Are asymptomatic gastrointestinal findings on imaging more common in COVID-19 infection? Study to determine frequency of abdominal findings of COVID-19 infection in patients with and without abdominal symptoms and in patients with chest-only CT scans

Tirumani, Sree H.; Rahnemai-Azar, Ata A.; Pierce, Jonathan D.; Parikh, Keval; Martin, Sooyoung; Gilkeson, Robert C.; Ramaiya, Nikhil H.

doi:10.1007/s00261-020-02920-w

Cited by 21 publications

(39 citation statements)

References 28 publications

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“…Fibrin clots were detected in arterioles adjacent to the necrotic mucosa in histological samples. In a retrospective study, Tirumani et al [ 48 ] described small bowel pneumatosis with portal venous gas in one of 73 SARS-CoV-2 infected patients with abdominal CT scans. Pneumatosis intestinalis of the small bowel was also reported in a small study of three cases and in a single-patient case report.…”

Section: Resultsmentioning

confidence: 99%

Acute mesenteric ischemia and small bowel imaging findings in COVID-19: A comprehensive review of the literature

Pirola¹,

Palermo²,

Mulinacci³

et al. 2021

WJGS

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BACKGROUND Coronavirus disease 2019 (COVID-19), an infectious condition caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread worldwide since its first description in Wuhan in December 2019. Even though respiratory manifestations are the most prevalent and responsible for disease morbidity and mortality, extrapulmonary involvement has progressively gained relevance. In particular, gastrointestinal (GI) signs and symptoms, reported in up to two-thirds of patients with COVID-19, might represent the first and, in some cases, the only disease presentation. Their presence has been associated in some studies with an increased risk of a severe disease course. Proposed pathogenic mechanisms explaining GI tract involvement are either direct viral access to intestinal cells via angiotensin-converting enzyme 2 or indirect damage of the intestinal wall through mesenteric ischemia induced by the hypercoagulable state associated with COVID-19 infection. Although not typical of SARS-CoV-2 infection, several small bowel manifestations have been described in infected patients who underwent any form of abdominal imaging. The radiological findings were mainly reported in patients with abdominal symptoms, among which abdominal pain was the most common. AIM To discuss small bowel radiological manifestations of SARS-CoV-2 infection in abdominal imaging studies. METHODS Bibliographical searches were performed in PubMed, using the following keywords: “COVID-19” AND “imaging” AND “gastrointestinal” OR “abdominal” OR “small bowel”. RESULTS Of 62 patients with described radiologic small bowel alterations, mesenteric ischemia was diagnosed in 31 cases (50%), small bowel wall thickening in 10 cases (16%), pneumatosis in nine cases (15%), intussusception in eight cases (13%), pneumoperitoneum in two cases (3%) and paralytic ileus in two cases (3%). We also reported mesenteric adipose tissue hypertrophy and lymph nodes enlargement in a young woman. CONCLUSION So far it is difficult to establish whether these manifestations are the direct consequence of SARS-CoV-2 infection or collateral findings in infected patients, but their recognition would be pivotal to set a closer follow-up and to reduce missed diagnoses.

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Section: Resultsmentioning

confidence: 99%

Acute mesenteric ischemia and small bowel imaging findings in COVID-19: A comprehensive review of the literature

Pirola¹,

Palermo²,

Mulinacci³

et al. 2021

WJGS

View full text Add to dashboard Cite

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“…Details of these studies are shown in Table 1 and online supplementary Table 1 (for all online suppl. material, see www.karger.com/doi/10.1159/000518473 ) [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 …”

Section: Resultsmentioning

confidence: 99%

“…In both these studies, indications for imaging were not described. A recent study by Tirumani et al [ 10 ] compared abdominal imaging findings of COVID-19 in 34 patients who were not having any abdominal symptoms to 38 patients who were having abdominal symptoms. They found that two-thirds (61.5%) of patients having bowel imaging findings were not having any abdominal symptoms.…”

Section: Resultsmentioning

confidence: 99%

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A Systematic Review of Abdominal Imaging Findings in COVID-19 Patients

