Abdominopelvic CT findings in patients with novel coronavirus disease 2019 (COVID-19)

Abstract

Purpose Some patients with novel coronavirus disease 2019 (COVID-2019) present with abdominal symptoms. Abdominal manifestations of COVID on imaging are not yet established. The goal of this study was to quantify the frequency of positive findings on abdominopelvic CT in COVID-positive patients, and to identify clinical factors associated with positive findings to assist with imaging triage. Materials and methods This retrospective study included adult COVID-positive patients with abdominopelvic CT performed within 14 days of their COVID PCR nasal swab assay from 3/1/2020 to 5/1/2020. Clinical CT reports were reviewed for the provided indication and any positive abdominopelvic findings. Demographic and laboratory data closest to the CT date were recorded. Multivariate logistic regression model with binary outcome of having no reported positive abdominopelvic findings was constructed. Results Of 141 COVID-positive patients having abdominopelvic CT (average age 64 years [± 16], 91 [64%] women), 80 (57%) had positive abdominopelvic findings. Abdominal pain was the most common indication, provided in 54% (43/80) and 74% (45/61) of patients with and without reported positive abdominopelvic findings, respectively ( p = 0.015). 70% (98/141) of patients overall had reported findings in the lung bases. Findings either typical or intermediate for COVID were reported in 50% (40/80) and 64% (39/61) of patients with and without positive abdominopelvic findings, respectively ( p = 0.099). Of 80 patients with positive abdominopelvic findings, 25 (31%) had an abnormality of gastrointestinal tract, and 14 (18%) had solid organ infarctions or vascular thromboses. In multivariate analysis, age (OR 0.85, p = 0.023), hemoglobin (OR 0.83, p = 0.029) and male gender (OR 2.58, p = 0.032) were independent predictors of positive abdominopelvic findings, adjusted for race and Charlson comorbidity index. Conclusion Abdominopelvic CT performed on COVID-positive patients yielded a positive finding in 57% of patients. Younger age, male gender, and lower hemoglobin were associated with higher odds of having reportable positive abdominopelvic CT findings.

Are asymptomatic gastrointestinal findings on imaging more common in COVID-19 infection? Study to determine frequency of abdominal findings of COVID-19 infection in patients with and without abdominal symptoms and in patients with chest-only CT scans

“…The findings in our study are in partial agreement with two recently published studies [ 12 , 13 ]. Similar to the study by Goldberg-Stein et al and Bhayana et al [ 12 , 13 ], the most common abdominal finding in our study was in the GI tract with fluid-filled colon being the most common finding.…”

Abdominal CT in COVID-19 patients: incidence, indications, and findings

“…Only three (7%) patients showed CT findings of a nonspecific enteritis, with pneumatosis intestinalis present on one scan, and no findings of portal venous gas. Our results are more similar to Goldberg-Stein et al [15] who also found that gastrointestinal tract findings were the most common category of abnormality on abdominal CTs (31.2%), but with wall thickening being less common (15%) and no reported cases of pneumatosis or portal venous gas. Another study [9] of 23 patients with lung base findings suspicious for COVID-19 infection reported a variety of typical findings characteristic of pre-COVID-19 abdominal pain diagnoses, with no abnormalities of the luminal gastrointestinal tract.…”

“…Pre-pandemic reports have assessed the value of close examination of the lung bases for clinically significant abnormalities [16]. Our study, and others [8][9][10]15], show that lung base abnormalities on abdominal CT may now include findings that suggest a diagnosis of COVID-19 disease in a substantial percentage of cases.…”

“…Another study [9] of 23 patients with lung base findings suspicious for COVID-19 infection reported a variety of typical findings characteristic of pre-COVID-19 abdominal pain diagnoses, with no abnormalities of the luminal gastrointestinal tract. A potential reason for the differences among the studies is that Bhayana et al may have included patients later in the course of their disease, whereas our study and those of Goldberg-Stein et al [15] and Dane et al [9] reviewed CT scans obtained around the time of COVID-19 diagnosis.…”

Abdominal pelvic CT findings compared between COVID-19 positive and COVID-19 negative patients in the emergency department setting

“…When abdominal pathology is present, the bowel is often affected. Goldberg-Stein et al reported abdominal pelvic pathology in 57% of COVID-19 positive patients with 31% showing GI tract abnormalities [12]. Bhayana et al found 31% of CT scans had bowel pathology in patients with COVID-19.…”