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
Abdom Radiol (NY) . 2021 Jun;46(6):2407-2414. doi: 10.1007/s00261-020-02920-w. Epub 2021 Jan 4.
Sree Harsha Tirumani, Ata A Rahnemai-Azar, Jonathan D Pierce, Keval D Parikh, Sooyoung S Martin, Robert Gilkeson, Nikhil H Ramaiya
Purpose: To identify incidence of abdominal findings in COVID-19 patients with and without abdominal symptoms on various imaging modalities including chest-only CT scans and to correlate them with clinical, laboratory and chest CT findings.
Materials and methods: In this retrospective study, we searched our clinical database between March 1st, 2020 and May 22nd, 2020 to identify patients who had positive real-time reverse transcriptase polymerase chain reaction (RT-PCR) on throat swabs for COVID-19, had availability of clinical, laboratory information and had availability of CT scan of chest or abdominal radiograph, abdominal ultrasound or CT scan within 2 weeks of the diagnosis. Abdominal imaging findings on all imaging modalities were documented. Chest CT severity score (CT-SS) was assessed in all patients. Clinical and laboratory findings were recorded from the electronic medical record. Statistical analysis was performed to determine correlation of abdominal findings with CT-SS, clinical and laboratory findings.
Results: Out of 264 patients with positive RT-PCR, 73 patients (38 males and 35 females; 35 African American) with mean age of 62.2 (range 21-94) years were included. The median CTSS was 13.5 (IQR 75-25 18-8). Most common finding in the abdomen on CT scans (n = 72) were in the gastrointestinal system in 13/72 patients (18.1%) with fluid-filled colon without wall thickening or pericolonic stranding (n = 12) being the most common finding. Chest-only CT (n = 49) found bowel findings in 3 patients. CTSS did not differ in terms of age, sex, race or number of comorbidities but was associated with longer duration of hospitalization (p = 0.0.0256), longer intensive care unit stay (p = 0.0263), more frequent serum lactate dehydrogenase elevation (p = 0.0120) and serum C-reactive protein elevation (p = 0.0402). No statistically significant correlation of occurrence of bowel abnormalities with CTSS, clinical or laboratory features. Deep venous thrombosis was seen in 7/72 patients (9.8%) with three patients developing pulmonary embolism
CONCLUSION: Abnormal bowel is the most common finding in the abdomen in patients with COVID-19 infection, is often without abdominal symptoms and occurs independent of severity of pulmonary involvement, other clinical and laboratory features.
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