Abdominal and gastrointestinal manifestations in COVID-19 patients: Is imaging useful?

Figure 1 A 63-year-old man who presented to the emergency room for abdominal pain and no significant alterations on abdominal computed tomography. A: Computed tomography scan with pulmonary window at the level of lung inferior lobes (included in the volume acquisition) shows the presence of ground-glass opacities and crazy-paving pattern in the right side; B: Computed tomography scan with pulmonary window at lower levels of lung inferior lobes always exhibited ground-glass opacities and crazy-paving pattern in the right side.

Figure 2 An 83-year-old woman with epigastric pain. A: Abdominal contrast-enhanced portal-venous phase computed tomography showed diffuse thickening of the submucosa of the gastric walls and intrahepatic biliary dilatation; B: Abdominal contrast-enhanced portal-venous phase computed tomography also depicts thickening of the submucosa of the pyloric region and signs of cholecystitis.

Figure 3 A 68-year-old woman with abdominal pain. Abdominal contrast-enhanced portal-venous phase computed tomography image showed circumferential thickening of the submucosa of the right colon that appeared hypodense, in the absence of both significant contrast-enhancement and perivisceral fat stranding.

Figure 4 A 74-year-old man with abdominal pain. Abdominal contrast-enhanced portal-venous phase computed tomography image showed well-circumscribed hyperattenuation of the fat surrounding the mesenteric vessels.

Figure 5 A 73-year-old woman with abdominal pain. A: Contrast-enhanced portal-venous phase computed tomography image of the lower abdomen demonstrated gas distension of the sigma-rectum with evidence of multiple stools inside the lumen; free effusion was also appreciable around the colon; B: Contrast-enhanced portal-venous phase computed tomography image of the abdomen showed distention of the left bowel and hyperemic thickened walls (particularly affecting the mucosa) of the right colon with perivisceral fat suffusion; C: Coronal multiplanar reconstruction from contrast-enhanced computed tomography well demonstrated these findings.

Figure 6 A 69-year-old woman with diarrhea. Contrast-enhanced portal-venous phase computed tomography image of the abdomen showed evidence of fluid-filled distension of the large bowel, particularly of the sigma and rectum, without evidence of parietal thickening. Free effusion was also present in the abdomen and between the intestinal loops with associated diffuse imbibition of the subcutaneous soft tissues.

Figure 7 A 65-year-old man with abdominal pain and severe pulmonary involvement. A: Unenhanced computed tomography scan of the upper abdomen showed signs of pneumoperitoneum secondary to mechanical ventilation and cholelithiasis; B: The presence of gas within the peritoneal cavity was also appreciable at lower levels of the abdomen on unenhanced computed tomography scan.

Figure 8 A 38-year-old man with abdominal discomfort. A: Abdominal ultrasound image demonstrated hepatic steatosis as an increase in echogenicity compared to the renal cortex; B: Abdominal ultrasound image demonstrated hepatic steatosis as loss of physiological hyperechogenicity of the wall of the portal branches; C: Abdominal ultrasound image demonstrated hepatic steatosis as posterior attenuation of the ultrasonic beam with failure to visualize the diaphragm.

Figure 9 A 46-year-old woman with abdominal discomfort. Unenhanced computed tomography image showed increased liver hypodensity compared to the spleen, with attenuation value less than 40 HU.

Figure 10  A 46-year-old woman with right hypochondrium pain. Abdominal ultrasound showed an enlarged gallbladder containing deposit of biliary sludge in the infundibular region.

Figure 11  A 60-year-old man with abdominal pain and increased amylase and lipase levels. Abdominal contrast-enhanced portal-venous phase computed tomography image showed fluid collections at the level of the pancreatic head and isthmic region and thickening of the left anterior pararenal fascia and perivisceral fat.

Figure 12  A 69-year-old man with hematuria and right abdominal pain. Abdominal contrast-enhanced portal-venous phase computed tomography image depicted wedge-shaped parenchymal defects that involved both the renal cortex and medulla with extension to the capsular surface, suggesting a renal infarct.

Figure 13  A 77-year-old man with abdominal tenderness. A: Contrast-enhanced portal-venous phase computed tomography image of the abdomen demonstrated a wedge-shaped low-attenuation area at the level of the spleen, typical of infarction. Pericardial effusion was also present; B: A further rounded low-attenuation area with peripheral localization was present in a lower portion of the spleen on contrast-enhanced portal-venous phase computed tomography scan.