Diagnostic value of abdominal sonography in confirmed COVID-19 intensive care patients

Abstract

Background In December 2019, a large outbreak of a novel coronavirus infection occurred in Wuhan, China. The pneumonic disease caused by this virus is called coronavirus disease 2019 (COVID-19) by the World Health Organization (WHO). As case numbers have increased worldwide, gastro-intestinal symptoms like diarrhea, constipation, abdominal pain, and vomiting have been increased, these symptoms associated with positive laboratory results including abnormal liver function tests, renal function tests, and D-Dimer levels. Although there are multiple articles evaluated the imaging findings in HRCT of COVID-19 patients that helped in understanding the disease course and potential complications in the chest, yet there are—to our knowledge—limited data about the abdominal imaging findings of the course and potential abdominal complications of COVID-19 notably in the intensive care units (ICU). Results Forty-one sonographic examinations were done for 30 confirmed COVID-intensive care patients presented with abdominal symptoms. Of the 30 patients, 26 were males (86.66%), and 4 were females (13.3%), the average age of the patients was 57.7 years old. The most common sonographic observation was hepatomegaly (n, 23/41, 56%) and biliary system disease (n, 17/41, 41.4%); the imaging findings were correlated with the clinical and laboratory data. CT examination when indicated (in our study to assess hematomas for active extravasation and to assess bowel obstruction and its level). Conclusion Abdominal sonographic imaging was often performed for inpatients with COVID-19. Hepatobiliary dysfunction as well as nephropathy was the most common imaging findings.

Long-COVID and Post-COVID Health Complications: An Up-to-Date Review on Clinical Conditions and Their Possible Molecular Mechanisms

“…Inflammatory complications involving the digestive system are not uncommon in individuals affected by COVID-19 [88][89][90]. Clinical manifestations, such as diarrhea, nausea, vomiting, abdominal pain, anorexia [91], acid reflux [88], gastrointestinal hemorrhage [92], lack of appetite [90], and constipation [93] have been reported in epidemiological studies of patients affected by the novel coronavirus. These symptoms can occur during the early stages of the disease, known as the viral phase, or manifest as long-term adverse gastrointestinal effects [90].…”

Current understanding of the impact of COVID-19 on gastrointestinal disease: Challenges and openings

“…Recently, Abdelmohsen and coworkers conducted abdominal imaging studies (sonographic examination) at 30 intensive care units with 41 confirmed COVID-19 patients with abdominal complications. They reported that 51.2% of patients had increased liver function tests, particularly serum bilirubin, followed by elevated renal function tests in 14.6% of patients[ 77 ]. Tullie et al [ 78 ] conducted abdominal US and CT imaging in pediatric COVID-19 confirmed patients and found that US was the best diagnostic imaging tool in patients with GI symptoms.…”

Imaging spectrum of abdominal manifestations of COVID-19

“…Very few studies have investigated the role of abdominal imaging in the evaluation of COVID-19 related hepato-biliary dysfunction. The predominant abnormalities seen in these studies on CT/US imaging were distension of the gallbladder and gallbladder sludge (Figure 8 ), which are indicative of cholestasis[ 46 - 48 ]. Additional imaging features such as gallbladder wall thickening/mural edema were detected in fewer cases.…”

“…Hepatomegaly with increased parenchymal echogenicity is reported to be the most commonly encountered liver abnormality on abdominal US, possibly indicative of a diffuse parenchymal disease[ 46 - 48 ]. These findings may also be seen in COVID-19 patients with obesity and non-alcoholic fatty liver disease, which serve as potential risk factors for the increase in COVID-19 disease severity[ 49 ].…”