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Goyal H, Sureka B, Mangaraj N, Agarwal A, Kothari N, Garg MK, Banerjee M, Agarwal A, Garg P, Yadav T, Khera P. Comparison between abdominal CT findings in intensive care unit (ICU) and non-ICU patients with Covid-19: experience from a tertiary care hospital. Afr Health Sci 2023; 23:64-74. [PMID: 38974306 PMCID: PMC11225447 DOI: 10.4314/ahs.v23i4.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Background 16-66% of COVID-19 positive patients may have abdominal symptoms and findings in abdominal CT. The yield of abdominal CT scan in patients having abdominal complaints is not known. Objectives The aim of this study was to explore the various abdominal imaging manifestations of COVID-19 and COVID-19 associated Mucormycosis (CAM) and to identify the relevant clinical and laboratory features associated with severity of the symptoms. Methods A retrospective single centre observational study was performed at a tertiary care hospital in Northwest India. All consecutive patients who had COVID positive RT-PCR report and had undergone abdominal Computed Tomography scan from March 2020 to November 2021 for various abdominal complaints were included. Demographic data, CT images and reports and all relevant lab parameters were collected. Results Out of 75 patients, positive abdominal findings were seen in 65 patients. Hepatobiliary findings were seen in 41.3% (31 of 75; OR=1.9) and bowel abnormalities were found in 37.3% (28 of 75; OR=2.1) of COVID-19 patients. 7 patients who had renal infarcts or bowel ischemia were found to have COVID-19 associated Mucormycosis on histopathology. Conclusion Chest CT severity score was positively correlated with most of the abdominal manifestations in patients requiring ICU admission. Elevated D-dimer levels were significantly associated with abdominal symptoms.
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Affiliation(s)
- Himanshu Goyal
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences - Jodhpur, India
| | - Binit Sureka
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences - Jodhpur, India
| | - Nachiketa Mangaraj
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences - Jodhpur, India
| | - Ashish Agarwal
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences - Jodhpur, India
| | - Nikhil Kothari
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences - Jodhpur, India
| | - M K Garg
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences - Jodhpur, India
| | - Mithu Banerjee
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences - Jodhpur, India
| | - Ashwini Agarwal
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences - Jodhpur, India
| | - Pawan Garg
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences - Jodhpur, India
| | - Taruna Yadav
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences - Jodhpur, India
| | - Pushpinder Khera
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences - Jodhpur, India
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Onur MR, Özbay Y, İdilman İ, Karaosmanoğlu AD, Uysal Ramadan S, Barlık F, Aydın S, Odaman H, Altay C, Başara Akın I, Dicle O, Appak Ö, Gülpınar B, Erden A, Kula S, Gürsöy Çoruh A, Kuru Öz D, Kul M, Uzun Ç, Karavaş E, Levent A, Artaş H, Eryeşil H, Solmaz O, Öztürk Kaygusuz T, Faraşat M, Kale AB, Düzgün F, Pekindil G, Apaydın FD, Nass Duce M, Balcı Y, Esen K, Sağır Kahraman A, Karaca L, Maraş Özdemir Z, Kahraman B, Tosun M, Nural MS, Çamlıdağ İ, Onar MA, Ballı K, Güler E, Harman M, Elmas NZ, Öztürk C, Güngör Ö, Herek D, Yağcı AB, Erol C, Şeker M, İşlek İ, Can Y, Aslan S, Karadeniz Bilgili MY, Göncüoğlu A, Keleş H, Bekin Sarıkaya PZ, Bakır B, Dağoğlu Kartal MG, Durak G, Yücel Oğuzdoğan G, Alper F, Yalçın A, Gürel S, Alan B, Gündoğdu E, Aydın N, Cansu A, Civan Kuş C, Ofluoğlu Tuncer E, Pişkin FC, Çolakoğlu Er H, Değirmenci B, Özmen MN, Kantarcı M, Karçaaltıncaba M. Evaluation of abdominal computed tomography findings in patients with COVID-19: a multicenter study. Diagn Interv Radiol 2023; 29:414-427. [PMID: 36960669 PMCID: PMC10679620 DOI: 10.4274/dir.2022.221575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 07/13/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE To evaluate the frequency of abdominal computed tomography (CT) findings in patients with coronavirus disease-2019 (COVID-19) and interrogate the relationship between abdominal CT findings and patient demographic features, clinical findings, and laboratory test results as well as the CT atherosclerosis score in the abdominal aorta. METHODS This study was designed as a multicenter retrospective study. The abdominal CT findings of 1.181 patients with positive abdominal symptoms from 26 tertiary medical centers with a positive polymerase chain-reaction test for severe acute respiratory syndrome coronavirus 2 were reviewed. The frequency of ischemic and non-ischemic CT findings as well as the association between CT findings, clinical features, and abdominal aortic calcific atherosclerosis score (AA-CAS) were recorded. RESULTS Ischemic and non-ischemic abdominal CT findings were detected in 240 (20.3%) and 328 (27.7%) patients, respectively. In 147 patients (12.4%), intra-abdominal malignancy was present. The most frequent ischemic abdominal CT findings were bowel wall thickening (n = 120; 10.2%) and perivascular infiltration (n = 40; 3.4%). As for non-ischemic findings, colitis (n = 91; 7.7%) and small bowel inflammation (n = 73; 6.2%) constituted the most frequent disease processes. The duration of hospital stay was found to be higher in patients with abdominal CT findings than in patients without any positive findings (13.8 ± 13 vs. 10.4 ± 12.8 days, P < 0.001). The frequency of abdominal CT findings was significantly higher in patients who did not survive the infection than in patients who were discharged after recovery (41.7% vs. 27.4%, P < 0.001). Increased AA-CAS was found to be associated with a higher risk of ischemic conditions in abdominal CT examinations. CONCLUSION Abdominal symptoms in patients with COVID-19 are usually associated with positive CT findings. The presence of ischemic findings on CT correlates with poor COVID-19 outcomes. A high AA-CAS is associated with abdominal ischemic findings in patients with COVID-19.
