Multiorgan Involvement in SARS-CoV-2 Infection: The Role of the Radiologist from Head to Toe

Abstract

Radiology plays a crucial role for the diagnosis and management of COVID-19 patients during the different stages of the disease, allowing for early detection of manifestations and complications of COVID-19 in the different organs. Lungs are the most common organs involved by SARS-CoV-2 and chest computed tomography (CT) represents a reliable imaging-based tool in acute, subacute, and chronic settings for diagnosis, prognosis, and management of lung disease and the evaluation of acute and chronic complications. Cardiac involvement can be evaluated by using cardiac computed tomography angiography (CCTA), considered as the best choice to solve the differential diagnosis between the most common cardiac conditions: acute coronary syndrome, myocarditis, and cardiac dysrhythmia. By using compressive ultrasound it's possible to study the peripheral arteries and veins and to exclude the deep vein thrombosis, directly linked to the onset of pulmonary embolism. Moreover, CT and especially MRI can help to evaluate the gastrointestinal involvement and assess hepatic function, pancreas involvement, and exclude causes of lymphocytopenia, thrombocytopenia, and leukopenia, typical of COVID-19 patients. Finally, radiology plays a crucial role in the early identification of renal damage in COVID-19 patients, by using both CT and US. This narrative review aims to provide a comprehensive radiological analysis of commonly involved organs in patients with COVID-19 disease.

Keywords: X-ray computed; coronavirus; infections; radiography; tomography.

Figure 1

Schematic representation of the role of diagnostic radiology: confirm clinical suspicion in case of non-diagnostic polymerase chain reaction test, help solving the differential diagnosis, identify and follow the progression of possible complications and, finally, perform a risk stratification of patients affected with SARS-CoV-2.

Figure 2

Axial chest CT images with windowing and leveling for the evaluation of lung parenchyma in patients affected by SARS-CoV-2 according to the different stages of the disease. (A). Early or initial stage (0–4 days): normal CT or sporadic ground-glass opacities (white arrow). (B). Progressive stage (5–8 days): ground-glass opacities are widely distributed, and crazy paving appearance can be evident (white arrowhead). (C). Peak stage (9–13 days): lung consolidations (black arrow) appear nearby the ground-glass opacities. (D). Absorption stage (>14 days): consolidations and ground-glass opacities slowly disappear while fibrotic findings can be evident, especially in the peripheral and lower zones (black arrowhead).

Figure 3

Chest X-ray of patients affected by SARS-CoV-2 according to the extent of lung abnormalities involvement. (A). Lung involvement ≤ 25% (arrow). (B). Lung involvement 25–50% (arrowheads). (C). Lung involvement 50–75%. (D). Lung involvement ≥ 75%.

Figure 4

Brain findings in COVID-19 patients. (A,B) Axial brain CT images of a 56-year-old man affected by SARS-CoV-2-related pneumonia showing multiple hypoattenuating areas located in the cortical junction bilaterally, with a predominant extension in the parietal and occipital lobes, due to ischemia (white arrows). (C) Axial brain CT images of a 71-year-old woman affected by SARS-CoV-2-related pneumonia showing hyperdense artery sign in the right middle cerebral artery (white arrowhead), due to acute thrombosis. This finding was confirmed by brain CT angiography (D) showing a complete thrombosis of the middle cerebral artery. After 15 days brain CT images (E) show a large hypoattenuating area in the fronto-parietal lobe (black arrow) due to the brain ischemia.

Figure 5

Intestinal findings in a COVID-19 patient admitted to the Emergency Department for abdominal pain. (A,B) Unenhanced axial abdominal CT images show bowel wall thickening in the transvers colon (arrows) with adjacent fat stranding consistent with intestinal involvement with ischemic lesions.