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Published on: December 19, 2020
Abdominal Imaging Findings in COVID-19: Preliminary Observations
Rajesh Bhayana1, Avik Som1, Matthew D Li1
1From the Division of Abdominal Imaging, Department of Radiology (R.B., A.S., M.D.L., M.A.A., M.A.B., O.C., M.S.G., P.F.H., M.H., A. Kilcoyne, S.I.L., A.M., P.V.P., T.T.P., D.A.R., S.S., A.E.S., J.F.S., D.A.G., A. Kambadakone), Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery (G.V.), and Department of Pathology (J.M.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114-2696; and Harvard Medical School, Boston, Mass (D.E.C.).
Abdominal imaging revealed common bowel abnormalities and gallbladder bile stasis in patients with coronavirus disease 2019 (COVID-19). Laparotomy cases often showed ischemia, potentially from small-vessel thrombosis in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections.
Area of Science:
- Gastroenterology
- Radiology
- Infectious Diseases
Background:
- Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) targets angiotensin-converting enzyme 2, highly expressed in the gut and vasculature.
- This suggests potential for abdominal organ injury in patients with coronavirus disease 2019 (COVID-19).
Purpose of the Study:
- To describe and analyze abdominal imaging findings in patients diagnosed with COVID-19.
Main Methods:
- Retrospective cross-sectional study of 412 patients with confirmed SARS-CoV-2 infection.
- Reviewed 224 abdominal imaging studies (radiography, US, CT, MRI) and correlated findings with clinical data.
- Performed univariable and logistic regression analyses to identify associations.
Main Results:
- Abdominal imaging was performed in 33% of patients, associated with older age and ICU admission.
- Bowel-wall abnormalities were noted in 31% of CT scans, particularly in ICU patients, with some cases showing pneumatosis or portal venous gas.
- Gallbladder bile stasis was observed in 54% of relevant US exams; surgical correlation revealed bowel infarction in 2 of 4 patients.
Conclusions:
- Bowel abnormalities and gallbladder bile stasis are frequent findings on abdominal imaging in COVID-19 patients.
- Ischemia, possibly due to small-vessel thrombosis, was a significant finding in patients undergoing laparotomy.
- Abdominal imaging plays a crucial role in identifying visceral complications of COVID-19.
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