Abdominal Computed Tomography Angiography and Venography in Evaluation of Hemorrhagic and Thrombotic lesions in Hospitalized COVID-19 patients

Abdelmohsen, Mohsen Ahmed; Alkandari, Buthaina M.; Razek, Ahmed Abdel Khalek Abdel; Tobar, Ahmed Mohamed; Gupta, Vikash K.; Elsebaie, Nermeen

doi:10.1016/j.clinimag.2021.04.002

Cited by 15 publications

(25 citation statements)

References 33 publications

(37 reference statements)

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“…Similarly, Abdelmohsen reports that in 27 of 40 patients (67.5%), a CT scan revealed acute vascular pathologies. Therefore, the authors highlight the importance of abdominal CT imaging in COVID-19 patients [ 7 ]. Considering the high mortality rate in case of delayed surgery, the therapeutic algorithm for COVID-19 patients should include a rapid indication for surgery, if there are clinical or radiological signs of ischemia.…”

Section: Discussionmentioning

confidence: 99%

Colon ischemia in patients with severe COVID-19: a single-center retrospective cohort study of 20 patients

Yang

Hakenberg

Weiß

et al. 2021

Int J Colorectal Dis

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Purpose Thromboembolic complications due to COVID-19 are common in patients requiring critical care and are associated with high morbidity and mortality rates. The aim of this study was to evaluate clinical manifestations and postoperative outcomes after colectomy for COVID-19-associated colonic ischemia in the first versus the second wave of the pandemic. Methods A retrospective cohort study of patients with severe COVID-19 at our institution between 1 March 2020 and 31 January 2021 was performed. All patients with severe COVID-19, requiring critical care and surgical treatment of colonic ischemia, were included. The main outcomes were surgical complications and mortality rate. Results A total of 190 patients were included of whom 20 (10.5%) patients underwent surgery for colon ischemia. Preoperatively, d -dimer was elevated, especially in the first wave (median 15.24 (interquartile range 6.00–32.00) vs. 2.09 (1.42–4.28) mg/L, p = 0.025). Twelve (60%) patients underwent a (sub)total colectomy, 7 (35%) a right hemicolectomy, and one patient (5%) an ileocecal resection. Grade 3b complications occurred in one of 5 patients (20%) in the first and in 9 of 15 patients (60%) in the second wave. The overall in-hospital mortality was similar in both waves (40% vs. 47%), with death occurring after a median stay of 21 days. Conclusion In this cohort study of patients with severe COVID-19 and colonic ischemia, clinical presentation and laboratory findings varied. However, the majority of patients required (sub)total colectomy. Despite a lower threshold to surgery in the second wave, mortality remained high.

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Section: Discussionmentioning

confidence: 99%

Colon ischemia in patients with severe COVID-19: a single-center retrospective cohort study of 20 patients

Yang

Hakenberg

Weiß

et al. 2021

Int J Colorectal Dis

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“…In our study 13 patients had abdominal thrombosis, 5 of them required extracorporeal membrane oxygenation (ECMO). On various imaging methods, the presence of a filling defect within a vessel, with or without occlusion, is the characteristic finding of venous thrombosis [3,10]. CT angiography/venography helps for adequate evaluation of thrombus extension into central veins.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound features of abdominal thrombosis in COVID 19 patients

Dong

Qiu

Cao

et al. 2022

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Purpose: Abdominal thromboses are a poorly characterized thrombotic complication of COVID-19. The aim of this paper is to report multimodality ultrasound imaging findings of the abdomen in evaluation of thrombotic lesions in hospitalized patients with COVID-19. Patients & Methods: In this retrospective observational study, patients admitted to a single University Hospital from April 1, 2020 to April 30, 2022, who tested positive for COVID-19 and developed acute abdominal pain over the course of hospitalization were included. Abdominal ultrasound imaging studies performed in these patients were reviewed, including B mode ultrasound (BMUS), color-coded Doppler ultrasound (CCDS) and contrast enhanced ultrasound (CEUS). Thromboembolic findings on contrast enhanced computed tomography (CTA) were also recorded. Results: Finally, 13 cases of abdominal thrombosis in 226 with COVID 19 infections were included (mean age, 56.69±8.97 years; 10 men, 3 women). Thromboembolic events included: iliac thrombosis (n = 4), portal venous (PV) thrombosis (n = 3), superior mesenteric vein (VMS) thrombosis (n = 2), inferior vena cava (IVC) thrombosis (n = 5) and inferior mesenteric vein (VMI) thrombosis (n = 1). In all cases of abdominal thrombosis, during high resolution BMUS scan, intra-luminary hypoechogenic appositional thrombi could be detected. Meanwhile blood flow with reduced speed less than 20 cm/s could be observed by CCDS. High arterial flow speed was a sign of collateral flow changes with diffuse venous dilatation. On CEUS, changes of the microcirculation of the liver, spleen, kidneys or small bowel by infarctions or micro-emboli could be detected. In 3 cases of PV thrombosis and in 2 cases of IVC thrombosis, catheter interventions were successful performed for recanalization without relevant lumen reduction afterwards. In other cases, without interventional procedure, partial recanalization happened with venous flow speed over 15 cm/s and lumen reduction more than 50%. Conclusions: Our study highlights those thromboembolic complications can be seen in hospitalized patients with COVID-19. Multimodality ultrasound examinations is helpful for early and accurate diagnosis of these complications.

