PET/CT identifies FDG uptake, but presently there is no role for Nuclear Medicine in COVID-19 [1, 2]. However, thrombophilia is reported, and pulmonary emboli described [3,4,5]. In an 85-year-old man with dilated cardiomyopathy referred to the hospital because of dyspnea and cough, CT revealed bilateral pleural effusion with lower lobe ground glass opacities, but nasopharyngeal swab was negative for COVID-19, and hemoptysis plus persistence of severe hypoxemia with hypocapnia raised the suspicion of pulmonary embolism. Owing to elevated creatinine level, pulmonary perfusion SPECT was preferred, and initially reported as abnormal, but not diagnostic of acute embolism, because of uptake defects mainly coinciding with parenchymal anomalies. Subsequently, a second swab revealed infection by SARS-CoV-2. The patient was transferred to a COVID Unit, developed respiratory failure and fever (38.5°), and died 3 days later; last D-dimer was 1299 ng/mL and LDH 350 U/L. The lung scan was then reviewed after fusion with last CT. Figures 1 and 2 show the presence in the perfusion SPECT images (left panel, upper row: transaxial and coronal slices; lower row: sagittal slice and three-dimensional rendering) of small peripheral uptake defects (white arrows and arrowhead). In the corresponding CT images (right panel: same disposition, scout image in the lower right corner), the red arrows point to the parenchymal areas corresponding to the perfusion defects, which appear normally ventilated. These findings suggest that lung perfusion SPECT could identify perfusion abnormalities in early phase of COVID-19. Further studies are desirable to establish whether this could be helpful for these patients.
References
Qin C, Liu F, Yen TC, Lan X. F-FDG PET/CT findings of COVID-19: a series of four highly suspected cases. Eur J Nucl Med Mol Imaging. 2020;47:1281–6.
Guedj E, Verger A, Cammilleri S. PET imaging of COVID-19: the target and the number [published online ahead of print, 2020 Apr 17]. Eur J Nucl Med Mol Imaging. 2020:1–2. https://doi.org/10.1007/s00259-020-04820-z.
Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia [published online ahead of print, 2020 Feb 19]. J Thromb Haemost. 2020. https://doi.org/10.1111/jth.14768.
Han H, Yang L, Liu R, Liu F, Wu KL, Li J, et al. Prominent changes in blood coagulation of patients with SARS-CoV-2 infection. Clin Chem Lab Med. 2020. https://doi.org/10.1515/cclm-2020-0188.
Rotzinger DC, Beigelman-Aubry C, von Garnier C, Qanadli SD. Pulmonary embolism in patients with COVID-19: time to change the paradigm of computed tomography [published online ahead of print, 2020 Apr 11]. Thromb Res. 2020;190:58–9. https://doi.org/10.1016/j.thromres.2020.04.011.
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Sciagrà, R., Rubino, F., Malandrino, D. et al. Are disease-related pulmonary perfusion abnormalities detectable in COVID-19 patients? Suspicious findings in a lung perfusion SPECT performed for ruling out classical pulmonary embolism. Eur J Nucl Med Mol Imaging 47, 2211–2213 (2020). https://doi.org/10.1007/s00259-020-04868-x
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DOI: https://doi.org/10.1007/s00259-020-04868-x