Singh

Verma

et al. 2021

Visc Med

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Objective: The objective of this systematic review was to evaluate key imaging manifestations of COVID-19 on abdominal imaging by utilizing a comprehensive review of the published literature. Method: A systematic literature search from PubMed, Google Scholar, and Scopus was performed for studies mentioning abdominal imaging findings in COVID-19 patients. Studies published from inception to 15 March 2021 were included. Results: A total of 116 studies comprising 1,198 patients were included. Abdominal pain was the most common indication for abdominal imaging in 50.2% of the patients. No abnormality was seen in 48.1% of abdominopelvic computed tomography scans. Segmental bowel wall thickening (14.7%) was the most common imaging abnormality, followed by bowel ischemia (7.1%), solid organ infarction (6.7%), vessel thrombosis (6.7%), and fluid-filled colon (6.2%). Other relevant findings were dilated air-filled bowel, pancreatitis, pneumatosis/portal venous gas, bowel perforation, and appendicitis. Other than abdominal findings, COVID-19-related basal lung changes were incidentally detected in many studies. Moreover, the presence of bowel imaging findings was positively correlated with the clinical severity of COVID-19 infection. Conclusion: This review describes the abdominal imaging findings in COVID-19 patients. This is pertinent for the early diagnosis of COVID-19 in patients presenting solely with abdominal symptoms as well as in identifying abdominal complications in a known case of COVID-19.

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“…CT abnormalities in the abdomen have been identified in 18.1% of patients admitted with COVID-19, with fluidfilled colon and pericolic stranding reported as the most common features 67 ; however, these appearances did not correlate with abdominal symptoms. There have been isolated case reports of colonic ischaemic change, 68,69 in line with the increased thromboembolic tendency seen in more severe cases of COVID-19.…”

Section: Gastrointestinalmentioning

confidence: 98%

Pathophysiology of infection with SARS‐CoV‐2—What is known and what remains a mystery

Sridhar

Nicholls

2021

Respirology

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Coronavirus disease 2019 (COVID-19), caused by coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused extensive disruption and mortality since its recent emergence. Concomitantly, there has been a race to understand the virus and its pathophysiology. The clinical manifestations of COVID-19 are manifold and not restricted to the respiratory tract. Extrapulmonary manifestations involving the gastrointestinal tract, hepatobiliary system, cardiovascular and renal systems have been widely reported. However, the pathophysiology of many of these manifestations is controversial with questionable support for direct viral invasion and an abundance of alternative explanations such as pre-existing medical conditions and critical illness. Prior research on SARS-Co-V and NL63 was rapidly leveraged to identify angiotensin-converting enzyme 2 (ACE2) receptor as the key cell surface receptor for SARS-CoV-2. The distribution of ACE2 has been used as a starting point for estimating vulnerability of various tissue types to SARS-CoV-2 infection. Sophisticated organoid and animal models have been used to demonstrate such infectivity of extrapulmonary tissues in vitro, but the clinical relevance of these findings remains uncertain. Clinical autopsy studies are typically small and inevitably biased towards patients with severe COVID-19 and prolonged hospitalization. Technical issues such as delay between time of death and autopsy, use of inappropriate antibodies for paraffin-embedded tissue sections and misinterpretation of cellular structures as virus particles on electron micrograph images are additional problems encountered in the extant literature. Given that SARS-CoV-2 is likely to circulate permanently in human populations, there is no doubt that further work is required to clarify the pathobiology of COVID-19.

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Are asymptomatic gastrointestinal findings on imaging more common in COVID-19 infection? Study to determine frequency of abdominal findings of COVID-19 infection in patients with and without abdominal symptoms and in patients with chest-only CT scans

Cited by 21 publications

References 28 publications

Acute mesenteric ischemia and small bowel imaging findings in COVID-19: A comprehensive review of the literature

Acute mesenteric ischemia and small bowel imaging findings in COVID-19: A comprehensive review of the literature

A Systematic Review of Abdominal Imaging Findings in COVID-19 Patients

Pathophysiology of infection with SARS‐CoV‐2—What is known and what remains a mystery

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