COVID-19: Abdominal and Pelvic Imaging Findings: A Primer for Radiologists

Abstract

The COVID-19 pandemic presents an ongoing global health threat. The SARS-CoV-2 is known to cause substantial pulmonary disease, and most of the current radiological publications are dedicated to describing and characterizing these findings. However, studies regarding imaging findings in the abdomen and pelvis of infected patients are still very limited. The aim of this review is to discuss the most frequent abdominal manifestations based on the current literature and representative images from our local experience.

Coronavirus Disease in the Abdomen

“…The findings of ischemia are also not etiology-specific and include bowel wall nonenhancement, pneumatosis intestinalis, and portal or mesenteric venous gas ( Figs. 2 and 3 ) [ 18 ]. The characteristic pathologic findings of necrotic, ischemic bowel in COVID-19 patients are a yellowing anti-mesenteric discoloration grossly with microvascular fibrin thrombi in the submucosal arterioles on histologic examination [ 1 , 3 , 29 ].…”

“…COVID-19 patients with severe LFT abnormalities have a worse prognosis than those without LFT abnormalities, including significantly higher rates of ICU admission, intubation, renal replacement therapy, and mortality [ 4 , 7 , 37 ]. Hepatobiliary abnormalities detected by imaging and attributed to COVID-19 include cholestasis, acute cholecystitis, hemobilia, periportal edema, hepatomegaly, and secondary sclerosing cholangitis [ 10 , 14 , 15 , 18 , 21 , 38 , 39 ]. As with bowel abnormalities, the imaging manifestations of gallbladder and liver inflammation are nonspecific and include findings such as gallbladder distension and wall thickening, hepatomegaly, and periportal edema [ 14 , 39 ].…”

“…Pancreatitis has been described as an initial presentation of COVID-19, with later development of respiratory symptoms and eventually respiratory failure [ 13 ]. Recurrent acute pancreatitis during COVID-19 illness and necrotizing pancreatitis have also been described [ 11 , 18 ]. 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 ].…”

“…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] ].…”

Use of Computed Tomography (CT)-Scan in the Current Coronavirus Pandemic

“…COVID 19 is a systemic disease, although thoracic and particularly pulmonary involvement is prominent. CT can be an important tool for some of these extra thoracic conditions [22].…”