Multisystemic Infarctions in COVID-19: Focus on the Spleen

Abstract

The literature suggests that COVID-19 provokes arterial and venous thrombotic events, although the mechanism is still unknown. In this study, we describe patients with confirmed coronavirus infection associated with multisystemic infarction, focusing on splenic infarction. More data are required to elucidate how COVID-19 and thrombotic disease interact and so that preventive and early diagnosis strategies can be developed.

Learning points: Thrombotic disease as a complication of COVID-19 must be suspected by clinicians, and recognized and monitored by radiologists.Thrombosis is often the initial manifestation of SARS-CoV-2, hence the importance of early diagnosis to avoid complications and reduce morbidity and mortality.

Keywords: COVID-19; SARS-CoV-2; coronavirus; disseminated intravascular coagulation; pneumonia; splenic infarction.

Figure 1

Non-contrast axial CT showing an area of corticosubcortical hypoattenuation in the right pre-central gyrus (A, B). CTA of the cerebral arteries shows an area with a smaller number of vessels asymmetrically in relation to the contralateral in the right pre-central gyrus, territory of the right middle cerebral artery (C)

Figure 2

Axial tomography images of the chest showing ground-glass opacities, some with thickening of interlobular septa, featuring mosaic paving, and some consolidations (A). CTA of the chest, oblique reconstruction, demonstrating filling defects in arterial branches to the right lower lobe compatible with thromboembolism (B)

Figure 3

Axial and coronal CTA images showing wedge-shaped areas based on the convex surface of the spleen and the apex facing the hilar/concave surface compatible with splenic infarctions (A, B). Axial CTA image showing filling defects in segmental branches of the splenic artery featuring thrombi (C)

Figure 4

Axial and coronal abdominal CTA images showing wedge-shaped areas close to the convex face of the spleen compatible with splenic infarctions (A, B). Ultrasound images showing hypoechoic areas suggestive of splenic infarction (C, D)

Figure 5

CTA images with MIP reformatting showing filling defects in subsegmental branches of the splenic artery near the concave surface, which associated with wedge-shaped areas of no enhancement near the convex face characterize splenic infarctions (A, B)

Figure 6

High resolution axial chest tomography images with radiation dose reduction protocol demonstrating multiple opacity with ground-glass attenuation and thickening of interlobular septa forming a mosaic paving pattern, highlighting perilobular opacity (arrows), involving both lungs in peripheral and peribronchovascular regions (A, B).