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Affiliation(s)
- Mehmet Ruhi Onur
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yakup Özbay
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - İlkay İdilman
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | - Selma Uysal Ramadan
- Clinic of Radiology, University of Health Sciences Turkey, Ankara Atatürk Sanatorium Training and Research Hospital, Ankara, Turkey
| | - Funda Barlık
- Department of Radiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Sonay Aydın
- Department of Radiology, Binali Yıldırım University Faculty of Medicine, Erzincan, Turkey
| | - Hüseyin Odaman
- Department of Radiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Canan Altay
- Department of Radiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Işıl Başara Akın
- Department of Radiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Oğuz Dicle
- Department of Radiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Özgür Appak
- Department of Medical Microbiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Başak Gülpınar
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ayşe Erden
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Sezer Kula
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | | | - Diğdem Kuru Öz
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Melahat Kul
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Çağlar Uzun
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Erdal Karavaş
- Department of Radiology, Binali Yıldırım University Faculty of Medicine, Erzincan, Turkey
| | - Akın Levent
- Department of Radiology, Binali Yıldırım University Faculty of Medicine, Erzincan, Turkey
| | - Hakan Artaş
- Department of Radiology, Fırat University Faculty of Medicine, Elazığ, Turkey
| | - Hasan Eryeşil
- Department of Radiology, Fırat University Faculty of Medicine, Elazığ, Turkey
| | - Onur Solmaz
- Department of Radiology, Fırat University Faculty of Medicine, Elazığ, Turkey
| | - Türkkan Öztürk Kaygusuz
- Department of Infectious Diseases and Clinical Microbiology, Fırat University Faculty of Medicine, Elazığ, Turkey
| | - Mustafa Faraşat
- Department of Radiology, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Ahmet Burak Kale
- Department of Radiology, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Fatih Düzgün
- Department of Radiology, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Gökhan Pekindil
- Department of Radiology, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - F. Demir Apaydın
- Department of Radiology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Meltem Nass Duce
- Department of Radiology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Yüksel Balcı
- Department of Radiology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Kaan Esen
- Department of Radiology, Mersin University Faculty of Medicine, Mersin, Turkey
| | | | - Leyla Karaca
- Department of Radiology, İnönü University Faculty of Medicine, Malatya, Turkey
| | | | - Bayram Kahraman
- Clinic of Radiology, Specialist Doctor Bayram Kahraman Radiology Clinic, Malatya, Turkey
| | - Mesude Tosun
- Department of Radiology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Mehmet Selim Nural
- Department of Radiology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - İlkay Çamlıdağ
- Department of Radiology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Mustafa Arda Onar
- Department of Radiology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Kaan Ballı
- Department of Radiology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Ezgi Güler
- Department of Radiology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Mustafa Harman
- Department of Radiology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Nevra Zehra Elmas
- Department of Radiology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Cansu Öztürk
- Clinic of Radiology, University of Health Sciences Turkey, Ankara Atatürk Sanatorium Training and Research Hospital, Ankara, Turkey
| | - Özlem Güngör
- Clinic of Radiology, University of Health Sciences Turkey, Ankara Atatürk Sanatorium Training and Research Hospital, Ankara, Turkey
| | - Duygu Herek
- Department of Radiology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Ahmet Baki Yağcı
- Department of Radiology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Cengiz Erol
- Department of Radiology, Medipol University Faculty of Medicine, İstanbul, Turkey
| | - Mehmet Şeker
- Department of Radiology, Medipol University Faculty of Medicine, İstanbul, Turkey
| | - İrem İşlek
- Department of Radiology, Medipol University Faculty of Medicine, İstanbul, Turkey
| | - Yusuf Can
- Department of Radiology, Medipol University Faculty of Medicine, İstanbul, Turkey
| | - Serdar Aslan
- Department of Radiology, Giresun University Faculty of Medicine, Giresun, Turkey
| | | | - Alper Göncüoğlu
- Department of Radiology, Kırıkkale University Faculty of Medicine, Kırıkkale, Turkey
| | - Hatice Keleş
- Department of Internal Medicine, Kırıkkale University Faculty of Medicine, Kırıkkale, Turkey
| | | | - Barış Bakır
- Department of Radiology, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | | | - Görkem Durak
- Department of Radiology, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Gülşen Yücel Oğuzdoğan
- Clinic of Radiology, University of Health Sciences Turkey, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
| | - Fatih Alper
- Department of Radiology, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Ahmet Yalçın
- Department of Radiology, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Safiye Gürel
- Department of Radiology, Bolu Abant İzzet Baysal University Faculty of Medicine, Bolu, Turkey
| | - Bircan Alan
- Department of Radiology, Bolu Abant İzzet Baysal University Faculty of Medicine, Bolu, Turkey
| | - Elif Gündoğdu
- Department of Radiology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Nevin Aydın
- Department of Radiology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Ayşegül Cansu
- Department of Radiology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Ceyda Civan Kuş
