E1530. Thrombotic Complications of COVID-19 Infection: A Multimodality Pictorial Review
New York Presbyterian- Columbia University Irving Medical Center
COVID-19 infection has emerged as a global health threat with millions infected and many thousands requiring hospitalization. Initial symptoms include respiratory symptoms and myalgias however many patients go on to experience thrombotic complications. Research has demonstrated that the pathophysiology includes endothelial damage and a procoagulant state resulting in microthrombosis. It is essential for the radiologist to have a high index of suspicion in patients with COVID-19 when evaluating for thrombosis in any organ system and to recommend appropriate confirmatory imaging when thrombosis is suspected.
Educational Goals / Teaching Points
Patients with symptoms of COVID-19 may have thrombotic complications on admission or may be hospitalized when thrombotic complications develop. Here, we will review positive cases of thrombotic complications in patients with COVID-19 using multiple modalities. Additional teaching points will include appropriate studies based on guidelines for imaging COVID-19 and the ACR appropriateness criteria.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Thrombotic complications frequently seen in patients infected with COVID-19 include pulmonary embolism, DVT, ACS, and stroke. Less commonly the integumentary system, GI, and GU systems are involved. Multiple modalities are used to assess thrombotic complications. These include CT for patients presenting with shortness of breath, which may diagnose PE in addition to demonstrating characteristic findings of COVID-19 infection. DVT and arterial occlusion are often diagnosed on Dopper ultrasound, however can also be seen on CT or MRI. In the case of stroke, initial CT is obtained to rule out hemorrhage, however a follow-up MRI with or without contrast is often obtained to better characterize location and extent of the lesion. ACS is seen on cardiac MRI as coronary artery thrombus and the stigmata of ischemia. GI and GU complications are commonly assessed with cross-sectional imaging.
Patients with COVID-19 infection have a high rate of thrombotic complications, which must be promptly diagnosed by radiologists so that patients can receive appropriate therapy. Here we review guidelines for imaging, findings on exam, and the appropriate imaging modalities based on COVID-19 literature, recommendations of professional societies, and ACR appropriateness criteria so that radiologists are prepared to make an accurate and timely diagnosis.