Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Radiology, University Medical Center Regensburg, Germany.
Clin Hemorheol Microcirc. 2022;82(3):239-248. doi: 10.3233/CH-221487.
Abdominal thromboses are a poorly characterized thrombotic complication of COVID-19. The aim of this paper is to report multimodality ultrasound imaging findings of the abdomen in evaluation of thrombotic lesions in hospitalized patients with COVID-19.
PATIENTS & METHODS: In this retrospective observational study, patients admitted to a single University Hospital from April 1, 2020 to April 30, 2022, who tested positive for COVID-19 and developed acute abdominal pain over the course of hospitalization were included. Abdominal ultrasound imaging studies performed in these patients were reviewed, including B mode ultrasound (BMUS), color-coded Doppler ultrasound (CCDS) and contrast enhanced ultrasound (CEUS). Thromboembolic findings on contrast enhanced computed tomography (CTA) were also recorded.
Finally, 13 cases of abdominal thrombosis in 226 with COVID 19 infections were included (mean age, 56.69±8.97 years; 10 men, 3 women). Thromboembolic events included: iliac thrombosis (n = 4), portal venous (PV) thrombosis (n = 3), superior mesenteric vein (VMS) thrombosis (n = 2), inferior vena cava (IVC) thrombosis (n = 5) and inferior mesenteric vein (VMI) thrombosis (n = 1). In all cases of abdominal thrombosis, during high resolution BMUS scan, intra-luminary hypoechogenic appositional thrombi could be detected. Meanwhile blood flow with reduced speed less than 20 cm/s could be observed by CCDS. High arterial flow speed was a sign of collateral flow changes with diffuse venous dilatation. On CEUS, changes of the microcirculation of the liver, spleen, kidneys or small bowel by infarctions or micro-emboli could be detected. In 3 cases of PV thrombosis and in 2 cases of IVC thrombosis, catheter interventions were successful performed for recanalization without relevant lumen reduction afterwards. In other cases, without interventional procedure, partial recanalization happened with venous flow speed over 15 cm/s and lumen reduction more than 50%.
Our study highlights those thromboembolic complications can be seen in hospitalized patients with COVID-19. Multimodality ultrasound examinations is helpful for early and accurate diagnosis of these complications.
腹部血栓是 COVID-19 的一种特征不明确的血栓并发症。本文旨在报告多模态超声成像在评估住院 COVID-19 患者的血栓病变中的腹部检查结果。
在这项回顾性观察性研究中，纳入了 2020 年 4 月 1 日至 2022 年 4 月 30 日期间因 COVID-19 检测呈阳性并在住院期间出现急性腹痛而入住一家大学医院的患者。对这些患者进行的腹部超声成像研究进行了回顾性分析，包括 B 型超声（BMUS）、彩色多普勒超声（CCDS）和对比增强超声（CEUS）。还记录了对比增强计算机断层扫描（CTA）上的血栓栓塞发现。
最终，纳入了 226 例 COVID-19 感染患者中 13 例腹部血栓形成患者（平均年龄 56.69±8.97 岁；男性 10 例，女性 3 例）。血栓栓塞事件包括：髂静脉血栓形成（n=4）、门静脉（PV）血栓形成（n=3）、肠系膜上静脉（VMS）血栓形成（n=2）、下腔静脉（IVC）血栓形成（n=5）和肠系膜下静脉（VMI）血栓形成（n=1）。在所有腹部血栓形成的病例中，在高分辨率 BMUS 扫描中，可以检测到腔内低回声附壁血栓。同时，通过 CCDS 可以观察到血流速度小于 20cm/s。高动脉血流速度是弥漫性静脉扩张引起的侧支血流变化的标志。在 CEUS 中，可以检测到肝脏、脾脏、肾脏或小肠的微循环通过梗死或微栓塞发生变化。在 3 例 PV 血栓形成和 2 例 IVC 血栓形成的病例中，进行了导管介入治疗以实现再通，随后没有相关管腔缩小。在其他情况下，未进行介入治疗，静脉血流速度超过 15cm/s，管腔缩小超过 50%，部分再通。
本研究强调了这些血栓栓塞并发症可发生于住院 COVID-19 患者中。多模态超声检查有助于对这些并发症进行早期和准确的诊断。
