Saddle Pulmonary Embolism: Causes, Symptoms, and Treatments

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COVID-19 And Pulmonary Embolism: Is There A Connection?

Cases of COVID-19, particularly severe ones, may increase a person's risk of developing a pulmonary embolism.

COVID-19 is a highly contagious, rapidly spreading illness. It can cause pneumonia, cold, or flu-like symptoms. The condition is often mild, but in some cases, it can be severe or even fatal.

The virus can affect several areas of the body. Even people with mild or no symptoms may develop long lasting issues.

A pulmonary embolism is a blood clot that breaks free and travels to the lungs. The clot cuts off blood supply to the lungs and can be fatal.

Several studies suggest that having COVID-19 may increase a person's risk of developing a pulmonary embolism.

This article explores what scientists have learned about COVID-19 and pulmonary embolism.

Several studies examined how COVID-19 may connect to pulmonary embolism. Researchers started exploring this relationship in 2020, during the height of the pandemic.

In a 2020 case study, researchers described the case of a bilateral pulmonary embolism that occurred following a positive COVID-19 case. The researchers could not draw any firm conclusions about COVID-19 and pulmonary embolism. However, they noted that future studies should further investigate a possible risk factor link, as the person in the study did not have any other risk factors for a pulmonary embolism.

In a 2021 study of over 400 people with COVID-19 in a hospital setting, researchers diagnosed pulmonary embolism in 25% of the individuals, or just over 100. They noted that their findings were a bit higher than those of other studies and reports. In other studies, this figure was about 17% overall and 21% among people with severe cases of COVID-19.

They also noted that people assigned male at birth had a higher overall risk of developing a pulmonary embolism. Additionally, people with severe infection may have a higher risk of developing a pulmonary embolism.

A 2022 study from Sweden examined over 1 million people diagnosed with COVID-19 between 2020 and 2021. The authors found that COVID-19 is an independent risk factor for pulmonary embolism, deep vein thrombosis (DVT), and bleeding events.

Studies also explore how having a pulmonary embolism increases mortality and severe infection risk in those who develop COVID-19.

In a 2023 study, researchers found that duel cases of COVID-19 and pulmonary embolism increased the risk of several severe events, which include:

increased in-hospital mortality

septic shock

longer length of hospital stay

respiratory failure

Another 2023 study found similar results. It concluded that having concurrent cases of both conditions increases the risk of mortality.

It may not be possible to prevent all cases of pulmonary embolism associated with COVID-19.

The long-term complications of COVID-19 are not well understood. It is unknown how COVID-19 may influence post-infection pulmonary embolism events or for how many months following infection a person may be susceptible.

To reduce the risk of pulmonary embolism due to COVID-19, a person should consider a COVID-19 vaccination and stay up to date on booster shots. These can help reduce the risk of infection as well as the potential severity of infection if it occurs.

Some general ways to help prevent DVT, which can lead to pulmonary embolism, include:

moving around every 1–2 hours

maintaining a moderate weight

avoiding a sedentary lifestyle

moving around whenever possible following illness, surgery, or prolonged bed rest

wearing loose-fitting clothes

discussing medication or compression stockings with a healthcare professional if risk factors are present

Not everyone who has COVID-19 will need treatment or screening for pulmonary embolisms.

The National Institutes of Health's Antithrombotic Therapy in Patients With COVID-19 guidelines provide the following recommendations regarding pulmonary embolism and COVID-19:

Not enough evidence exists to support or contest routine screenings for thrombotic events when a person does not present with signs or symptoms.

People taking anticoagulants should continue taking their medication unless directed otherwise.

Prior to adding anticoagulant medications, healthcare professionals should review all medications to prevent interactions.

When imaging is not possible, healthcare professionals should start anticoagulant therapy in people with COVID-19 and a higher risk of DVT.

People not hospitalized for COVID-19 should not receive anticoagulant therapy.

Research indicates that people with the highest risk of a pulmonary embolism with COVID-19 are those with severe infection or those who are hospitalized for the infection.

People already taking anticoagulant medication for other conditions may have a protective effect against pulmonary embolism due to COVID-19.

The following sections provide answers to some frequently asked questions about pulmonary embolisms and COVID-19.

What is the life expectancy after pulmonary embolism?

The average life expectancy following a pulmonary embolism can vary.

Healthcare professionals use a pulmonary embolism severity scale when determining the chances a person will survive for 30 days or longer.

A score of 65 or less on the scale means a person has a 1–6% chance of dying within 30 days. A score of 125 or more means a person has a 10 to 24.5% chance of dying within 30 days following a pulmonary embolism.

What are the chances of surviving a blood clot in the lung?

Pulmonary embolism is the third leading cause of cardiovascular-related death in the United States.

Prompt treatment can help improve a person's chances of survival.

The type of blood clot can influence survival. According to an older study from 2013, nearly 25% of people with an acute massive pulmonary embolism die suddenly.

Long-term follow-up studies show that cancer is the leading cause of death in 3- and 5-year follow-ups.

Are blood clots in the lungs common with COVID-19?

Several studies show that COVID-19 is a risk factor for blood clots, particularly in severe cases of the illness.

Scientists generally consider COVID-19 a risk factor for pulmonary embolism. People with severe cases and those who are hospitalized for COVID-19 may have a greater risk.

A person may not be able to prevent a pulmonary embolism due to COVID-19 infection. However, getting the vaccination and boosters may help prevent infection or severe infections.

