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eConsult Clinical Question

Patient is a 26-year-old man with a history of Nodular Sclerosis Hodgkin Lymphoma that was previously treated by radiation, now just followed with yearly appointments (no current treatment) who experienced a breakthrough case of COVID-19 diagnosed with an ED visit shortly after due to concern for a pulmonary embolus from family history of the same (unknown cause) in parental grandfather, parental grandmother, and uncle.

Chest x-ray normal at that time and no hypoxia <90%. Patient is now two weeks out and recovering well except for persistent tachycardia (120s-130s) with minimal exertion and increased heart rate (~95bpm) when baseline was previously 60-70bpm, as well as O2 saturations as low as 90-91% with minimal exertion that recovers quickly to 93-94% with rest.

Would you recommend additional lung imaging at this time? Should I consider a CT pulmonary angiogram or CT chest?

eConsult Response

Given the tachycardia and the frequency of pulmonary embolus in COVID, I would get a CT pulmonary angiogram scan. For return to exercise after COVID (typically 4 weeks after positive) I have been referring to the rehabilitation program. If he feels well with that then he can progress to his usual activity level.

These real-life examples have some limitations. Given the evolving recommendations and guidance on COVID-19 care, these cases should not be considered complete or definitive and may not reflect the most up-to-date guidance.