COVID-19 pneumonia identified by CT of the abdomen: A report of three emergency patients presenting with abdominal pain

Abstract

Patients with COVID-19 infection may present to the Emergency Department (ED) with gastrointestinal complaints and no respiratory symptoms. We are presenting 3 patients who came to the ED with abdominal pain; and the computed tomography [CT] of the abdomen showed findings suggestive of COVID-19 pneumonia. A 65-year-old male patient presented with symptoms of urinary tract infection and left renal angle tenderness. A 42-year-old male patient presented with right flank pain postextracorporeal shock wave lithotripsy. A 71-year-old male known to have type 2 diabetes mellitus and who had had whipple surgery for a neoplasm of the head of the pancreas presented with a painful epigasteric swelling. The 3 patients had positive COVID-19 polymerase chain reaction (PCR) tests and mild-to-moderate illness, and were discharged home after 2 weeks with a good recovery. The first patient had a false negative early PCR test, which turned positive on 2 repetitions of the test. A systematic review of CT abdomen, including inspection of the lung bases using the lung window in all CT abdomen, is essential to detect findings suggestive of COVID-19 pneumonia in patients requiring a CT abdomen study. As proven in the literature, CT findings of COVID-19 pneumonia have a higher sensitivity than the PCR test.

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

“…Multiple studies have recently reported the abdominopelvic findings on CT scans of the abdomen and pelvis in COVID-19 patients with abdominal symptoms [ 9 – 18 ]. However, a significant number of COVID-19 patients undergo only a chest CT.…”

Incidence of Missed Diagnosed COVID-19 Pneumonia on Patients Who Admitted Urology Outpatient Clinic

“…None of these patients had pulmonary CT. Abnormal imaging findings were seen on the pulmonary component of abdominal CT in two of these patients (20). Similarly, other studies examining this issue consisted of case series (21)(22)(23)(24). Moreover, in their study, Barkmeier et al stated that there were 42 patients with COVID-19 have abdominal CT that visualized lung bases.…”

A Systematic Review of Abdominal Imaging Findings in COVID-19 Patients

“…Details of these studies are shown in Table 1 and online supplementary Table 1 (for all online suppl. material, see www.karger.com/doi/10.1159/000518473 ) [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 …”

“…Another study by Tirumani et al [ 10 ] showed that among 59 patients having normal imaging findings, 18 (31%) patients were having abdominal symptoms. Additionally, many case series have shown the importance of lung base findings in detecting COVID-19 in otherwise normal abdominal scans [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 30 ].…”