Pulmonary Embolism

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Doctors usually treat pulmonary embolism with medicines called anticoagulants. They are often called blood thinners, but they don't really thin the blood. They help prevent new clots and keep existing clots from growing.

Most people take a blood thinner for a few months. People at high risk for blood clots may take it for the rest of their lives.

If symptoms are severe and life-threatening, "clot-busting" drugs called thrombolytics may be used. These medicines can dissolve clots quickly, but they increase the risk of serious bleeding. Another option is surgery or a less invasive procedure to remove the clot (embolectomy).

Some people may have a filter put into the large vein (vena cava) that carries blood from the lower body to the heart. A vena cava filter helps keep blood clots from reaching the lungs. This filter might be used if you have problems taking an anticoagulant.

Can Chest X-rays Show Pulmonary Embolisms?

A pulmonary embolism is a blood clot that blocks the lung's arteries. Blood clots do not show on chest X-rays. However, these X-rays may help doctors rule out other health conditions with similar symptoms.

Pulmonary embolisms can reduce oxygen in the blood, increase pressure on the heart, and spike blood pressure in the lungs. They are potentially life threatening.

However, people can recover from pulmonary embolisms after receiving prompt and correct treatment. A person can speak with a healthcare professional about possible pulmonary embolism symptoms. A doctor may recommend several imaging scans, including CT, angiography, and ultrasound.

This article explains when X-rays may be useful, how doctors diagnose pulmonary embolisms, and how to treat the condition.

X-rays do not show blood clots directly, including pulmonary embolisms. However, they may be able to show:

While X-rays cannot directly show an embolism, a 2023 case study highlighted that X-rays can show certain physical effects of some clots to direct further scans. These may include:

Fleischner's sign: Doctors see this sign when one of the main blood vessels in the lungs looks larger than usual. It can happen when the blood pressure in the lungs is too high or due to blockage by a pulmonary embolism.

Knuckle sign: This occurs when one of the main blood vessels in the lungs suddenly gets smaller. This can happen when the blood flow reduces because of a clot.

Westermark sign: X-rays show this sign when one part of the lung may look brighter than the rest. It can develop when less blood reaches that part of the lung due to small clots.

Hampton's hump: This is a wedge-shaped area of darkness at the edge of the lung. It can happen when there is bleeding or swelling in the lung tissue because of a clot.

These signs are rare and do not always indicate a pulmonary embolism. However, they may help doctors recognize and treat the condition.

Healthcare professionals may find it difficult to diagnose pulmonary embolism. It is also a potentially life threatening health problem unless a person receives prompt treatment.

Symptoms of pulmonary embolism may include breathing difficulty or cardiac arrest (heartbeat stopping). These symptoms are not unique and may occur due to other conditions, including:

A chest X-ray may help a doctor rule out other conditions that cause breathlessness, such as tumors or pneumonia. They may also check the legs for a red, swollen, warm, or tender area — a possible sign of a deep vein clot. This type of clot can move up to the lungs and cause a pulmonary embolism.

Other scans and tests might include:

Computed tomographic angiography (CTPA): This test uses a special type of X-ray and a contrast dye to analyze blood vessels.

D-dimer blood tests: A D-dimer blood test can indicate blood clots have formed in the bloodstream.

Pulmonary angiography: Unlike an X-ray, this scan can directly show a blood clot in the lungs.

Pulmonary V/Q scan: This scan shows which parts of the lungs are getting enough air and blood supply.

Ultrasound of the legs: Ultrasound measures blood flow and checks the veins for clots.

Electrocardiogram (EKG): An EKG records heart activity and checks how the organ is functioning.

Echocardiogram: An echocardiogram measures heart function and checks for raised blood pressure in the blood vessels that feed the lungs.

MRI: Doctors usually only recommend an MRI for pregnant people if they suspect a pulmonary embolism. This may also apply to people who cannot tolerate the contrast in tests such as a CTPA.

Treating most pulmonary embolisms generally involves taking medication to prevent the clot from growing and reducing the risk of new clots. People with a large clot may need surgery to remove it to avoid it from becoming life threatening.

Treatments might include:

Blood thinners: People who have to stay in the hospital to treat pulmonary embolism may receive an injection of blood-thinning medication. This medication does not shrink the clot but may stop it from getting larger.

Thrombolytics: Some people with severe clots may need a type of medication called a thrombolytic that dissolves the clot. This can cause severe bleeding. Doctors may reserve using this for only life threatening clots.

An inferior vena cava filter: A doctor may use a catheter, a long, flexible tube, to implant a filter into the vein running from the leg to the lungs. This can prevent blood clots from reaching the arteries of the lung.

Embolectomy: This procedure can treat severe pulmonary embolism. A surgeon uses a catheter or a large cut to remove the blood clot directly.

A person with pulmonary embolism may not show symptoms at all. Up to two-thirds of people with pulmonary embolism do not show symptoms, according to a 2018 review.

However, symptoms that may occur include:

It is best to speak to a doctor upon noticing these symptoms. They may indicate a pulmonary embolism or other serious heart and lung problems.

A chest X-ray does not directly show pulmonary embolism. However, it may help a doctor rule out health problems that cause similar symptoms, such as pneumonia and some heart conditions. An X-ray may also show some physical lung changes that can indicate a blood clot.

Once a doctor has used an X-ray to guide diagnosis, they often order a CTPA, an ultrasound scan, and blood tests to locate clots. Treatment usually includes blood-thinning medications but may require surgery.

People should contact a doctor if they notice any symptoms of pulmonary embolism.

Signs of Pulmonary Embolism