Fig. 1.

78-year-old female patient, RT-PCR-confirmed COVID-19, 8 days since symptom onset, complicated with pulmonary embolism. Admission PaO₂/FiO₂ ratio was 162, and d-dimer levels > 2000 ng/mL. Admitted to the intensive care unit, managed with invasive mechanical ventilation. She died 2 weeks after admission. a Axial lung-window CT angiography image shows extensive lung involvement with patchy ground-glass opacities in both lungs, with vascular dilatation in small peripheral subsegmental pulmonary arterial branches, some of them with a varicose appearance (black arrows). b Coronal CT angiography image shows pulmonary embolism in the posterior basal segment of the lower left lobe (white arrow). c 5 mm coronal-plane reconstruction of a subtraction iodine map shows moderate to severe hypoperfusion in superior and inferior regions of the lung (*), in areas of apparently healthy lung parenchyma in conventional chest CT images, which is more pronounced in the posterior basal segment of the lower left lobe, in relation to the area of pulmonary embolism. Areas of ground-glass opacities show normal or increased perfusion, most probably due to vasoplegia