embolism patient.

Case presentation: A 46-year-old woman with COVID-19 complained of a bloody cough (estimated 10 ml). She had COVID-19 five days before presenting. Vital signs were normal, but the respiratory rate went 30 times per minute. A lab test revealed 838.64 ng/ml of D-dimer. A chest x-ray showed bilateral lower lobes opacity. The first HRCT showed consolidation with fibrosis and minimal traction bronchiectasis in the 7th and 8th segment of the right lower lobe, an atypical sign of a COVID-19 lesions. The patient was later hospitalized in a negative pressure chamber, given heparin for 72 hours, and discharged on an oral anticoagulant.

Conclusions: This is one of the first reports of segmental PE in a COVID-19 patient with no VTE risk factor. Emergency care doctors must be aware of the possible link between COVID-19 and PE. Hemoptysis is uncommon in PE patients and is seldom documented in COVID-19 infections. All suspected or confirmed COVID-19 patients should begin thromboprophylaxis to avoid morbidity and death.

References

Peys E, Stevens D, Weygaerde YV, Malfait T, Hermie L, Rogiers P, et al. Hemoptysis as the first presentation of COVID-19: a case report. BMC Pulmonary Medicine. 2020;20(1):1-4.
Casey K, Iteen A, Nicolini R, Auten J. COVID-19 pneumonia with hemoptysis: acute segmental pulmonary emboli associated with novel coronavirus infection. The American Journal of Emergency Medicine. 2020;38(7):1544.e1-1544.e3.
Stals M, Kaptein F, Kroft L, Klok F, Huisman M. Challenges in the diagnostic approach of suspected pulmonary embolism in COVID-19 patients. Postgraduate Medicine. 2021;133(Suppl 1):36-41.
Ogunleye O, Ajibola O, Chukwu N, Suseelan H. A comparison of two cases presenting with hemoptysis attributable to covid-19 pnemonia. Chest. 2021;160(4):A326.
Pasula S, Chandrasekar P. Spontaneous hemoptysis in a patient with COVID-19. Chest. 2021;160(1):39-44.
Barış SA, Coşkun İS, Selvi G, Boyacı H, Başyiğit İ. Case series of COVID-19 presenting with massive hemoptysis. Turkish Thoracic Journal. 2020;21(6):454-456.
Davidson K, Shojaee S. Managing massive hemoptysis. Chest. 2020;157(1):77-88.
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The lancet. 2020;395(10223):497-506.
Xu X-W, Wu X-X, Jiang X-G, Xu K-J, Ying L-J, Ma C-L, et al. Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series. BMJ. 2020;1(1):368.
Cui S, Chen S, Li X, Liu S, Wang F. Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia. Journal of Thrombosis and Haemostasis. 2020;18(6):1421-1424.
Klok F, Kruip M, Van der Meer N, Arbous M, Gommers D, Kant K, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thrombosis Research. 2020;191:145-147.
Stein PD, Terrin ML, Hales CA, Palevsky HI, Saltzman HA, Thompson BT, et al. Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease. Chest. 1991;100(3):598-603.
Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. Jama. 2020;323(11):1061-1069.
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The lancet. 2020;395(10229):1054-1062.
Prabawa IMY, Silakarma D, Prabawa IPY, Manuaba IBAP. Physical rehabilitation therapy for long COVID-19 patient with respiratory sequelae: A systematic review. Open Access Macedonian Journal of Medical Sciences. 2022;10(F):468-474.
Pranata S, Vranada A, Armiyati Y, Samiasih A, Aisah S, Kurnia A, et al. Inflammatory markers for predicting severity, mortality, and need for intensive care treatments of a patient infected with covid-19: a scoping review. Bali Medical Journal. 2023;12(1):324–330.
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Kline J, Mitchell A, Kabrhel C, Richman P, Courtney D. Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. Journal of Thrombosis and Haemostasis. 2004;2(8):1247-1255.

[1] Peys E, Stevens D, Weygaerde YV, Malfait T, Hermie L, Rogiers P, et al. Hemoptysis as the first presentation of COVID-19: a case report. BMC Pulmonary Medicine. 2020;20(1):1-4.

[2] Casey K, Iteen A, Nicolini R, Auten J. COVID-19 pneumonia with hemoptysis: acute segmental pulmonary emboli associated with novel coronavirus infection. The American Journal of Emergency Medicine. 2020;38(7):1544.e1-1544.e3.

[3] Stals M, Kaptein F, Kroft L, Klok F, Huisman M. Challenges in the diagnostic approach of suspected pulmonary embolism in COVID-19 patients. Postgraduate Medicine. 2021;133(Suppl 1):36-41.

[4] Ogunleye O, Ajibola O, Chukwu N, Suseelan H. A comparison of two cases presenting with hemoptysis attributable to covid-19 pnemonia. Chest. 2021;160(4):A326.

[5] Pasula S, Chandrasekar P. Spontaneous hemoptysis in a patient with COVID-19. Chest. 2021;160(1):39-44.

[6] Barış SA, Coşkun İS, Selvi G, Boyacı H, Başyiğit İ. Case series of COVID-19 presenting with massive hemoptysis. Turkish Thoracic Journal. 2020;21(6):454-456.

[7] Davidson K, Shojaee S. Managing massive hemoptysis. Chest. 2020;157(1):77-88.

[8] Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The lancet. 2020;395(10223):497-506.

[9] Xu X-W, Wu X-X, Jiang X-G, Xu K-J, Ying L-J, Ma C-L, et al. Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series. BMJ. 2020;1(1):368.

[10] Cui S, Chen S, Li X, Liu S, Wang F. Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia. Journal of Thrombosis and Haemostasis. 2020;18(6):1421-1424.

[11] Klok F, Kruip M, Van der Meer N, Arbous M, Gommers D, Kant K, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thrombosis Research. 2020;191:145-147.

[12] Stein PD, Terrin ML, Hales CA, Palevsky HI, Saltzman HA, Thompson BT, et al. Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease. Chest. 1991;100(3):598-603.

[13] Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. Jama. 2020;323(11):1061-1069.

[14] Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The lancet. 2020;395(10229):1054-1062.

[15] Prabawa IMY, Silakarma D, Prabawa IPY, Manuaba IBAP. Physical rehabilitation therapy for long COVID-19 patient with respiratory sequelae: A systematic review. Open Access Macedonian Journal of Medical Sciences. 2022;10(F):468-474.

[16] Pranata S, Vranada A, Armiyati Y, Samiasih A, Aisah S, Kurnia A, et al. Inflammatory markers for predicting severity, mortality, and need for intensive care treatments of a patient infected with covid-19: a scoping review. Bali Medical Journal. 2023;12(1):324–330.

[17] Nareswari T, Prihharsanti CHN, Sukmaningytyas H, Ningrum FH, Satoto B, Santoso AG. A review of chest X-ray in pulmonary hypertension: correlation of right descending pulmonary artery diameter with mean pulmonary artery pressure. Bali Medical Journal. 2021;10(1):467–469.

[18] Kusumawardani RI, Tinduh D, Andriati, Poerwandari D, Marhana IA, Melaniani S. The effectiveness of incentive spirometry exercise on pulmonary function in COVID-19 survivors: a randomized controlled trial study. Bali Medical Journal. 2023;12(1): 539–544.

[19] Kline J, Mitchell A, Kabrhel C, Richman P, Courtney D. Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. Journal of Thrombosis and Haemostasis. 2004;2(8):1247-1255.

Hemoptysis in COVID-19 pulmonary embolism patient: a case report

Abstract

References

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