Although primarily associated with the respiratory system and adults, COVID-19 can also manifest in other systems.
During a Tuesday Hot Topic Session, researchers discussed the imaging manifestations of COVID-19 in the abdomen and pelvis in adults, along with pediatric manifestations of the disease.
"Imaging plays an essential role in the diagnosis of all manifestations of COVID-19 as well as its related complications," said moderator Christine Menias, MD, a radiologist at the Mayo Clinic.
"With the growing global COVID-19 outbreak, a comprehensive understanding of the diagnostic imaging hallmarks, imaging features, multisystem involvement and evolution of imaging findings is needed for effective patient management and treatment," added Javad Azadi, MD, a radiologist at Johns Hopkins Medicine, who also moderated the session.
Pediatric Manifestations
Lee
There have been more than 380,000 pediatric COVID-19 cases in the U.S., with infants under one year of age being the most vulnerable to severe infection, according to presenter Edward Lee, MD, MPH, a radiologist at the Boston Children’s Hospital.
“The challenge for radiologists is to understand the differences between how the disease manifests in children and adults,” Dr. Lee said. “For example, bronchial wall thickening or peribronchovascular opacities are more frequent in children with COVID-19 infection.”
Another emerging difference between the adult and pediatric population is the unique pulmonary and non-pulmonary manifestations of COVID-19 in children, particularly Multisystem Inflammatory Syndrome in Children (MIS-C).
“This is a serious condition where different body parts can be inflamed so that, in 80 to 100% of all cases, SARS-CoV-2 antibodies have been found,” Dr. Lee said. “Because the condition typically emerges two-to-four weeks after infection or exposure, radiologists must familiarize themselves with the imaging findings of pediatric COVID-19 versus MIS-C.”
Manifestations in the Abdomen and Pelvis
Revzin
Presenters also discussed recent research on clinical presentation of the SARS-CoV-2 virus in the abdomen and pelvis 2.
“Radiology professionals play a significant role in diagnosing infected individuals, identifying complications that are not apparent on physical exam or laboratory analysis,” said Margarita Revzin, MD, MS, an associate professor at Yale School of Medicine. “They’re also playing an increasingly important role in the follow-up imaging assessment of known COVID-related complications.”
Take for example the viral targeting of the abdominal and pelvic organs, which can cause injury and, in some cases, organ failure. According to Dr. Revzin, imaging is essential for detecting, diagnosing, assessing and following up on a viral-induced injury, as well as its associated complications.
“Having an understanding of viral pathophysiology, particularly its effects on the immune system and coagulation, will help identify any associated complications,” Dr. Revzin said. “Furthermore, the recognition of one complication should prompt intense scrutiny for others, especially if a patient is critically ill.”
For More Information:
View the RSNA 2020 session Non-pulmonary Manifestation of COVID-19 — SPSH54 at RSNA2020.RSNA.org.
