Pulmonary thromboembolism as presenting feature of COVID-19: Report of four cases

Coronavirus disease 2019 (COVID-19) infection is associated with a hypercoagulable state. The similarity in clinical presentation between Pulmonary Thromboembolism (PTE) and COVID-19 render the triage of these patients challenging. We present four cases of COVID-19 who were admitted with first impression of pulmonary thromboembolism in emergency department. The patients were male with age ranged between 46 and 60 years old. None of the patients had criteria of severe COVID-19. Pulmonary Computed Tomography (CT) angiography at admission was consistent with PTE. Incidental finding in pulmonary CT angiography was lung lesions in favor of COVID-19. Pulmonary thromboembolism might be a first presentation feature in COVID-19 patients. Overlaps between presenting symptoms and paraclinical findings such as chest CT and elevations in D-dimer levels in PTE and COVID-19 should be kept in mind.