Abdominopelvic CT findings in patients with novel coronavirus disease 2019 (COVID-19)

Abstract

Purpose: Some patients with novel coronavirus disease 2019 (COVID-2019) present with abdominal symptoms. Abdominal manifestations of COVID on imaging are not yet established. The goal of this study was to quantify the frequency of positive findings on abdominopelvic CT in COVID-positive patients, and to identify clinical factors associated with positive findings to assist with imaging triage.

Materials and methods: This retrospective study included adult COVID-positive patients with abdominopelvic CT performed within 14 days of their COVID PCR nasal swab assay from 3/1/2020 to 5/1/2020. Clinical CT reports were reviewed for the provided indication and any positive abdominopelvic findings. Demographic and laboratory data closest to the CT date were recorded. Multivariate logistic regression model with binary outcome of having no reported positive abdominopelvic findings was constructed.

Results: Of 141 COVID-positive patients having abdominopelvic CT (average age 64 years [± 16], 91 [64%] women), 80 (57%) had positive abdominopelvic findings. Abdominal pain was the most common indication, provided in 54% (43/80) and 74% (45/61) of patients with and without reported positive abdominopelvic findings, respectively (p = 0.015). 70% (98/141) of patients overall had reported findings in the lung bases. Findings either typical or intermediate for COVID were reported in 50% (40/80) and 64% (39/61) of patients with and without positive abdominopelvic findings, respectively (p = 0.099). Of 80 patients with positive abdominopelvic findings, 25 (31%) had an abnormality of gastrointestinal tract, and 14 (18%) had solid organ infarctions or vascular thromboses. In multivariate analysis, age (OR 0.85, p = 0.023), hemoglobin (OR 0.83, p = 0.029) and male gender (OR 2.58, p = 0.032) were independent predictors of positive abdominopelvic findings, adjusted for race and Charlson comorbidity index.

Conclusion: Abdominopelvic CT performed on COVID-positive patients yielded a positive finding in 57% of patients. Younger age, male gender, and lower hemoglobin were associated with higher odds of having reportable positive abdominopelvic CT findings.

Keywords: COVID-19; Coronavirus; Pandemic; SARS-CoV-2.

Fig. 1

CT in a 70-year-old female with clinical indication of epigastric abdominal pain. Axial image through the lung bases demonstrates multiple bilateral peripheral ground-glass opacities in rounded configuration (arrows), reported as typical features of COVID pneumonia. No positive abdominopelvic findings were reported

Fig. 2

CT in a 21-year-old female with clinical indication of abdominal pain and diarrhea. Axial images through the upper abdomen (a) and pelvis (b) demonstrate liquid stool in the colon (long arrow, a) and rectum (long arrow, b). There is marked mural edema in the gallbladder (short arrow, a). Axial image through the lung bases c demonstrates several nonrounded peripheral ground-glass opacities (arrows) at the right lung base, reported as intermediate confidence features for COVID pneumonia

Fig. 3

CT in a 69-year-old female with clinical indication of abdominal pain. Axial (a) and coronal (b) images through the abdomen demonstrate wedge-shaped areas of decreased enhancement in the left kidney (long arrows), consistent with renal infarcts. A filling defect in the left renal artery (short arrow, b) is consistent with an arterial thrombus. Axial image through the lung bases c demonstrates multiple peripheral ground-glass opacities (arrows) at the lung bases bilaterally, reported as typical features for COVID pneumonia

Fig. 4

CT in a 30-year-old female with clinical indication of abdominal pain. Axial (a) and coronal (b) CT images through the abdomen demonstrate mural thickening in the left colon (arrows). No abnormalities were reported in the lung bases