Abdominal Imaging Findings in COVID-19: Preliminary Observations.
Radiology. 2020 May 11;:201908
Authors: Bhayana R, Som A, Li MD, Carey DE, Anderson MA, Blake MA, Catalano O, Gee MS, Hahn PF, Harisinghani M, Kilcoyne A, Lee SI, Mojtahed A, Pandharipande PV, Pierce TT, Rosman DA, Saini S, Samir AE, Simeone JF, Gervais DA, Velmahos G, Misdraji J, Kambadakone A
Background Angiotensin converting enzyme 2 (ACE2), a target of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), demonstrates its highest surface expression in the lung, small bowel, and vasculature, suggesting abdominal viscera may be susceptible to injury. Purpose To report abdominal imaging findings in patients with coronavirus disease 2019 (COVID-19). Materials and Methods In this retrospective cross-sectional study, patients consecutively admitted to a single quaternary care center from 3/27/2020 to 4/10/2020 who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were included. Abdominal imaging studies performed in these patients were reviewed and salient findings recorded. Medical records were reviewed for clinical data. Univariable analysis and logistic regression were performed. Results 412 patients (average age 57 years; range 18->90 years; 241 men, 171 women) were evaluated. 224 abdominal imaging studies were performed (radiographs, n=137; ultrasound, n=44; CT, n=42; MRI, n=1) in 134 patients (33%). Abdominal imaging was associated with age (odds ratio [OR] 1.03 per year increase, p=0.001) and ICU admission (OR 17.3, p<0.001). Bowel wall abnormalities were seen on 31% of CT scans (13 of 42) and were associated with ICU admission (OR 15.5, p=0.01). Bowel findings included pneumatosis or portal venous gas, seen on 20% of CT scans in ICU patients (4 of 20). Surgical correlation (n=4) revealed unusual yellow discoloration of bowel (n=3) and bowel infarction (n=2). Pathology demonstrated ischemic enteritis with patchy necrosis and fibrin thrombi in arterioles (n=2). Of right upper quadrant ultrasounds, 87% (32 of 37) were performed for liver laboratory findings, and 54% (20 of 37) demonstrated a dilated sludge-filled gallbladder suggestive of cholestasis. Patients with a cholecystostomy tube placed (n=4) had negative bacterial cultures. Conclusion Bowel abnormalities and cholestasis were common findings on abdominal imaging of inpatients with COVID-19. Patients who went to laparotomy often had ischemia, possibly due to small vessel thrombosis.
PMID: 32391742 [PubMed - as supplied by publisher]