Detection of unexpected coronavirus disease (COVID-19) involvement in lung bases on abdominal CT of patients presenting with abdominal symptoms

Abstract

Aim: Coronavirus disease 2019 (COVID-19) can present with nonspecific abdominal symptoms. The aim of this study is to emphasize the importance of detecting lung basis involvement on abdominal computed tomography (CT) in patients hospitalized with abdominal complaints without known COVID-19 disease. Methods: CT images of 250 patients who underwent abdominopelvic CT scan due to various abdominal complaints were retrospectively evaluated. Inclusion criteria included patients presenting with primary abdominal complaints without respiratory symptoms, who had suspicious COVID-19 CT findings on lung basis. COVID-19 was not among the differential diagnoses of these patients at the time of admission. Results: Among 240 patients, twelve (8 females, 4 males, aged 30-69 years) had suspicious findings of COVID-19 on lung bases. Presenting complaints were abdominal pain (n=7), lack of appetite (n=5), diarrhea (n=7), vomiting (n=3), nausea (n=4) and gastric pain (n=1). Lung base CT findings included ground-glass opacities (100%), which were peribronchovascular (66.6%), bilateral (91.6%), peripheral (91.6%), or multifocal (58.3%). Cases were confirmed with laboratory testing. Conclusion: Considering that some patients present with nonspecific abdominal complaints, identifying the characteristic signs of COVID-19 incidentally in the visualized part of the lung basis on abdominal CT is important for early diagnosis, the protection of health professionals, and in reducing the spread of disease.

Keywords

• Abdominal CT
• Coronavirus
• lung bases
• COVID-19
• SARS-CoV-2

Abdominal şikayetler ile başvuran hastalarda karın BT’de akciğer bazallerinde beklenmedik koronavirüs hastalığı (COVID-19) tutulumunun saptanması

Öz

Amaç: Koronavirüs hastalığı 2019 (COVID-19), spesifik olmayan karın şikayetleri ile karşımıza çıkabilir. Bu çalışmanın amacı, abdominal yakınmalarla başvuran hastalarda akciğer bazallerindeki bulgulara bakarak COVID-19 tanısı koymada abdomen BT’nin önemini vurgulamaktır. Yöntemler: Çeşitli abdominal şikayetler nedeniyle abdominopelvik BT taraması yapılan 250 hastanın görüntüleri geriye dönük olarak değerlendirildi. Dahil etme kriterleri, başlangıçta solunum şikayetleri olmaksızın abdominal yakınma ile başvuran, akciğer bazallerinde COVID-19 şüpheli BT bulguları olan, ancak başvuru anında COVID-19 ön tanısı olmayan hastaları içerir. Bulgular: 240 hastadan 12'sinde (8K, 4M; 30-69 yaş) akciğer bazallerinde şüpheli COVID-19 bulguları vardı. Başvuru şikayetleri iştahsızlık (n=5), karın ağrısı (n=7), ishal (n=7), bulantı (n=4), kusma (n=3) ve mide ağrısı (n=1) idi. Akciğer bazalleri tutulumunun dağılımı peribronkovasküler (%66,6), bilateral (%91,6), periferik (%91,6) veya multifokal (%58,3) olan buzlu cam opasiteleri (%100) idi. Vakalar laboratuvar testleri ile doğrulandı. Sonuç: Bazı hastaların nonspesifik karın şikayetleri ile başvurduğu düşünülürse; abdominal BT'de akciğer bazallerinin tetkike dahil kısımlarında COVID-19' un tipik belirtilerini tespit etmek, zamanında tanı koymak, sağlık çalışanlarını korumak ve hastalığın yayılmasını azaltmak açısından çok önemlidir.