- Clinic of Radiology, Marmara University Training and Research Hospital, İstanbul, Turkey
| | - Elif Ofluoğlu Tuncer
- Clinic of Radiology, University of Health Sciences Turkey, Sultan 2. Abdulhamid Han Training and Research Hospital, İstanbul, Turkey
| | - Ferhat Can Pişkin
- Department of Radiology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Hale Çolakoğlu Er
- Department of Radiology, Ufuk University Faculty of Medicine, Ankara, Turkey
| | | | - Mustafa Nasuh Özmen
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mecit Kantarcı
- Department of Radiology, Binali Yıldırım University Faculty of Medicine, Erzincan, Turkey
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Tews HC, Kandulski A, Schmid S, Schlosser S, Schirner S, Putz FJ, Cosma L, Gülow K, Müller M, Jung EM. Multimodal ultrasound imaging with conventional B-mode, elastography, and parametric analysis of contrast-enhanced ultrasound (CEUS): A novel approach to assess small bowel manifestation in severe COVID-19 disease. Clin Hemorheol Microcirc 2022; 82:341-360. [PMID: 35871323 DOI: 10.3233/ch-221540] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The aim was to describe the small bowel morphology with conventional B-mode and elastography and additionally to evaluate dynamic effects of COVID-19 associated small bowel microvascularization using CEUS with color coded perfusion parameters.Thirteen patients with severe COVID-19 acute respiratory distress syndrome (ARDS) were investigated. 13 patients required intensive care treatment with mechanical ventilation. Five patients required extracorporeal membrane oxygenation (ECMO). Contrast-enhanced ultrasound (CEUS) was performed by an experienced investigator as a bolus injection of up to 2.4 ml sulfur hexafluoride microbubbles via a central venous catheter. In the parametric analysis of CEUS, the flare of microbubbles over time is visualized with colors. This is the first work using parametric analysis of CEUS to detect perfusion differences in the small bowel.Parametric analysis of CEUS in the intestinal phase was carried out, using DICOM loops for 20 seconds. In 5 patients, parametric analysis revealed intraindividual differences in contrast agent behavior in the small bowel region. Analogous to the computed tomography (CT) images parametric analysis showed regions of simultaneous hyper- and hypoperfusion of the small intestine in a subgroup of patients. In 5 patients, the parametric image of transmural global contrast enhancement was visualized.Our results using CEUS to investigate small bowel affection in COVID-19 suggest that in severe COVID-19 ARDS systemic inflammation and concomitant micro embolisms may lead to disruption of the epithelial barrier of the small intestine.This is the first study using parametric analysis of CEUS to evaluate the extent of small bowel involvement in severe COVID-19 disease and to detect microemboli. In summary, we show that in COVID-19 the small bowel may also be an important interaction site. This is in line with the fact that enterocytes have been shown to a plenitude of angiotensin converting enzyme (ACE)-2 receptors as entry sites of the virus.
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Affiliation(s)
- H C Tews
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital, Regensburg, Germany
| | - A Kandulski
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital, Regensburg, Germany
| | - S Schmid
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital, Regensburg, Germany
| | - S Schlosser
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital, Regensburg, Germany
| | - S Schirner
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital, Regensburg, Germany
| | - F J Putz
- Department of Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - L Cosma
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital, Regensburg, Germany
| | - K Gülow
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital, Regensburg, Germany
| | - M Müller
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital, Regensburg, Germany
| | - E M Jung
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
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Shokri Varniab Z, Pourabhari Langroudi A, Amouei M, Pak N, Khosravi B, Radmard AR. Abdominal Imaging Findings in Patients with COVID-19 Part 2: Solid Organs. Middle East J Dig Dis 2022; 14:373-381. [PMID: 37547497 PMCID: PMC10404099 DOI: 10.34172/mejdd.2022.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/10/2022] [Indexed: 08/08/2023] Open
Abstract
Since severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) first appeared in China in December 2019, the globe has been dealing with an ever-increasing incidence of coronavirus disease 2019 (COVID-19). In addition to respiratory disorders, 40% of patients present with gastrointestinal (GI) involvement. Abdominal pain is the most common indication for computed tomography (CT) and ultrasonography. After GI tract involvement, solid visceral organ infarction is the most prevalent abdominal abnormality in COVID-19. This review aims to gather the available data in the literature about imaging features of solid abdominal organs in patients with COVID-19. Gallbladder wall thickening and distension, cholelithiasis, hyperdense biliary sludge, acalculous cholecystitis, periportal edema, heterogeneous liver enhancement, and liver hypodensity and infarction are among hepatobiliary imaging findings in CT, particularly in patients admitted to ICU. Pancreatic involvement can develop as a result of direct SARS-CoV2 invasion with signs of acute pancreatitis in abdominal CT, such as edema and inflammation of the pancreas. Infarction was the most prevalent renal and splenic involvement in patients with COVID-19 who underwent abdominal CT presenting with areas of parenchymal hypodensity. In conclusion, although solid abdominal organs are rarely affected by COVID-19, clinicians must be familiar with the manifestations since they are associated with the disease severity and poor outcome.
