COVID-19 ENFEKSİYONUNDA ABDOMİNAL RADYOLOJİK GÖRÜNTÜLEME

Öz

Koronavirüs hastalığı 2019 (COVID-19), şiddetli akut solunum sendromu koronavirüs 2'nin (SARS-CoV-2) neden olduğu viral bir enfeksiyondur. Ancak yaygın mikrotromboemboliler ve immün kompleks vasküliti tarzında davranış göstermekte ve tüm sistemleri etkilemektedir. Genellikle ateş, halsizlik, yorgunluk, öksürük ve miyalji gibi akut solunum yolu enfeksiyon semptomları yada, bulantı kusma, karın ağrısı, iştahsızlık ve diare gibi gastrointestinal semptomlar ile prezente olur. Hastalık çok büyük oranda erişkilerde görülmekle beraber, multisistemik inflamatuar sendrom (MİS-C) olarak tanımlanan pediatrik formları da tanımlanmıştır. Klinik olarak akciğer tutulumunun ön planda olması nedeniyle, abdominal tutuluma ait radyolojik bulgular daha az bilinmektedir. Abdominal tutulum gösteren vakalarda klinik seyir daha ciddi olmakla beraber, etkin tedavi ile başarılı sonuçlar alınmaktadır. Bu nedenle Covid-19’da abdominal tutulumun radyolojik görünümlerinin bilinmesi, erken tanı ve doğru tedavi yaklaşımı açısından son derece önemlidir.

Anahtar Kelimeler

• Covid-19
• abdomen
• gastrointestinal sistem
• radyoloji

ABDOMINAL IMAGING IN COVID-19 INFECTION

Öz

Coronavirus disease 2019 (COVID-19) is a viral infection caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). However, it behaves like diffuse microthromboembolism and immune complex vasculitis and affects all systems. It usually presents with acute respiratory tract infection symptoms such as fever, weakness, fatigue, cough and myalgia, or gastrointestinal symptoms such as nausea, vomiting, abdominal pain, anorexia and diarrhea. Although the disease is mostly seen in adults, pediatric forms defined as multisystemic inflammatory syndrome (MIS-C) have also been described. Radiological findings of abdominal involvement are less known due to the clinical predominance of lung involvement. Although the clinical course is more serious in cases with abdominal involvement, successful results are obtained with effective treatment. Therefore, knowing the radiological aspects of abdominal involvement in Covid-19 is extremely important in terms of early diagnosis and correct treatment approach.

Anahtar Kelimeler

• Covid-19
• abdomen
• Gastrointestinal Tract
• Radiology

Kaynakça

1. 1. Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H. Evidence for gastrointestinal infection of SARS-CoV-2. Gastroenterology. 2020;158(6):1831–3.
2. 2. Bhayana R, Som A, Li MD, Carey DE, Anderson MA, Blake MA, et al. Abdominal imaging findings in COVID-19: preliminary observations. Radiology. 2020;297(1):E207–15.
3. 3. Dane B, Brusca-Augello G, Kim D, Katz DS. Unexpected findings of coronavirus disease (COVID-19) at the lung bases on abdominopelvic CT. Am J Roentgenol. 2020;215(3):603–6.
4. 4. Chai X, Hu L, Zhang Y, Han W, Lu Z, Ke A, et al. Specific ACE2 expression in cholangiocytes may cause liver damage after 2019-nCoV infection. biorxiv. 2020;
5. 5. Olson MC, Lubner MG, Menias CO, Mellnick VM, Gettle LM, Kim DH, et al. Radiographics update: Venous thrombosis and hypercoagulability in the abdomen and pelvis—findings in COVID-19. Radiographics. 2020;40(5):E24–8.
6. 6. Cheung S, Quiwa JC, Pillai A, Onwu C, Tharayil ZJ, Gupta R. Superior mesenteric artery thrombosis and acute intestinal ischemia as a consequence of COVID-19 infection. Am J Case Rep. 2020;21:e925753-1.
7. 7. Kanne JP, Bai H, Bernheim A, Chung M, Haramati LB, Kallmes DF, et al. COVID-19 imaging: What we know now and what remains unknown. Radiology. 2021;204522.
8. 8. Wong K, Kim DH, Khanijo S, Melamud A, Zaidi G. Pneumatosis Intestinalis in COVID-19: Case Series. Cureus. 2020;12(10).

9. 9. Cheung KS, Hung IFN, Chan PPY, Lung KC, Tso E, Liu R, et al. Gastrointestinal manifestations of SARS-CoV-2 infection and virus load in fecal samples from a Hong Kong cohort: systematic review and meta-analysis. Gastroenterology. 2020;159(1):81–95.
10. 10. Luo S, Zhang X, Xu H. Don’t overlook digestive symptoms in patients with 2019 novel coronavirus disease (COVID-19). Clin Gastroenterol Hepatol. 2020;18(7):1636–7.
11. 11. Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18(4):844–7.
12. 12. Hameed S, Elbaaly H, Reid CEL, Santos RMF, Shivamurthy V, Wong J, et al. Spectrum of Imaging Findings at Chest Radiography, US, CT, and MRI in Multisystem Inflammatory Syndrome in Children Associated with COVID-19. Radiology. 2021;298(1):E1–10.
13. 13. Ho LM, Paulson EK, Thompson WM. Pneumatosis intestinalis in the adult: benign to life-threatening causes. Am J Roentgenol. 2007;188(6):1604–13.
14. 14. Nelson AL, Millington TM, Sahani D, Chung RT, Bauer C, Hertl M, et al. Hepatic portal venous gas: the ABCs of management. Arch Surg. 2009;144(6):575–81.
15. 15. Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet. 2020;395(10237):1607–8.
16. 16. Blumfield E, Levin TL, Kurian J, Lee EY, Liszewski MC. Imaging findings in multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease (COVID-19). Am J Roentgenol. 2021;216(2):507–17.
17. 17. Verdoni L, Mazza A, Gervasoni A, Martelli L, Ruggeri M, Ciuffreda M, et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet. 2020;395(10239):1771–8.
18. 18. Asadi-Pooya AA, Simani L. Central nervous system manifestations of COVID-19: a systematic review. J Neurol Sci. 2020;116832.