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“…This study disagreed with the previous research by Vadvala et al [ 20 ] which reported that the bleeding complications with or without contrast extravasation were most commonly seen in 71% of included patients, while thromboembolic and ischemic complications were seen only in 17.8% of patients. Other worldwide researchers also disagreed with this, including Shah et al [ 21 ], Lodigiani et al [ 22 ], Lee et al [ 23 ], O'Shea et al [ 24 ], Abdelmohsen et al [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Imaging of COVID-19 vasculopathy from head to toe: Egyptian collective experience after 2 years of the pandemic

Fathy

Rizk

Elnekeidy

et al. 2022

Egypt J Radiol Nucl Med

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Background COVID-19 vasculopathy is a critical condition that impacts the disease prognosis including vasculitis and thromboembolic complications. This study aimed to provide the Egyptian experience about the COVID-19 vasculopathy during the past two years of the pandemic and to collectively include the different modalities and imaging techniques for the diagnosis of cerebrovascular, pulmonary, gastrointestinal, and peripheral arterial vascular complications. Results This is a multi-center retrospective analysis of 3500 PCR-proved COVID-19 infection between March 2020 and December 2021. A cohort of 282 consecutive patients with COVID-19 vasculopathy was considered for inclusion. They included 204 males and 78 females (72:28%). The mean age was 68 years, and age ranged from 48 to 90 years. Five radiologists evaluated the different imaging examinations in consensus including computed tomography (CT), CT-angiography (CTA), CT-perfusion (CTP), magnetic resonance imaging (MRI), MR-arteriography (MRA), and MR-venography (MRV). 244/282 (86.5%) patients suffered from non-hemorrhagic cerebral ischemic infarctions. 13/282 (4.6%) patients suffered from hemorrhagic cerebral infarctions. 5/282 (1.8%) patients suffered from cerebral vasculitis. Pulmonary vascular angiopathy was detected in 10/282 (3.5%) patients, including pulmonary embolism in 10/10 patients, pulmonary infarctions in 8/10 patients, pulmonary vascular enlargement in 5/10 patients, and vascular "tree-in-bud" sign in 2/10 patients. Intestinal ischemia and small bowel obstruction were detected in 3/282 patients (1%) while GIT bleeding was encountered in 4/282 patients (1.4%). Lower limb arterial ischemia was found in 3/282 patients (1%). Additionally; 39/282 (13.8%) patients developed peripheral deep venous thrombosis (DVT) due to prolonged ICU recumbence while 28/282 (10%) patients developed jugular vein thrombosis sequel to prolonged catheterization. A p value (0.002) and (r) = 0.8 statistically proved strong significant relation between COVID-19 vasculopathy and D-dimer levels. Conclusions Multi-system vasculopathy was a serious complication of COVID-19 which impacted the patients' morbidity and mortality. An Egyptian experience about the COVID-19 vasculopathy during the past two years of the pandemic was provided. It encountered the different modalities and imaging techniques for the diagnosis of cerebrovascular, pulmonary, gastrointestinal, and peripheral arterial COVID-19 vascular complications.

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Abdominal Computed Tomography Angiography and Venography in Evaluation of Hemorrhagic and Thrombotic lesions in Hospitalized COVID-19 patients

Cited by 15 publications

References 33 publications

Colon ischemia in patients with severe COVID-19: a single-center retrospective cohort study of 20 patients

Colon ischemia in patients with severe COVID-19: a single-center retrospective cohort study of 20 patients

Ultrasound features of abdominal thrombosis in COVID 19 patients

Imaging of COVID-19 vasculopathy from head to toe: Egyptian collective experience after 2 years of the pandemic

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