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Affiliation(s)
- Zahra Shokri Varniab
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mehrnam Amouei
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Pak
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Bardia Khosravi
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Reza Radmard
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Pourabhari Langroudi A, Shokri Varniab Z, Amouei M, Pak N, Khosravi B, Mirsharifi A, Radmard AR. Findings of Abdominal Imaging in Patients with COVID-19 - Part 1: Hollow Organs. Middle East J Dig Dis 2022; 14:278-286. [PMID: 36619269 PMCID: PMC9489432 DOI: 10.34172/mejdd.2022.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 04/04/2022] [Indexed: 11/06/2022] Open
Abstract
Since COVID-19 has spread worldwide, the role of imaging for early detection of the disease has become more prominent. Abdominal symptoms in COVID-19 are common in addition to respiratory manifestations. This review collected the available data about abdominal computed tomography (CT) and ultrasonography indications in hollow abdominal organs in patients with COVID-19 and their findings. Since abdominal imaging is less frequently used in COVID-19, there is limited information about the gastrointestinal findings. The most common indications for abdominal CT in patients with COVID-19 were abdominal pain and sepsis. Bowel wall thickening and fluid-filled colon were the most common findings in abdominal imaging. Acute mesenteric ischemia (AMI) was one of the COVID-19 presentations secondary to coagulation dysfunction. AMI manifests with sudden abdominal pain associated with high morbidity and mortality in admitted patients; therefore, CT angiography should be considered for early diagnosis of AMI. Ultrasonography is a practical modality because of its availability, safety, rapidity, and ability to be used at the bedside. Clinicians and radiologists should be alert to indications and findings of abdominal imaging modalities in COVID-19 to diagnose the disease and its potentially serious complications promptly.
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Affiliation(s)
| | - Zahra Shokri Varniab
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrnam Amouei
- Assistant Professor, Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Pak
- Associate Professor, Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Bardia Khosravi
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Mirsharifi
- Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Reza Radmard
- Associate Professor, Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran,Corresponding Author: Amir Reza Radmard, MD Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Shariati Hospital, 14117, North Kargar St., Tehran, Iran Tel: +98 21 84902178 Fax:+98 21 82415400 ,
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Ippolito D, Vernuccio F, Maino C, Cannella R, Giandola T, Ragusi M, Bigiogera V, Capodaglio C, Sironi S. Multiorgan Involvement in SARS-CoV-2 Infection: The Role of the Radiologist from Head to Toe. Diagnostics (Basel) 2022; 12:1188. [PMID: 35626344 PMCID: PMC9140872 DOI: 10.3390/diagnostics12051188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/29/2022] [Accepted: 05/05/2022] [Indexed: 01/08/2023] Open
Abstract
Radiology plays a crucial role for the diagnosis and management of COVID-19 patients during the different stages of the disease, allowing for early detection of manifestations and complications of COVID-19 in the different organs. Lungs are the most common organs involved by SARS-CoV-2 and chest computed tomography (CT) represents a reliable imaging-based tool in acute, subacute, and chronic settings for diagnosis, prognosis, and management of lung disease and the evaluation of acute and chronic complications. Cardiac involvement can be evaluated by using cardiac computed tomography angiography (CCTA), considered as the best choice to solve the differential diagnosis between the most common cardiac conditions: acute coronary syndrome, myocarditis, and cardiac dysrhythmia. By using compressive ultrasound it's possible to study the peripheral arteries and veins and to exclude the deep vein thrombosis, directly linked to the onset of pulmonary embolism. Moreover, CT and especially MRI can help to evaluate the gastrointestinal involvement and assess hepatic function, pancreas involvement, and exclude causes of lymphocytopenia, thrombocytopenia, and leukopenia, typical of COVID-19 patients. Finally, radiology plays a crucial role in the early identification of renal damage in COVID-19 patients, by using both CT and US. This narrative review aims to provide a comprehensive radiological analysis of commonly involved organs in patients with COVID-19 disease.
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Affiliation(s)
- Davide Ippolito
- Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, MB, Italy; (D.I.); (C.M.); (T.G.); (M.R.); (V.B.); (C.C.)
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy;
| | - Federica Vernuccio
- Department of Radiology, University Hospital of Padova, Via Nicolò Giustiniani, 2, 35128 Padova, PD, Italy
| | - Cesare Maino
- Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, MB, Italy; (D.I.); (C.M.); (T.G.); (M.R.); (V.B.); (C.C.)
| | - Roberto Cannella
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Via del Vespro, 129, 90127 Palermo, PA, Italy;
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Via del Vespro, 129, 90127 Palermo, PA, Italy
| | - Teresa Giandola
- Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, MB, Italy; (D.I.); (C.M.); (T.G.); (M.R.); (V.B.); (C.C.)
| | - Maria Ragusi
- Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, MB, Italy; (D.I.); (C.M.); (T.G.); (M.R.); (V.B.); (C.C.)
| | - Vittorio Bigiogera
- Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, MB, Italy; (D.I.); (C.M.); (T.G.); (M.R.); (V.B.); (C.C.)
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy;
| | - Carlo Capodaglio
- Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, MB, Italy; (D.I.); (C.M.); (T.G.); (M.R.); (V.B.); (C.C.)
