Multisystem Imaging Manifestations of COVID-19, Part 2: From Cardiac Complications to Pediatric Manifestations

Abstract

Infection with severe acute respiratory syndrome coronavirus 2 results in coronavirus disease 2019 (COVID-19), which was declared an official pandemic by the World Health Organization on March 11, 2020. COVID-19 has been reported in most countries, and as of August 15, 2020, there have been over 21 million cases of COVID-19 reported worldwide, with over 800 000 COVID-19-associated deaths. Although COVID-19 predominantly affects the respiratory system, it has become apparent that many other organ systems can also be involved. Imaging plays an essential role in the diagnosis of all manifestations of the disease and its related complications, and proper utilization and interpretation of imaging examinations is crucial. A comprehensive understanding of the diagnostic imaging hallmarks, imaging features, multisystem involvement, and evolution of imaging findings is essential for effective patient management and treatment. In part 1 of this article, the authors described the viral pathogenesis, diagnostic imaging hallmarks, and manifestations of the pulmonary and peripheral and central vascular systems of COVID-19. In part 2 of this article, the authors focus on the key imaging features of the varied pathologic manifestations of COVID-19, involving the cardiac, neurologic, abdominal, dermatologic and ocular, and musculoskeletal systems, as well as the pediatric and pregnancy-related manifestations of the virus.

Musculoskeletal involvement of COVID-19: review of imaging

“…Myalgia, defined as muscle aches and pain, has been frequently reported in COVID-19 patients with a prevalence ranging from 11 to 50% in large cohort studies [ 5 ]. Several case reports have described myositis and rhabdomyolysis in COVID-19 patients, both as a late complication and as a presenting symptom [ 3 , 5 , 7 ]. Rare cases of SARS-CoV-2 triggering necrotizing autoimmune myositis have been described [ 6 ].…”

“…Rhabdomyolysis is a complication of myositis involving infarction of muscle (myonecrosis) and high levels of myoglobin in the blood (myoglobinemia). Rhabdomyolysis is a life-threatening condition that can lead to acute kidney failure, compartment syndrome, and intravascular coagulation [ 3 , 9 ]. Clinical findings of myositis/rhabdomyolysis generally include myalgia/weakness and elevated creatine phosphokinase kinase levels, both of which have been reported in COVID-19 patients with myositis/rhabdomyolysis [ 5 , 8 ].…”

“…Electrodiagnostic studies, such as electromyography (EMG), and nerve conduction studies can be helpful to confirm a myopathic process and exclude mimickers such as motor neuron disease [ 10 ]. Imaging can support diagnosis and delineate sites for muscle biopsy, which is the gold standard for diagnosis [ 3 , 9 ]. MR imaging is the modality of choice, preferably with either a 1.5-T or 3.0-T magnet and inclusive of multiplanar fluid-sensitive and anatomic sequences.…”

“…2 ) [ 9 ]. Patterns of disease include homogeneous hyperintense signal and enhancement (type 1) and heterogeneous hyperintense signal and rim enhancement (type 2) [ 3 ]. In severe disease, areas of necrosis or loss of normal muscle architecture may be seen.…”

“…Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in Wuhan, China, in December 2019 and rapidly spread throughout the world. Coronavirus disease 2019 (COVID-19) was officially declared a pandemic on March 11, 2020, by the World Health Organization, with over 90 million cases worldwide as of January 2021 [ 1 – 3 ]. An estimated 5% of COVID-19 patients have severe symptoms that require intensive care [ 4 ].…”