Lesson by SARS-CoV-2 disease (COVID-19): whole-body CT angiography detection of “relevant” and “other/incidental” systemic vascular findings

• Published in: European radiology Vol. 31; no. 10; pp. 7363 - 7370
• Main Authors: Rea, Gaetano, Lassandro, Francesco, Lieto, Roberta, Bocchini, Giorgio, Romano, Federica, Sica, Giacomo, Valente, Tullio, Muto, Emanuele, Murino, Patrizia, Pinto, Antonio, Montesarchio, Vincenzo, Muto, Maurizio, Pacella, Daniela, Capitelli, Ludovica, Bocchino, Marialuisa
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2021; Springer Nature B.V
• Subjects: Aneurysm; Aneurysms; Angiography; Brain; Chest; Computed Tomography Angiography; Coronaviruses; COVID-19; Diagnostic Radiology; Embolism; Embolisms; Evaluation; Humans; Imaging; Internal Medicine; Interventional Radiology; Ischemia; Kidneys; Liver; Medical imaging; Medicine; Medicine & Public Health; Neuroradiology; Organs; Population studies; Pulmonary Embolism - diagnostic imaging; Pulmonary embolisms; Radiology; Retrospective Studies; SARS-CoV-2; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Spleen; Thromboembolism; Thrombosis; Ultrasound; Viral diseases; COVID-19; CT angiography; Infarction; Thrombosis; Embolism
• ISSN: 0938-7994; 1432-1084; 1432-1084
• DOI: 10.1007/s00330-021-07904-y

Objectives Increasing evidence suggests that SARS-CoV-2 infection may lead to severe and multi-site vascular involvement. Our study aimed at assessing the frequency of vascular and extravascular events’ distribution in a retrospective cohort of 42 COVID-19 patients. Methods Patients were evaluated by whole-body CT angiography between March 16 and April 30, 2020. Twenty-three out of the 42 patients evaluated were admitted to the intensive care unit (ICU). Vascular and extravascular findings were categorized into “relevant” or “other/incidental,” first referring to the need for immediate patient care and management. Student T-test, Mann-Whitney U test, or Fisher exact test was used to compare study groups, where appropriate. Results Relevant vascular events were recorded in 71.4% of cases (n = 30). Pulmonary embolism was the most frequent in both ICU and non-ICU cases (56.5% vs. 10.5%, p  = 0.002). Ischemic infarctions at several sites such as the gut, spleen, liver, brain, and kidney were detected (n = 20), with multi-site involvement in some cases. Systemic venous thrombosis occurred in 30.9% of cases compared to 7.1% of systemic arterial events, the first being significantly higher in ICU patients ( p  = 0.002). Among incidental findings, small-sized splanchnic arterial aneurysms were reported in 21.4% of the study population, with no significant differences in ICU and non-ICU patients. Conclusions Vascular involvement is not negligible in COVID-19 and should be carefully investigated as it may significantly affect disease behavior and prognosis. Key Points • Relevant vascular events were recorded in 71.4% of the study population, with pulmonary embolism being the most frequent event in ICU and non-ICU cases. • Apart from the lung, other organs such as the gut, spleen, liver, brain, and kidneys were involved with episodes of ischemic infarction. Systemic venous and arterial thrombosis occurred in 30.9% and 7.1% of cases, respectively, with venous events being significantly higher in ICU patients (p = 0.002). • Among incidental findings, small-sized splanchnic arterial aneurysms were reported in 21.4% of the whole population.