Abdominal imaging findings on computed tomography in patients acutely infected with SARS-CoV-2: what are the findings?

Abstract

Objectives: To investigate what findings are new on contrast-enhanced abdominopelvic CT in patients infected with SARS-CoV-2.

Methods: Contrast-enhanced CT of the abdomen and pelvis of patients with COVID-19 at a tertiary oncologic center acquired over a 2-month period were reviewed independently by two readers and scored for new imaging abnormalities compared with a prior scan. CT scans were included if the study was performed between - 3 and 45 days from the time of COVID-19 diagnosis. Clinical information was gathered from the medical records.

Results: A total of 63 patients (34 male, 29 female; mean age 60.6 years, range 24.4-85.0 years) were included in this retrospective cross-sectional study. Aside from new ground glass opacities seen at the lung bases (29/63, 46.0%), the most common findings were new thickening of the stomach, small bowel or colon or fluid-filled colon (14/63, 22.2%), new small volume ascites (7/63, 14.3%), gallbladder distention in those without prior cholecystectomy (3/43, 7.0%), and single cases each of acute pancreatitis (1/63, 1.6%) as well as new portal vein thrombosis (1/63, 1.6%).

Conclusion: Aside from lung base ground glass opacities, the most common new imaging abnormality on abdominopelvic CT in patients with COVID-19 finding in our cohort was abnormalities of the gastrointestinal tract, followed by small volume ascites, gallbladder distention, and isolated cases of pancreatitis and portal vein thrombosis. These findings overlap with those previously reported that did not have a prior scan for comparison, and provide supportive evidence that some of these findings may be related to SARS-CoV-2 infection.

Keywords: COVID-19; Computed tomography; Coronavirus; Enterocolitis; SARS-CoV-2.

Fig. 1

Flow chart for patient selection in the final study cohort

Fig. 2

Chart summarizing the distribution of GI tract findings seen in patients with COVID-19 and new abnormalities of the stomach, small bowel, or colon on contrast-enhanced CT

Fig. 3

A 72-year-old female with endometrial cancer and thickening of the gastric fundus (arrows) after diagnosis with COVID-19, which was new from the prior scan

Fig. 4

A 68-year-old male with colon cancer presents with new small bowel wall thickening. Axial images show loops of small bowel in the mid-abdomen with wall thickening greater than 3 mm (a, arrows), also shown in the coronal reformat (b, arrow). There is also moderate volume ascites

Fig. 5

A 63-year-old male with new wall thickening of the transverse colon (a, arrow). A CT scan performed 4 months prior shows the same segment of transverse colon without wall thickening (b, arrow)

Fig. 6

A 63-year-old male with bladder cancer and COVID-19 presents with abdominal pain. CT of the upper abdomen shows enlargement of the pancreatic head with peripancreatic edema and fat infiltration (a, arrow). A comparison scan from 1 month prior shows a normal pancreatic head (b, arrow)

Fig. 7

A 67-year-old female with intrahepatic cholangiocarcinoma and new thrombosis of a branch of the right portal vein (a, arrow). A CT from 2 months prior shows no thrombus (b, arrow)

Fig. 8

A 71-year-old male with lung cancer and COVID-19. Axial and sagittal CT images show new fluid-filled ascending (a, arrow) and rectosigmoid (b, arrows) colon