Imaging of abdominal complications of COVID-19 infection

Abstract

Coronavirus disease 2019 (COVID-19) is a respiratory syndrome caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) first described in Wuhan, Hubei Province, China in the last months of 2019 and then declared as a pandemic. Typical symptoms are represented by fever, cough, dyspnea and fatigue, but SARS-CoV-2 infection can also cause gastrointestinal symptoms (vomiting, diarrhoea, abdominal pain, loss of appetite) or be totally asymptomatic. As reported in literature, many patients with COVID-19 pneumonia had a secondary abdominal involvement (bowel, pancreas, gallbladder, spleen, liver, kidneys), confirmed by laboratory tests and also by radiological features. Usually the diagnosis of COVID-19 is suspected and then confirmed by real-time reverse-transcription-polymerase chain reaction (RT-PCR), after the examination of the lung bases of patients, admitted to the emergency department with abdominal symptoms and signs, who underwent abdominal-CT. The aim of this review is to describe the typical and atypical abdominal imaging findings in patients with SARS-CoV-2 infection reported since now in literature.

Figure 1.

Enhanced CT scan (portal phase) of the abdomen of a 55-yo female admitted to emergency department with abdominal pain and rectorrhagia. (a and b) Axial images, (c) Coronal MPR image and (d) Sagittal MPR image. Principal finding is the wall thickening of the descending colon with enhancing mucosa and muscularis propria with the oedematous submucosa in between (arrows). (e) Axial image, (f) Coronal MPR image. Analysis of lung basis shows the ground-glass opacities (GGOs) of lung parenchyma in the right lower lobe posterior segment suggestive for COVID-19 infection (arrows).

Figure 2.

Enhanced CT scan (portal phase) of the abdomen of a 25-yo female admitted to emergency department with abdominal pain and fever. (a) Coronal MPR image, (b) Axial images. Principal finding is the wall thickening and enhancing of the small intestine (arrows). Mesenteric lymphadenopathy is present (arrowhead). (c) Axial image: analysis of lung basis did not show findings suggestive for COVID-19 infection, further confirmed by real-time reverse-transcription polymerase chain reaction (RT-PCR).

Figure 3.

Enhanced CT scan. (a) Arterial phase, Axial image, (b) Portal phase, Axial image (c) Portal phase, Coronal MPR image of the abdomen of a 69-yo female admitted to emergency department with abdominal pain. Principal finding is the enlargement of the pancreas that appears oedematous, with indistinct margins (arrows). A huge amount of fluid is present (asterisk). (d) Axial image: lung basis analysis shows the ground-glass opacities (GGOs) and consolidation of lung parenchyma in both lower lobes posterior segment suggestive for COVID-19 infection (arrows).

Figure 4.

Enhanced CT scan. (a and b) Arterial phase, Axial images, (c) Portal phase, Axial image, of the abdomen of a 62-yo female admitted to emergency department with abdominal pain and fever. Principal findings are the gallbladder wall that appears thickened and hyper enhanced (asterisk) with pericholecystic fluid (white arrow); (b) image shows concomitant diffuse pancreatic parenchymal enlargement, surrounding retroperitoneal fat stranding and fluid collection (arrowhead). (d) Axial image: analysis of lung basis shows the ground-glass opacities (GGOs) of lung parenchyma in the right lower lobe suggestive for COVID-19 infection (grey arrow).

Figure 5.

Enhanced CT scan (portal phase) of the abdomen of a 67-yo female admitted to emergency department with abdominal pain, fever and jaundice. (a and b) Axial images, (c) Coronal MPR image. Principal finding is the intrahepatic and extrahepatic biliary dilatation (white arrows) and pancreatic duct dilatation (arrowhead). Enhancement of pancreatic papilla, suggestive for phlogosis, is present (asterisk). (d) Magnetic resonance cholangiopancreatography (MRCP) image shows absence of intraluminal obstruction of biliary system. (e) Axial image: analysis of lung basis shows the ground-glass opacities (GGOs) of lung parenchyma in the left lower lobe suggestive for COVID-19 infection (grey arrow).