PMC8721424_01
(a) CXR image shows diffuse bilateral airspace consolidation with sparing of the lung apices. (b) CXR image shows marked interval improvement in appearances of the left and right hemithorax with some residual infiltrates. (c) CXR image showing almost complete resolution of previous infiltrates.
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Arterial blood gas on 40% oxygen revealed mild alkalosis and an urgent chest X-ray (CXR) (Figure 1(a)) was performed. Repeat CXR was performed at 8 weeks (Figure 1(b)) and 3 months (Figure 1(c)).
Axial view of CTPA: (a) pulmonary embolism in the left upper lobar pulmonary artery extending towards segmental and subsegmental branches. Further pulmonary embolism identified in the middle lobar pulmonary artery. (b) Widespread bilateral consolidation with sparing of the lung apices bilaterally likely representing COVID-19-related pneumonia.
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D-Dimer, tachycardia and persistent oxygen requirements prompted a computed tomography pulmonary angiogram (CTPA) (Figure 2(a) and (b)) which confirmed pulmonary embolism (PE). Despite an ICU stay of 8 days, she never required intubation.
A line graph depicting HR increments and BP response on active stand testing: (a) Day 4 - during acute phase of illness; (b) Day 7 - trialled on Bisoprolol 2.5 mg post exclusion of other causes; and (c) 12-week follow-up - HR remained > 30 bpm on 10 min of standing despite up titration to Bisoprolol 3.75 mg. No postural drop in blood pressure was noted on all three occasions.
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An active stand test demonstrated increased heart rate by 38 bpm from supine after 10 min of standing on Day 4 (Figure 3).