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy;
| | - Sandro Sironi
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy;
- Department of Diagnostic Radiology, H Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, BG, Italy
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Ojha V, Mani A, Mukherjee A, Kumar S, Jagia P. Mesenteric ischemia in patients with COVID-19: an updated systematic review of abdominal CT findings in 75 patients. Abdom Radiol (NY) 2022; 47:1565-1602. [PMID: 34761305 PMCID: PMC8580173 DOI: 10.1007/s00261-021-03337-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/22/2021] [Accepted: 10/26/2021] [Indexed: 12/12/2022]
Abstract
Background Acute mesenteric ischemia (AMI) is a less common but devastating complication of COVID-19 disease. The aim of this systematic review was to assess the most common CT imaging features of AMI in COVID-19 and also provide an updated review of the literature on symptoms, treatment, histopathological and operative findings, and follow-up of these patients. Methods A systematic literature search of four databases: Pubmed, EMBASE, WHO database, and Google Scholar, was performed to identify all the articles which described abdominal CT imaging findings of AMI in COVID-19. Results A total of 47 studies comprising 75 patients were included in the final review. Small bowel ischemia (46.67%) was the most prevalent abdominal CT finding, followed by ischemic colitis (37.3%). Non-occlusive mesenteric ischemia (NOMI; 67.9%) indicating microvascular involvement was the most common pattern of bowel involvement. Bowel wall thickening/edema (50.9%) was more common than bowel hypoperfusion (20.7%). While ileum and colon both were equally involved bowel segments (32.07% each), SMA (24.9%), SMV (14.3%), and the spleen (12.5%) were the most commonly involved artery, vein, and solid organ, respectively. 50% of the patients receiving conservative/medical management died, highlighting high mortality without surgery. Findings on laparotomy and histopathology corroborated strikingly with CT imaging findings. Conclusion In COVID-19 patients with AMI, small bowel ischemia is the most prevalent imaging diagnosis and NOMI is the most common pattern of bowel involvement. Contrast-enhanced CT is a powerful decision-making tool for prompt diagnosis of AMI in COVID-19, thereby potentially improving time to treat as well as clinical outcomes.
Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00261-021-03337-9.
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Affiliation(s)
- Vineeta Ojha
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Avinash Mani
- Department of Cardiology, Sri Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Aprateem Mukherjee
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Priya Jagia
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029, India.
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8
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Tews H, Kandulski A, Schmid S, Peschel G, Gülow K, Schlosser S, Schirner S, Stroszczynski C, Müller M, Jung E. Contrast enhanced ultrasonography (CEUS) a novel tool to detect intestinal epithelial barrier dysfunction in severe COVID-19 disease. Clin Hemorheol Microcirc 2022; 81:177-190. [DOI: 10.3233/ch-221407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ten patients with confirmed COVID-19 disease were studied. Nine patients required intensive care treatment, among them four needed extracorporeal membrane oxygenation (ECMO). Contrast enhanced ultrasonography (CEUS) was performed by one experienced investigator as a bolus injection of up to 2.4 ml of sulphur hexafluoride microbubbles via a central venous catheter. B-Mode evaluation and strain elastography showed mural edema of the small bowel with a thickness of up to 10 mm in all patients. We applied color coded Doppler sonography (CCDS) and power mode with flow-adapted parameters and early, dynamic capillary arterial contrast enhancement of bowel wall structures <10 s to assess perfusion of the small bowel. In all patients, reactive hyperemia was seen in the entire small bowel. In a subgroup of seven patients microbubbles translocated into the intestinal lumen. Thus, high-grade intestinal barrier disruption secondary to SARSCoV-2 infection can be postulated in these patients. This is the first description of perfusion changes and a disruption of the small bowel epithelial barrier in COVID-19 Patients using contrast ultrasonography and elastography.
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Affiliation(s)
- H.C. Tews
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital, Regensburg, Germany
| | - A. Kandulski
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital, Regensburg, Germany
| | - S. Schmid
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital, Regensburg, Germany
| | - G. Peschel
- Departement of Internal Medicine, Fürstenfeldbruck, Germany
| | - K. Gülow
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital, Regensburg, Germany
| | | | - S. Schirner
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital, Regensburg, Germany
| | - C. Stroszczynski
- Institute of Diagnostic Radiology, University Hospital, Regensburg, Germany
| | - M. Müller
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital, Regensburg, Germany
| | - E.M. Jung
- Institute of Diagnostic Radiology, University Hospital, Regensburg, Germany
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9
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Sadeghi S, Nasirian M, Keivany E, Nasri P, Mirenayat MS. The demographic, clinical, and medical manifestations of pulmonary thromboembolism development in COVID-19. Blood Res 2021; 56:293-300. [PMID: 34880142 PMCID: PMC8721446 DOI: 10.5045/br.2021.2021131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/05/2021] [Accepted: 11/04/2021] [Indexed: 01/08/2023] Open
Abstract
Background Since the emergence of coronavirus disease 2019 (COVID-19), various clinical manifestations ranging from asymptomatic to severe, life-threatening courses have been presented. It is well known that COVID-19 patients are at an increased risk of pulmonary thromboembolism (PTE) development; however, the associated demographic, medical, and clinical factors for developing PTE remain unknown. The current study aimed to assess the characteristics of patients with PTE. Methods This case-control study was derived from an ongoing population-based investigation of hospitalized patients with COVID-19 pneumonia. The case group included 99 patients with PTE confirmed by computed tomography pulmonary angiography (CTPA), and the controls (N=132) were age-matched patients selected from the PTE-suspected patients with a negative CTPA. The demographic, medical, and clinical characteristics of the study population were entered into the study checklist and compared. A logistic regression test was used to determine the factors associated with PTE development. Results Among the 13,099 admitted patients, 690 (5.26%) were suspected of having PTE according to their clinical manifestations. CTPA was performed for suspected cases, and PTE was confirmed in 132 patients (19.13%). Logistic regression assessments revealed that male gender (OR, 2.39; 95%CI, 1.38‒4.13), decreased oxygen saturation (OR, 2.33; 95%CI, 1.27‒4.26), and lower hemoglobin (OR, 0.83, 0.95), and albumin (OR, 0.31; 95%CI, 0.18‒0.53) levels were associated with PTE development. Conclusion PTE was confirmed in one-fifth of suspected patients who underwent CTPA imaging. Male sex, decreased oxygen saturation, and lower levels of hemoglobin and albumin were independent predictors of PTE in patients with COVID-19 pneumonia.
