COVID-19 induced mesenteric venous infarction

Abstract

We present a rare case of mesenteric venous infarction in a 36-year-old man due to coronavirus disease-19 (COVID-19). Although COVID-19 usually presents with respiratory disease, multi-system manifestations are increasingly reported. Coagulopathy manifestations are also reported on imaging, including in vascular thrombosis, embolus, and organ infarction. Because the clinical variables poorly predict or suspect coagulopathy and its complications, it is important to be aware of imaging manifestations of coagulopathy complications of COVID-19.

Keywords: COVID-19; CT imaging; Coagulopathy; Mesenteric venous infarction.

Fig. 1

(A) Axial contrast-enhanced CT of the abdomen demonstrated circumferential bowel wall thickening with a “target sign” (arrowhead). Diffuse mesenteric fat stranding (bold arrow) due to edema, and mild ascites also seen. (B) Coronal CT abdomen and pelvis showing circumferential bowel wall thickening with differential enhancement of the bowel loops. Proximal bowel segment shows increased enhancement (arrowhead), whereas distal segment shows reduced enhancement (bold arrow) suggesting infarction. Diffuse thrombosis within the superior mesenteric vein and its branches (thin arrows) and congestion of mesenteric venous arcade (curved arrow).

Fig. 2

Intraoperative image shows dusky, ischemic, and non-viable bowel loop (bold arrow) suggesting infarction. Curved arrow points to the congested and engorged mesenteric veins. Proximal bowel loop with slight discoloration (arrow head) is in earlier stage of ischemia which showed hyper enhancement on CT.