CT Reveals Higher Abdominal and Pelvic Hypercoagulability in COVID-19 Patients

Radiologists should alert referring clinicians to possible COVID-19 infection when they pick up evidence of thrombosis on abdominal and pelvic CT scans, new research reports.

Growing research around how COVID-19 manifests indicates that the virus can cause medium-to-large arterial and venous abdominal and extremity macrothrombi. And, in a new study published Sept. 24 in the American Journal of Roentgenology, a team of researchers from New York University (NYU) Langone Medical Center shared their results that these findings do occur more frequently in patients positive for viral infection.

“Thromboembolic findings occurred more frequently in patients with than without COVID-19,” said the team led by Bari Dane, M.D., an NYU radiologist and clinical assistant professor of radiology at NYU Grossman School of Medicine.

By retrospectively reviewing details from the electronic medical records and the abdominal CT scans from 82 patients – 58 men and 24 women with an average age of 58 – who were confirmed COVID-19-positive. They compared these scans to those from 82 patients – 43 men and 39 women with an average age of 53.5 – who did not have COVID-19. They examined the scans for thromboembolism and solid-organ infarction.

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Based on their analysis, nine patients (11 percent) with COVID-19 had thromboembolic findings in their CT scans– four had thromboembolism, three had arterial thromboembolism in the aorta or major branches, and two had splenic infarctions with patent vasculature.

76-year-old woman who presented to emergency department with upper back pain. Axial abdominopelvic CT angiogram shows nonocclusive acute aortic thrombus (arrow). Bilateral common iliac artery and left internal iliac artery thrombi (not shown) were also seen, as well as signs of chronic atherosclerotic disease. After findings of concurrently performed chest CT raised concerns, patient was determined to have COVID-19. Courtesy: American Journal of Roentgenology

In addition, IV contrast-enhanced chest CT angiograms that were performed concurrently revealed lobar and segmental pulmonary emboli; probable left lower lobe pulmonary infarction instead of pneumonia; and bilateral, multi-lobar, patchy, but confluent, ground-glass opacities that are characteristic of COVID-19 infection.

The team also noted that in many COVID-19-positive cases, patients had elevated coagulation and inflammatory markers. Of that group, 64 were admitted to the hospital. Among those patients, 28 were intubated, and 13 died. Overall, their inflammatory markers were elevated: 3,588+/-3,588 ng/mL D-dimer levels, 86.4 +/- 42.2 mm/h erythrocyte sedimentation rate, 143.6 +/-250.8 mg/L C-reactive protein level, and 2,652+/-4,385 ng/mL ferritin level.

The study did have limitations, though. Not only did it include a small sample size from a single institution, but the team also acknowledged that not all patients with thromboembolism undergo confirmative findings. Some may not even experience symptoms, meaning that the prevalence could be much larger than reported.

Consequently, Dane’s team reiterated, radiologists must pay attention when they identify these findings.

“Radiologists should raise concern for COVID-19 when identifying thromboembolic abdominopelvic findings during this pandemic,” they said.

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