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Affiliation(s)
- Somayeh Sadeghi
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Acquired Immunodeficiency Research Center, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Nasirian
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Epidemiology and Biostatistics Department, Health School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elaheh Keivany
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Pulmonology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Peiman Nasri
- Metabolic Liver Disease Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Sadat Mirenayat
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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10
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Abdominal Computed Tomography Imaging Findings in Hospitalized COVID-19 Patients: A Year-Long Experience and Associations Revealed by Explainable Artificial Intelligence. J Imaging 2021; 7:jimaging7120258. [PMID: 34940725 PMCID: PMC8704652 DOI: 10.3390/jimaging7120258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/10/2021] [Accepted: 11/26/2021] [Indexed: 12/22/2022] Open
Abstract
The aim of this retrospective study is to assess any association between abdominal CT findings and the radiological stage of COVID-19 pneumonia, pulmonary embolism and patient outcomes. We included 158 adult hospitalized COVID-19 patients between 1 March 2020 and 1 March 2021 who underwent 206 abdominal CTs. Two radiologists reviewed all CT images. Pathological findings were classified as acute or not. A subset of patients with inflammatory pathology in ACE2 organs (bowel, biliary tract, pancreas, urinary system) was identified. The radiological stage of COVID pneumonia, pulmonary embolism, overall days of hospitalization, ICU admission and outcome were registered. Univariate statistical analysis coupled with explainable artificial intelligence (AI) techniques were used to discover associations between variables. The most frequent acute findings were bowel abnormalities (n = 58), abdominal fluid (n = 42), hematomas (n = 28) and acute urologic conditions (n = 8). According to univariate statistical analysis, pneumonia stage > 2 was significantly associated with increased frequency of hematomas, active bleeding and fluid-filled colon. The presence of at least one hepatobiliary finding was associated with all the COVID-19 stages > 0. Free abdominal fluid, acute pathologies in ACE2 organs and fluid-filled colon were associated with ICU admission; free fluid also presented poor patient outcomes. Hematomas and active bleeding with at least a progressive stage of COVID pneumonia. The explainable AI techniques find no strong relationship between variables.
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11
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OKUTURLAR Y, GUNES R, ÇELİK BN, NASİROV N, KÖKSAL İ. Acute pulmonary embolism in COVID-19 disease: Case Report. TURKISH JOURNAL OF INTERNAL MEDICINE 2021. [DOI: 10.46310/tjim.877214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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12
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Morelli C, Francavilla M, Stabile Ianora AA, Cozzolino M, Gualano A, Stellacci G, Sacco A, Lorusso F, Pedote P, De Ceglie M, Scardapane A. The Multifaceted COVID-19: CT Aspects of Its Atypical Pulmonary and Abdominal Manifestations and Complications in Adults and Children. A Pictorial Review. Microorganisms 2021; 9:microorganisms9102037. [PMID: 34683358 PMCID: PMC8541408 DOI: 10.3390/microorganisms9102037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 12/12/2022] Open
Abstract
Our daily experience in a COVID hospital has allowed us to learn about this disease in many of its changing and unusual aspects. Some of these uncommon manifestations, however, appeared more frequently than others, giving shape to a multifaceted COVID-19 disease. This pictorial review has the aim to describe the radiological aspects of atypical presentations and of some complications of COVID-19 disease in adults and children and provide a simple guide for radiologists to become familiar with the multiform aspects of this disease.
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Affiliation(s)
- Chiara Morelli
- Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari Medical School, 70124 Bari, Italy; (A.A.S.I.); (M.C.); (A.G.); (A.S.); (F.L.); (P.P.); (M.D.C.); (A.S.)
- Correspondence:
| | | | - Amato Antonio Stabile Ianora
- Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari Medical School, 70124 Bari, Italy; (A.A.S.I.); (M.C.); (A.G.); (A.S.); (F.L.); (P.P.); (M.D.C.); (A.S.)
| | - Monica Cozzolino
- Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari Medical School, 70124 Bari, Italy; (A.A.S.I.); (M.C.); (A.G.); (A.S.); (F.L.); (P.P.); (M.D.C.); (A.S.)
| | - Alessandra Gualano
- Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari Medical School, 70124 Bari, Italy; (A.A.S.I.); (M.C.); (A.G.); (A.S.); (F.L.); (P.P.); (M.D.C.); (A.S.)
| | | | - Antonello Sacco
- Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari Medical School, 70124 Bari, Italy; (A.A.S.I.); (M.C.); (A.G.); (A.S.); (F.L.); (P.P.); (M.D.C.); (A.S.)
