Abdominal imaging findings on computed tomography in patients acutely infected with SARS-CoV-2: what are the findings?

Abstract

Objectives To investigate what findings are new on contrast-enhanced abdominopelvic CT in patients infected with SARS-CoV-2. Methods Contrast-enhanced CT of the abdomen and pelvis of patients with COVID-19 at a tertiary oncologic center acquired over a 2-month period were reviewed independently by two readers and scored for new imaging abnormalities compared with a prior scan. CT scans were included if the study was performed between − 3 and 45 days from the time of COVID-19 diagnosis. Clinical information was gathered from the medical records. Results A total of 63 patients (34 male, 29 female; mean age 60.6 years, range 24.4–85.0 years) were included in this retrospective cross-sectional study. Aside from new ground glass opacities seen at the lung bases (29/63, 46.0%), the most common findings were new thickening of the stomach, small bowel or colon or fluid-filled colon (14/63, 22.2%), new small volume ascites (7/63, 14.3%), gallbladder distention in those without prior cholecystectomy (3/43, 7.0%), and single cases each of acute pancreatitis (1/63, 1.6%) as well as new portal vein thrombosis (1/63, 1.6%). Conclusion Aside from lung base ground glass opacities, the most common new imaging abnormality on abdominopelvic CT in patients with COVID-19 finding in our cohort was abnormalities of the gastrointestinal tract, followed by small volume ascites, gallbladder distention, and isolated cases of pancreatitis and portal vein thrombosis. These findings overlap with those previously reported that did not have a prior scan for comparison, and provide supportive evidence that some of these findings may be related to SARS-CoV-2 infection.

Coronavirus Disease in the Abdomen

“…Bowel inflammation, hypomotility, and ischemia are the major reported bowel imaging abnormalities in COVID-19 patients, reported in approximately 30% of patients imaged by computed tomography (CT) including findings of ischemia in 20% of ICU patients [ 1 , 3 , 20 , 28 , 29 ]. Bowel inflammation due to COVID-19 has a similar appearance to other causes of gastritis, enteritis, and colitis, including circumferential mural thickening, hyperenhancement, and surrounding edema and fat stranding ( Fig.…”

“…Pancreatic inflammation associated with COVID-19 has been described with biochemical and imaging abnormalities ( Fig. 6 ) [ 3 , [11] , [12] , [13] , 20 ]. Wang and colleagues [ 12 ] reported abnormalities in amylase or lipase levels indicating pancreatic injury in 17% of inpatients (n = 52) presenting with COVID-19 pneumonia.…”

“…Pancreatic expression of ACE-2 receptors as the binding and entry site for SARS-CoV-2 supports COVID-19 as the causative agent in patients with acute pancreatitis [ 18 , 27 ]. Imaging manifestations on CT or MR include parenchymal swelling, edema, and peripancreatic inflammation, as well as parenchymal nonenhancement in cases of necrosis, which do not differ from other etiologies of pancreatitis [ 3 , [11] , [12] , [13] , 20 ]. Dual-energy CT iodine overlay reconstructions increase the conspicuity of non-enhancing parenchyma in necrotizing pancreatitis, and virtual unenhanced reconstructions can differentiate hemorrhagic pancreatitis from enhancing inflammation [ 43 ].…”

“…In the abdomen, involvement of the arterial vasculature (aorta, iliac, celiac, common hepatic, and superior mesenteric arteries) as well as venous structures (portal and renal veins) has been described ( Fig. 8 ) [ 20 , [58] , [59] , [60] ]. Visceral consequences of non-visualized microembolic events include renal infarcts, splenic infarcts, and bowel ischemia, as described above [ 1 , 58 ].…”

“…Numerous abdominal manifestations have been reported in patients with coronavirus disease 2019 (COVID-19), including involvement of the luminal gastrointestinal (GI) tract, hepatobiliary system, pancreas, kidneys, spleen, and blood vessels. Specific COVID-19 related pathologic entities described in the literature within these abdominal organ systems include ileus, Ogilvie syndrome, GI bleeding, bowel ischemia, gastric and bowel perforation, liver function abnormalities, acute hepatitis, fulminant liver failure, cholestasis, cholecystitis, secondary sclerosing cholangitis, hemobilia, pancreatitis, acute renal dysfunction, proteinuria, hematuria, splenomegaly, ascites, and arterial, portal venous, and systemic venous thrombosis [ [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] ].…”