Review of COVID-19, part 2: Musculoskeletal and neuroimaging manifestations including vascular involvement of the aorta and extremities

Abstract

The coronavirus disease 2019 (COVID-19) pandemic caused by the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) has affected almost every country in the world resulting in severe morbidity, mortality and economic hardship, altering the landscape of healthcare forever. Its devastating and most frequent thoracic and cardiac manifestations have been well reported since the start of the pandemic. Its extra-thoracic manifestations are myriad and understanding them is critical in diagnosis and disease management. The role of radiology is growing in the second wave and second year of the pandemic as the multiorgan manifestations of COVID-19 continue to unfold. Musculoskeletal, neurologic and vascular disease processes account for a significant number of COVID-19 complications and understanding their frequency, clinical sequelae and imaging manifestations is vital in guiding management and improving overall survival. The authors aim to provide a comprehensive overview of the pathophysiology of the virus along with a detailed and systematic imaging review of the extra-thoracic manifestation of COVID-19. In Part I, abdominal manifestations of COVID-19 in adults and multisystem inflammatory syndrome in children will be reviewed. In Part II, manifestations of COVID-19 in the musculoskeletal, central nervous and vascular systems will be reviewed.

The Musculoskeletal Involvement After Mild to Moderate COVID-19 Infection

“…Accumulating evidences have showed that the musculoskeletal symptoms can occur during the first days of infection, even before the common respiratory symptomatology (dry cough, nasal congestion, sore throat and dyspnoea). Fatigue, arthralgia (joint pain), myalgia (muscle pain) and muscle weakness have been reported as initial and common symptoms by COVID-19-positive individuals ( Figure 3 ) ( Baj et al, 2020 ; Chan et al, 2020 ; Cipollaro et al, 2020 ; Ali and Kunugi, 2021 ; Kanmaniraja et al, 2021 ; Knight et al, 2021 ). Unfortunately, these extenuating symptoms can decrease the individuals’ ability to perform activities of daily living (ADL) such as ambulating, dressing, housecleaning and working ( Edemekong et al, 2021 ), which reduces the quality of life, generating anxiety and depression.…”

“…These systematic and meta-analysis studies summarize evidences on extrapulmonary features of the infection, aiming to contribute to a better diagnosis, prevention and treatment of COVID-19. Generally, they cited the prevalent muscle symptoms reported by hospitalized patients during the acute phase of SARS-CoV-2 infection ( Abdullahi et al, 2020 ; Ashraf et al, 2020 ; Small and Beatty, 2020 ; Zaim et al, 2020 ; Disser et al, 2020 ; do Nascimento et al, 2020 ; Ghayda et al, 2020 ; Gupta et al, 2020 ; Kordzadeh-Kermani et al, 2020 ; White-Dzuro et al, 2021 ; Kanmaniraja et al, 2021 ; Ramani et al, 2021 ; Ramos-Casals et al, 2021 ), which highlights once more the biased towards severe cases of COVID-19.…”

Musculoskeletal manifectations of the new coronavirus infection: focus on arthralgia and myalgia

“…Вследствие полиорганной недостаточности, сепсиса, гипергликемии, искусственной вентиляции легких и парентерального питания развиваются электролитные и метаболические изменения, которые также могут способствовать так называемой миопатии и полинейропатии критического состояния [13]. Локальная боль в мышцах может быть следствием внутримышечных гематом, которые возникают в связи с применением антикоагулянтов для профилактики и лечения тромбоэмболических осложнений при COVID-19 [23]. Гематомы проявляются в виде пальпируемых образований, часто сопровождающихся болью и экхимозами; может отмечаться снижение гематокрита.…”

“…Иногда внутримышечные гематомы вызывают неврологические симптомы в результате сдавления соседних сосудисто-нервных структур [24]. В последующем может развиваться атрофия пораженной мышцы с развитием жировой инфильтрации и кальцификации [23].…”

“…Важным механизмом влияния на мышечную ткань является периферическая невропатия, в частности постинфекционная. Возможна также травматизация нерва вследствие применяющейся прон-позиции [23]. Кроме того, SARS-CoV-2 может непосредственно повреждать как центральную нервную систему, так и периферические нервы [25].…”