| | - Filomenamila Lorusso
- Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari Medical School, 70124 Bari, Italy; (A.A.S.I.); (M.C.); (A.G.); (A.S.); (F.L.); (P.P.); (M.D.C.); (A.S.)
| | - Pasquale Pedote
- Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari Medical School, 70124 Bari, Italy; (A.A.S.I.); (M.C.); (A.G.); (A.S.); (F.L.); (P.P.); (M.D.C.); (A.S.)
| | - Michele De Ceglie
- Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari Medical School, 70124 Bari, Italy; (A.A.S.I.); (M.C.); (A.G.); (A.S.); (F.L.); (P.P.); (M.D.C.); (A.S.)
| | - Arnaldo Scardapane
- Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari Medical School, 70124 Bari, Italy; (A.A.S.I.); (M.C.); (A.G.); (A.S.); (F.L.); (P.P.); (M.D.C.); (A.S.)
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13
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Singh P, Singh SP, Verma AK, Raju SN, Parihar A. A Systematic Review of Abdominal Imaging Findings in COVID-19 Patients. Visc Med 2021; 26:1-12. [PMID: 34580634 PMCID: PMC8450847 DOI: 10.1159/000518473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/13/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The objective of this systematic review was to evaluate key imaging manifestations of COVID-19 on abdominal imaging by utilizing a comprehensive review of the published literature. METHOD A systematic literature search from PubMed, Google Scholar, and Scopus was performed for studies mentioning abdominal imaging findings in COVID-19 patients. Studies published from inception to 15 March 2021 were included. RESULTS A total of 116 studies comprising 1,198 patients were included. Abdominal pain was the most common indication for abdominal imaging in 50.2% of the patients. No abnormality was seen in 48.1% of abdominopelvic computed tomography scans. Segmental bowel wall thickening (14.7%) was the most common imaging abnormality, followed by bowel ischemia (7.1%), solid organ infarction (6.7%), vessel thrombosis (6.7%), and fluid-filled colon (6.2%). Other relevant findings were dilated air-filled bowel, pancreatitis, pneumatosis/portal venous gas, bowel perforation, and appendicitis. Other than abdominal findings, COVID-19-related basal lung changes were incidentally detected in many studies. Moreover, the presence of bowel imaging findings was positively correlated with the clinical severity of COVID-19 infection. CONCLUSION This review describes the abdominal imaging findings in COVID-19 patients. This is pertinent for the early diagnosis of COVID-19 in patients presenting solely with abdominal symptoms as well as in identifying abdominal complications in a known case of COVID-19.
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Affiliation(s)
- Priya Singh
- Radiodiagnosis, King George Medical University, Lucknow, India
| | - Surya Pratap Singh
- Cardiovascular Radiology and Endovascular Intervention, All India Institute of Medical Science, New Delhi, India
| | | | - Sreenivasa Narayana Raju
- Cardiovascular Radiology and Endovascular Intervention, All India Institute of Medical Science, New Delhi, India
| | - Anit Parihar
- Radiodiagnosis, King George Medical University, Lucknow, India
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Pirola L, Palermo A, Mulinacci G, Ratti L, Fichera M, Invernizzi P, Viganò C, Massironi S. Acute mesenteric ischemia and small bowel imaging findings in COVID-19: A comprehensive review of the literature. World J Gastrointest Surg 2021; 13:702-716. [PMID: 34354803 PMCID: PMC8316849 DOI: 10.4240/wjgs.v13.i7.702] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/12/2021] [Accepted: 07/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19), an infectious condition caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread worldwide since its first description in Wuhan in December 2019. Even though respiratory manifestations are the most prevalent and responsible for disease morbidity and mortality, extrapulmonary involvement has progressively gained relevance. In particular, gastrointestinal (GI) signs and symptoms, reported in up to two-thirds of patients with COVID-19, might represent the first and, in some cases, the only disease presentation. Their presence has been associated in some studies with an increased risk of a severe disease course. Proposed pathogenic mechanisms explaining GI tract involvement are either direct viral access to intestinal cells via angiotensin-converting enzyme 2 or indirect damage of the intestinal wall through mesenteric ischemia induced by the hypercoagulable state associated with COVID-19 infection. Although not typical of SARS-CoV-2 infection, several small bowel manifestations have been described in infected patients who underwent any form of abdominal imaging. The radiological findings were mainly reported in patients with abdominal symptoms, among which abdominal pain was the most common.
AIM To discuss small bowel radiological manifestations of SARS-CoV-2 infection in abdominal imaging studies.
METHODS Bibliographical searches were performed in PubMed, using the following keywords: “COVID-19” AND “imaging” AND “gastrointestinal” OR “abdominal” OR “small bowel”.
RESULTS Of 62 patients with described radiologic small bowel alterations, mesenteric ischemia was diagnosed in 31 cases (50%), small bowel wall thickening in 10 cases (16%), pneumatosis in nine cases (15%), intussusception in eight cases (13%), pneumoperitoneum in two cases (3%) and paralytic ileus in two cases (3%). We also reported mesenteric adipose tissue hypertrophy and lymph nodes enlargement in a young woman.
CONCLUSION So far it is difficult to establish whether these manifestations are the direct consequence of SARS-CoV-2 infection or collateral findings in infected patients, but their recognition would be pivotal to set a closer follow-up and to reduce missed diagnoses.