Anahtar Kelimeler

• Koronavirüs
• Akciğer bazalleri
• Abdomen BT
• COVID-19
• SARS-CoV-2

Kaynakça

1. 1. Lenzen M, Li M, Malik A, Pomponi F, Sun Y, Wiedmann T, et al. Global socio-economic losses and environmental gains from the Coronavirus pandemic. PLoS One. 2020;15(7):e0235654. doi: 10.1371/journal.pone.0235654
2. 2. King MJ, Lewis S, El Homsi M, Meza GH, Bernheim A, Jacobi A, et al. Lung base CT findings in COVID-19 adult patients presenting with acute abdominal complaints: case series from a major New York City health system. Eur Radiol. 2020;1-9. doi: 10.1007/s00330-020-07040-z
3. 3. Pan L, Mu M, Yang P, Sun Y, Wang R, Yan J, et al. Clinical Characteristics of COVID-19 Patients With Digestive Symptoms in Hubei, China: A Descriptive, Cross-Sectional, Multicenter Study. Am J Gastroenterol. 2020;115(5):766-73. doi: 10.14309/ajg.0000000000000620
4. 4. Sendi AA, Saggat DF, Alzahrani SJ. Incidental typical COVID-19 appearance on the lung bases, visualized at abdominal CT for a patient that presented with abdominal pain and nausea. Radiol Case Rep. 2020;15(8):1238-41. doi: 10.1016/j.radcr.2020.05.039
5. 5. Wan Y, Li J, Shen L, Zou Y, Hou L, Zhu Li, et al. Enteric involvement in hospitalised patients with COVID-19 outside Wuhan. Lancet Gastroenterol Hepatol. 2020;5(6):534-5. doi: 10.1016/S2468-1253(20)30118-7
6. 6. Dane B, Brusca-Augello G, Kim D, Katz DS. Unexpected Findings of Coronavirus Disease (COVID-19) at the Lung Bases on Abdominopelvic CT. AJR Am J Roentgenol. 2020;1-4. doi: 10.2214/AJR.20.23240
7. 7. Siegel A, Chang PJ, Jarou ZJ, Paushter D, Harmath C, Arevalo B, et al. Lung Base Findings of Coronavirus Disease (COVID-19) on Abdominal CT in Patients With Predominant Gastrointestinal Symptoms. AJR Am J Roentgenol. 2020;1-3. doi: 10.2214/AJR.20.23232
8. 8. Voutsinas N, Toussie D, Jacobi A, Bernheim A, Chung M. Incidental CT findings in the lungs in COVID-19 patients presenting with abdominal pain. Clin Imaging. 2020;67:1-4. doi: 10.1016/j.clinimag.2020.05.021

9. 9. Kim J, Thomsen T, Sell N, Goldsmith AJ. Abdominal and testicular pain: An atypical presentation of COVID-19. Am J Emerg Med. 2020;38(7):1542.e1-3. doi: 10.1016/j.ajem.2020.03.052
10. 10. Minodier L, Masse S, Capai L, Blanchon T, Ceccaldi PE, Werf S, et al. Clinical and virological factors associated with gastrointestinal symptoms in patients with acute respiratory infection: a two-year prospective study in general practice medicine. BMC Infect Dis. 2017;17(1):729. doi: 10.1186/s12879-017-2823-9
11. 11. Wan Y, Shang J, Graham R, Baric RS, Li F. Receptor Recognition by the Novel Coronavirus from Wuhan: an Analysis Based on Decade-Long Structural Studies of SARS Coronavirus. J Virol. 2020;94(7):e00127-20. doi: 10.1128/JVI.00127-20
12. 12. D'Amico F, Baumgart DC, Danese S, Peyrin-Biroulet L. Diarrhea During COVID-19 Infection: Pathogenesis, Epidemiology, Prevention, and Management. Clin Gastroenterol Hepatol. 2020;18(8):1663-72. doi: 10.1016/j.cgh.2020.04.001
13. 13. Xu H, Zhong L, Deng J, Peng J, Dan H, Zeng X, et al. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. Int J Oral Sci. 2020;12(1):8. doi: 10.1038/s41368-020-0074-x
14. 14. Zou X, Chen K, Zou J, Han P, Hao J, Han Z. Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection. Front Med. 2020;14(2):185-92. doi: 10.1007/s11684-020-0754-0
15. 15. Gu J, Han B, Wang J. COVID-19: Gastrointestinal Manifestations and Potential Fecal-Oral Transmission. Gastroenterology. 2020;158(6):1518-9. doi: 10.1053/j.gastro.2020.02.054
16. 16. Chung M, Bernheim A, Mei X, Zhang N, Huang M, Zeng X, et al. CT Imaging Features of 2019 Novel Coronavirus (2019-nCoV). Radiology. 2020;295(1):202-7. doi: 10.1148/radiol.2020200230
17. 17. Bernheim A, Mei X, Huang M, Yang Y, Fayad Z, Zhang N, et al. Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection. Radiology. 2020;295(3):200463. doi: 10.1148/radiol.2020200463
18. 18. Wang Y, Dong C, Hu Y, Li C, Ren Q, Zhang X, et al. Temporal Changes of CT Findings in 90 Patients with COVID-19 Pneumonia: A Longitudinal Study. Radiology. 2020;296(2):E55-64. doi: 10.1148/radiol.2020200843
19. 19. Kim H, Hong H, Yoon SH. Diagnostic Performance of CT and Reverse Transcriptase-Polymerase Chain Reaction for Coronavirus Disease 2019: A Meta-Analysis. Radiology. 2020;201343. doi: 10.1148/radiol.2020201343
20. 20. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382(18):1708-20. doi: 10.1056/NEJMoa2002032
21. 21. Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, et al. Correlation of Chest CT and RT-PCR Testing for Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology. 2020;296(2):E32-40. doi: 10.1148/radiol.2020200642
22. 22. Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coronavirus Disease 2019 (COVID-19): A Systematic Review of Imaging Findings in 919 Patients. AJR Am J Roentgenol. 2020;215(1):87-93. doi: 10.2214/AJR.20.23034