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E2032. Coronavirus Disease 2019 (COVID-19): Beyond the Lungs
Authors
  1. Shima Behzad ; Islamic Azad University of Tehran Medical Branch
  2. Ali Gholamrezanezhad; Keck School of Medicine/University of Southern California
Background
Coronavirus disease 2019 (COVID-19), the first pandemic caused by a human infecting coronavirus, has now infected more than 24 million individuals and caused more than 800,000 deaths all around the world. The disease has developed to a global scare not only due to its highly contagious viral agent named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) officially by the world’s health organization (WHO) but because the disease diagnosis has become one of the major hurdles in controlling the spreading of the disease. Not only the inefficiency and shortage of medical tests are affecting the proper and early diagnosis of the disease, but the spectrum of clinical manifestations caused by the infection has itself became a challenging issue for clinicians worldwide. Literature review of reports around clinical presentations of confirmed cases shows that COVID-19 disease causes a spectrum of clinical manifestations. The patients’ presentation of the disease may range from completely asymptomatic to severe complications, including acute respiratory distress syndrome (ARDS) and death. Additionally, research around the disease pathogenesis demonstrated that the human angiotensin I converting enzyme 2 (ACE2), the entry receptor for SARS-CoV-2 cell invasion, is expressed not only on the surface of the lung epithelial cells but multiple extrapulmonary tissues and direct viral injury is a plausible mechanism of multi-organ involvement in COVID-19 disease. Extrapulmonary tissue damage might contribute to extra respiratory manifestations, including gastrointestinal, neurological, hematological, cardiovascular, renal, ocular, cutaneous, and liver or reproductive system dysfunction symptoms. Notably, there have been confirmed COVID-19 cases with initial and/or isolated extrapulmonary manifestations, which highlights the importance of recognizing and monitoring the spectrum of manifestations developed during the SARS-CoV-2 infection. Here we provide a literature review of reported and possible extrapulmonary manifestations in COVOD-19 cases for a better understanding of the patients’ presentation and subsequently efficient and early detection and diagnosis and better control of the disease spread.

Educational Goals / Teaching Points
To review possible extrapulmonary involvement in COVID-19 disease. To report, incidentally found COVID-19 cases with initial and/or isolated extrapulmonary manifestations.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Along with the role of imaging studies on early detection and diagnosis, these procedures have also become the indispensable means in monitoring the clinical course, evaluating the disease severity.

Conclusion
Hopefully, this exhibit will highlight the importance of high clinical index of suspicion and very low threshold for clinical and paraclinical screening and diagnostic testing, such as chest CT scan and how it leads to earlier recognition, detection, and patient management and treatment of potentially devastating disease.