Cross-Sectional Abdominal Imaging Findings in Patients With COVID-19

Abstract

Objective We aimed to review and analyze cross-sectional abdominal imaging findings in a cohort of 10 patients who had tested positive for coronavirus disease 2019 (COVID-19). Methods This retrospective study conducted from April 1, 2020, to May 13, 2020, involved two institutions that comprised a central tertiary academic institution and multiple smaller community hospitals. We reviewed and examined cross-sectional imaging studies of patients who tested positive for COVID-19 either during the emergency room (ER) visit or hospital admission. Salient imaging findings and medical records were reviewed. Results A total of 10 COVID-19-positive patients (seven males and three females) of ages ranging from 21-75 years underwent cross-sectional abdominopelvic imaging. Nine of the 10 patients demonstrated typical lung base findings associated with COVID-19 on both CT and MRI. Twelve CT abdominopelvic examinations, one MRI abdomen, and one right upper quadrant ultrasound (RUQ US) were performed, with three patients undergoing two CT scans during the course of hospitalization. Gastric and bowel wall abnormalities were found on 25% (n=3/12) of abdominal CT scans. Acute interstitial pancreatitis and acute cholecystitis were both found on one CT exam. The remaining (n=7/12, 58%) CT studies demonstrated no acute intraabdominal pathology with incidental findings including fatty liver disease, cirrhosis, and splenomegaly. Conclusion A spectrum of abdominal imaging findings ranging from colitis to pancreatitis may be correlated with COVID-19 infection, even though the majority of our patients with gastrointestinal (GI) symptoms did not have identifiable GI pathology on imaging.

Keywords: abdominal pain; covid 19; imaging findings; novel coronavirus; sars-cov-2.

Figure 1. CT showing acute colitis

Axial (A), coronal (B), and axial (C) CT of the abdomen and pelvis with IV contrast of a 24-year-old woman with abdominal pain and diarrhea. The edematous appearance of the transverse colon (arrows) with surrounding hyperemia is compatible with acute colitis. Lung findings in image C show typical COVID-19-associated bilateral nodular ground-glass opacities (arrows) CT: computed tomography; IV: intravenous; COVID-19: coronavirus disease 2019

Figure 2. CT showing acute pancreatitis

Axial (A) and (B) CT of the abdomen and pelvis with IV contrast of a 45-year-old man with abdominal pain. There is enlargement and edema of the pancreas with surrounding fluid and stranding (arrows), compatible with acute edematous pancreatitis. Ill-defined ground-glass opacities are also seen at lung bases (thin arrows in B) CT: computed tomography; IV: intravenous