Patients with SARS-CoV-2 infection may suffer from pulmonary embolism (PE), thrombotic lesions may disappear completely or persist. The persistence of thrombotic lesions (chronic thrombo-embolic pulmonary disease, CTPD) may affect a large number of patients, some of which may develop chronic thromboembolic pulmonary hypertension (CTEPH). The objective of this study was to assess the incidence of CTEPH in patients hospitalized for simultaneous pneumonia and PE due to SARS-CoV-2 and to evaluate their clinical and functional characteristics.

133 patients diagnosed with PE in the course of SARS-CoV-2 pneumonia. In all patients, computerized tomography angiography (n=111) and/or V/Q lung scan (n=47) were obtained within the first 6 months after discharge. Clinical findings, lung function tests with DLCO, exercise capacity, and echocardiogram were also assessed. We followed current recommendations for post-discharge monitoring for PE.

Twenty-four patients (18%) showed persistent thrombotic lesions. 56% (n=13) presented symptom of CTPD (dyspnea) and underwent echocardiography. One patient (0.75%) with signs suggestive of pulmonary hypertension was diagnosed with CTEPH on right heart catheterization and ultimately received surgical treatment. Exercise capacity and lung function were not significantly different between symptomatic and non-symptomatic. 

The persistence of thrombotic lesions after PE is a frequent finding following SARS-CoV-2 infection; however, the incidence of CTPD and CTEPH seem similar to those observed in PE not related to SARS-CoV-2. This study suggests that current follow-up recommendations would be adequate for patients with SARS-CoV-2 pneumonia and PE.