Unexpected Findings of Coronavirus Disease (COVID-19) at the Lung Bases on Abdominopelvic CT

Dane, Bari; Brusca-Augello, Geraldine; Kim, Danny; Katz, Douglas S.

doi:10.2214/ajr.20.23240

Cited by 52 publications

(56 citation statements)

References 1 publication

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“…Two recent studies have been published in patients presenting with abdominal symptoms who had imaging findings suggestive of COVID-19 in the lung bases, the largest report consisting of 23 patients undergoing abdominal CT that retrospectively evaluated the findings in the lungs but not their impact on diagnosis. (9,10).…”

Section: Discussionmentioning

confidence: 99%

CT Scans Obtained for Nonpulmonary Indications: Associated Respiratory Findings of COVID-19

Hossain

Lazarus

Roudenko³

et al. 2020

Radiology

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Background: Atypical manifestations of COVID-19 are being encountered as the pandemic unfolds, leading to non-chest CT scans that may uncover unsuspected pulmonary disease.Purpose: To investigate patients with primary non-respiratory symptoms who underwent abdomen/pelvis or cervical spine/neck CT with unsuspected findings highly suspicious for pulmonary COVID-19. three institutions, two in a region considered a hotspot (area of high prevalence) for COVID-19. Patients without known COVID-19 were included who presented to the emergency room (ER) with primary non-respiratory [gastrointestinal (GI) or neurological] symptoms, had lung parenchymal findings suspicious for COVID-19 on a non-chest CT but no concurrent chest CT and had COVID-19 testing in the ER. Group 1 patients had RT PCR obtained pre-CT read (COVID-19 suspected on presentation); Group 2 had RT PCR obtained post-CT read (COVID-19 not suspected). Presentation and imaging findings were compared and outcomes were evaluated. Descriptive statistics and Fisher exact tests were used for analysis.Results: Group 1 comprised 62 patients [31 men, 31 women, mean age 67(SD ±17) years] and group 2 comprised 57 patients [28 men, 29 women, mean age 63(SD ± 16) years). Cough and fever were more common in group 1 (37/62, 60%, 29/62, 47%) than group 2

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Section: Discussionmentioning

confidence: 99%

CT Scans Obtained for Nonpulmonary Indications: Associated Respiratory Findings of COVID-19

Hossain

Lazarus

Roudenko³

et al. 2020

Radiology

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“…The pulmonary manifestations have tended to overshadow the abdominal symptoms of the disease, even though some reports [7] have indicated that as many as 57% of patients with low-severity COVID-19 disease have abdominal complaints alone or in combination with pulmonary symptoms. If abdominal CT is performed, the radiologist may be the first to suggest COVID-19 when imaging of the lung bases show typical findings of COVID-19 pulmonary disease [8][9][10]. In other patients, the diagnosis of COVID-19 may already be known or suspected, but abdominal symptoms are of sufficient severity to result in requests for abdominal CT.…”

Section: Introductionmentioning

confidence: 99%

“…However, radiologists may be less familiar with the frequency of abdominal symptoms in these patients and that abdominal complaints may be present in the absence of clinical pulmonary disease. Findings at the lung bases in abdominal CT scans may be the first hint of novel coronavirus disease [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Purpose The purpose of this study was to evaluate the frequency, indications, and findings of abdominal CTs ordered in the initial evaluation of patients who had a positive COVID-19 test performed in our institution. Methods Retrospective chart review was performed on all patients who had a positive test for COVID-19 performed at a single quaternary care center from 1/20/2020 through 5/8/2020. In a subset of patients undergoing abdominal CT as part of the initial evaluation, the demographics, suspected COVID-19 status at the time of scan, presenting complaints, and abdominal CT findings were recorded. Cardiothoracic radiologists reviewed and scored the visualized lung bases for the likelihood of COVID-19. Results Only 43 (4.1%) of 1057 COVID-19 patients presented with abdominal complaints sufficient to warrant an abdominal CT. Of these 43 patients, the vast majority (39, 91%) were known or suspected to have COVID-19 at the time of the scan. Most (27/43, 63%) scans showed no acute abdominal abnormality, and those that were positive did not share a discernable pattern of abnormalities. Lung base abnormalities were common, and there was moderate inter-reviewer reliability. Conclusion A minority of COVID-19 patients present with abdominal complaints sufficient to warrant a dedicated CT of the abdomen, and most of these studies will be negative or have abdominal findings not associated with COVID-19. Appropriate lung base findings are a more consistent indication of COVID-19 infection than abdominal findings.

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“…A COVID negative surgical patient acquiring nosocomial COVID infection postoperatively. 5. COVID positive surgical patient with false negative COVID report.…”

Section: Resultsmentioning

confidence: 99%

“…[2] Such atypical patients can be missed in screening measures and hence would not get timely isolation leading to unexpected spread of COVID infection. [5] In the present study, we intend to present different scenarios when a surgeon may encounter a COVID-19 patient during his practice, through surgical cases presenting to study institute in past two months. We aim to better equip surgeons by our experience at the time when they are at the brink of restarting surgical practice post lockdown.…”

mentioning

confidence: 99%

COVID patients encountered by a general surgeon- 6 unique scenarios.

Jain¹,

Mehta²,

Aggarwal³

et al. 2020

Preprint

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Background and Objectives :With rising demand of surgical interventions post lockdown due to Corona Virus Infectious Disease(COVID)-19, surgeons need to restart their surgical practice shortly. To increase caution and safety, six scenarios in which a surgeon may encounter COVID patients are hereby highlighted in the present study.Patients and Methods:A hospital based case series analysis of eight surgical patients admitted in past two months was done. Clinical and radiological records of these patients were studied separately and concluded consensually by two surgeons.Results:Six unique scenarios were identified:1. COVID positive patient, with concurrent surgical pathology.2. COVID positive patient incidentally diagnosed with additional surgical pathology.3. A solely surgical patient mimicking COVID positive symptomatology.4. A COVID negative surgical patient acquiring nosocomial COVID infection postoperatively.5. COVID positive surgical patient with false negative COVID report.6. COVID suspected by intraoperative COVID specific intestinal findings and then getting postoperative COVID test positive for the patient.Interpretations:· Deferrable surgeries to be avoided· A stringent institutional protocol for all patients is the essence of current surgical practice.· Minimal surgical or radiological intervention should be sought whenever possible.· The bias towards COVID, should not let us miss a surgical pathology in patients mimicking COVID clinically.· The possibility of a false negative COVID test, should be kept in mind in patients with typical COVID like symptomatology.· Immunocompromised surgical patients susceptible to nosocomial COVID infections should be dealed with extra caution and precaution.

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Unexpected Findings of Coronavirus Disease (COVID-19) at the Lung Bases on Abdominopelvic CT

Cited by 52 publications

References 1 publication

CT Scans Obtained for Nonpulmonary Indications: Associated Respiratory Findings of COVID-19

CT Scans Obtained for Nonpulmonary Indications: Associated Respiratory Findings of COVID-19

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

COVID patients encountered by a general surgeon- 6 unique scenarios.

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