Multisystem Imaging Manifestations of COVID-19, Part 1: Viral Pathogenesis and Pulmonary and Vascular System Complications

Abstract

Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) results in coronavirus disease 2019 (COVID-19), which was declared an official pandemic by the World Health Organization on March 11, 2020. The infection has been reported in most countries around the world. As of August 2020, there have been over 21 million cases of COVID-19 reported worldwide, with over 800 000 COVID-19-associated deaths. It has become apparent that although COVID-19 predominantly affects the respiratory system, many other organ systems can also be involved. Imaging plays an essential role in the diagnosis of all manifestations of the disease, as well as its related complications, and proper utilization and interpretation of imaging examinations is crucial. With the growing global COVID-19 outbreak, a comprehensive understanding of the diagnostic imaging hallmarks, imaging features, multisystemic involvement, and evolution of imaging findings is essential for effective patient management and treatment. To date, only a few articles have been published that comprehensively describe the multisystemic imaging manifestations of COVID-19. The authors provide an inclusive system-by-system image-based review of this life-threatening and rapidly spreading infection. In part 1 of this article, the authors discuss general aspects of the disease, with an emphasis on virology, the pathophysiology of the virus, and clinical presentation of the disease. The key imaging features of the varied pathologic manifestations of this infection that involve the pulmonary and peripheral and central vascular systems are also described. Part 2 will focus on key imaging features of COVID-19 that involve the cardiac, neurologic, abdominal, dermatologic and ocular, and musculoskeletal systems, as well as pediatric and pregnancy-related manifestations of the virus. Vascular complications pertinent to each system will be also be discussed in part 2.

Musculoskeletal involvement of COVID-19: review of imaging

“…An estimated 5% of COVID-19 patients have severe symptoms that require intensive care [ 4 ]. Older age and comorbidities such as cardiovascular disease, diabetes mellitus, and obesity are risk factors for developing severe disease [ 2 ]. Potential therapeutic measures for acute symptomatic COVID-19 patients include supplemental oxygen and mechanical ventilation, corticosteroids, and thromboembolic prophylaxis [ 4 ].…”

“…1 ). There is high expression of the ACE2 receptor in lung epithelial cells as well as in the heart, kidney, pancreas, spleen, gastrointestinal system, bladder, cornea, and blood vessels [ 2 , 4 ]. The ACE2 receptor is also found in the central and peripheral nervous systems and in skeletal muscle [ 5 , 6 ].…”

“…The ACE2 receptor is also found in the central and peripheral nervous systems and in skeletal muscle [ 5 , 6 ]. Viral replication within human host cells is followed by viral release through cell destruction [ 2 , 4 ]. In addition, SARS-CoV-2 activates an inflammatory response (both innate and adaptive immune responses) which can result in a cytokine storm and ultimately multi-organ injury [ 2 , 4 ].…”

RSNA International Trends: A Global Perspective on the COVID-19 Pandemic and Radiology in Late 2020

“…CXR is no longer recommended for COVID-19 screening, due to the high false negative rate, but it can help to assess disease severity (21,22). Given the association of thrombotic complications, including pulmonary embolism (PE), chest CT is recommended whenever there is suspicion of pulmonary embolism (23,24).…”

“…Cardiac complications including arrhythmias, acute myocarditis, cardiomyopathy, and shock are also associated with COVID-19 infection (23,25). Cardiac magnetic resonance imaging (MRI) is used for differentiating types of myocardial injury and assessing the extent and severity of the injury (26).…”