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Affiliation(s)
- Lorena Pirola
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
- European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
| | - Andrea Palermo
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
- European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
| | - Giacomo Mulinacci
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
- European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
| | - Laura Ratti
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
- European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
| | - Maria Fichera
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
- European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
| | - Pietro Invernizzi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
- European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
| | - Chiara Viganò
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
- European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
| | - Sara Massironi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
- European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
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15
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Boraschi P, Giugliano L, Mercogliano G, Donati F, Romano S, Neri E. Abdominal and gastrointestinal manifestations in COVID-19 patients: Is imaging useful? World J Gastroenterol 2021; 27:4143-4159. [PMID: 34326615 PMCID: PMC8311532 DOI: 10.3748/wjg.v27.i26.4143] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/08/2021] [Accepted: 04/21/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) can be considered a systemic disease with a specific tropism for the vascular system, in which the alterations of the microcirculation have an important pathogenetic role. The lungs are the main organ involved in COVID-19, and severe progressive respiratory failure is the leading cause of death in the affected patients; however, many other organs can be involved with variable clinical manifestations. Concerning abdominal manifestations, the gastrointestinal tract and the hepatobiliary system are mainly affected, although the pancreas, urinary tract and spleen may also be involved. The most common gastrointestinal symptoms are loss of appetite, followed by nausea and vomiting, diarrhea and abdominal pain. Gastrointestinal imaging findings include bowel wall thickening, sometimes associated with hyperemia and mesenteric thickening, fluid-filled segments of the large bowel and rarely intestinal pneumatosis and ischemia. Hepatic involvement manifests as an increase in the enzymatic levels of alanine aminotransferase, aspartate aminotransferase, serum bilirubin and γ-glutamyl transferase with clinical manifestations in most cases mild and transient. The most frequent radiological features are hepatic steatosis, biliary sludge and gallstones. Edematous acute pancreatitis, kidney infarct and acute kidney injury from acute tubular necrosis have been described more rarely in COVID-19. Lastly, splenic involvement is characterized by splenomegaly and by the development of solitary or multifocal splenic infarcts with classic wedge-shaped or even rounded morphology, with irregular or smooth profiles. In summary, the abdominal radiological findings of COVID-19 are nonspecific and with poor pathological correlation reported in the literature. Ultrasound and particularly computed tomography with multiphasic acquisition are the diagnostic methods mainly utilized in COVID-19 patients with abdominal clinical symptoms and signs. Although radiological signs are not specific of abdominal and gastrointestinal involvement, the diagnostic imaging modalities and in particular computed tomography are helpful for the clinician in the management, evaluation of the severity and evolution of the COVID-19 patients.
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Affiliation(s)
- Piero Boraschi
- Department of Diagnostic Imaging, Second Division of Radiology, Azienda Ospedaliero-Universitaria Pisana-University of Pisa, Pisa 56124, Italy
| | - Luigi Giugliano
- Department of Radiology, University of Naples “Federico II”, Naples 80131, Italy
| | - Giuseppe Mercogliano
- Department of Radiology, University of Naples “Federico II”, Naples 80131, Italy
| | - Francescamaria Donati
- Department of Diagnostic Imaging, Second Division of Radiology, Azienda Ospedaliero-Universitaria Pisana-University of Pisa, Pisa 56124, Italy
| | - Stefania Romano
- Department of Diagnostic Imaging, Santa Maria delle Grazie Hospital, Naples 80078, Italy
| | - Emanuele Neri
- Diagnostic and Interventional Radiology, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa 56126, Italy
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Sridhar S, Nicholls J. Pathophysiology of infection with SARS-CoV-2-What is known and what remains a mystery. Respirology 2021; 26:652-665. [PMID: 34041821 PMCID: PMC8242464 DOI: 10.1111/resp.14091] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/03/2021] [Indexed: 12/12/2022]
Abstract
Coronavirus disease 2019 (COVID‐19), caused by coronavirus severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), has caused extensive disruption and mortality since its recent emergence. Concomitantly, there has been a race to understand the virus and its pathophysiology. The clinical manifestations of COVID‐19 are manifold and not restricted to the respiratory tract. Extrapulmonary manifestations involving the gastrointestinal tract, hepatobiliary system, cardiovascular and renal systems have been widely reported. However, the pathophysiology of many of these manifestations is controversial with questionable support for direct viral invasion and an abundance of alternative explanations such as pre‐existing medical conditions and critical illness. Prior research on SARS‐Co‐V and NL63 was rapidly leveraged to identify angiotensin‐converting enzyme 2 (ACE2) receptor as the key cell surface receptor for SARS‐CoV‐2. The distribution of ACE2 has been used as a starting point for estimating vulnerability of various tissue types to SARS‐CoV‐2 infection. Sophisticated organoid and animal models have been used to demonstrate such infectivity of extrapulmonary tissues in vitro, but the clinical relevance of these findings remains uncertain. Clinical autopsy studies are typically small and inevitably biased towards patients with severe COVID‐19 and prolonged hospitalization. Technical issues such as delay between time of death and autopsy, use of inappropriate antibodies for paraffin‐embedded tissue sections and misinterpretation of cellular structures as virus particles on electron micrograph images are additional problems encountered in the extant literature. Given that SARS‐CoV‐2 is likely to circulate permanently in human populations, there is no doubt that further work is required to clarify the pathobiology of COVID‐19.
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Affiliation(s)
- Siddharth Sridhar
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - John Nicholls
- Department of Pathology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
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