Purpose To report imaging findings at computed tomography angiography (CTA) and venography (CTV) of the abdomen and pelvis in evaluation of hemorrhagic and thrombotic lesions in hospitalized patients with COVID-19. Methods In this retrospective observational study, patients admitted to a single tertiary care center from April 1 to July 20, 2020, who tested positive for SARS-CoV-2 and developed acute abdominal pain or decreasing hemoglobin levels over the course of hospitalization were included. Abdominal CTA/CTV imaging studies performed in these patients were reviewed, and acute hemorrhagic or thromboembolic findings were recorded. Results A total of 40 patients (mean age, 59.7 years; 20 men, 20 women) were evaluated. Twenty-five patients (62.5%) required intensive care unit (ICU) admission and 15 patients (37.5%) were treated in the medical ward. Hemorrhagic complications were detected in 19 patients (47.5%), the most common was intramuscular hematoma diagnosed in 17 patients; It involved the iliopsoas compartment unilaterally in 10 patients, bilaterally in 2 patients and the rectus sheath in 5 cases. Pelvic extraperitoneal hemorrhage was found in 3 patients, and mesenteric hematoma in one patient. Thromboembolic events were diagnosed in 8 patients (20%) including; arterial thrombosis (n = 2), venous thrombosis (n = 2), splenic infarct (n = 1), bowel ischemia (n = 1) and multiple sites of thromboembolism (n = 2). Conclusion Our study highlights that both hemorrhagic and thromboembolic complications can be seen in hospitalized patients with COVID-19. It is important that radiologists maintain a high index of suspicion for early diagnosis of these complications.
Background In December 2019, a large outbreak of a novel coronavirus infection occurred in Wuhan, China. The pneumonic disease caused by this virus is called coronavirus disease 2019 (COVID-19) by the World Health Organization (WHO). As case numbers have increased worldwide, gastro-intestinal symptoms like diarrhea, constipation, abdominal pain, and vomiting have been increased, these symptoms associated with positive laboratory results including abnormal liver function tests, renal function tests, and D-Dimer levels. Although there are multiple articles evaluated the imaging findings in HRCT of COVID-19 patients that helped in understanding the disease course and potential complications in the chest, yet there are—to our knowledge—limited data about the abdominal imaging findings of the course and potential abdominal complications of COVID-19 notably in the intensive care units (ICU). Results Forty-one sonographic examinations were done for 30 confirmed COVID-intensive care patients presented with abdominal symptoms. Of the 30 patients, 26 were males (86.66%), and 4 were females (13.3%), the average age of the patients was 57.7 years old. The most common sonographic observation was hepatomegaly (n, 23/41, 56%) and biliary system disease (n, 17/41, 41.4%); the imaging findings were correlated with the clinical and laboratory data. CT examination when indicated (in our study to assess hematomas for active extravasation and to assess bowel obstruction and its level). Conclusion Abdominal sonographic imaging was often performed for inpatients with COVID-19. Hepatobiliary dysfunction as well as nephropathy was the most common imaging findings.
Management of severe coronavirus disease 2019 requires advanced respiratory support modalities including invasive mechanical ventilation (IMV), continuous positive airway pressure (C-PAP), and non-invasive ventilation ((NIV). IMV leads to either subtle forms of lung injury (pulmonary edema, lung cysts) or more severe form of lung injury manifested as subcutaneous emphysema, pneumomediastinum, and pneumothorax (herein collectively termed barotrauma). We have described two cases showing the two end of spectrum of ventilator associated lung injury (VALI).
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