Role of chest CT in patients with acute abdomen during the COVID-19 era.

Editor

Currently doctors, health professionals and medical students are facing a challenging pandemic caused by SARS-CoV-2 (COVID-19). As of 1 April, Italy is the country with the highest number of deaths. Gastrointestinal symptoms, such as diarrhoea, may arise before or even in the absence of respiratory symptoms. The relatively high incidence of chest CT changes suggestive of COVID-19 (‘ground-glass’ opacity) in asymptomatic patients is worth noting. Zhou et al. reported that 66 of 254 (26·0 per cent) COVID-19-positive patients had gastrointestinal symptoms, with a greater prevalence in female patients (62·8 per cent; P = 0·033). A possible explanation is mainly related to the high expression of angiotensin converting enzyme (ACE) 2 receptors in the alveolar type 2 (AT2) cells of the lungs and also enterocytes. The typical scenario is a bilateral ground glass picture with or without pulmonary consolidation, consistent with viral pneumonia. Other less commonly observed findings were pleural thickening, pleural effusion and lymphadenomegaly. A retrospective analysis of 51 patients demonstrated that sensitivity of cCT in COVID-19 detection may be higher than that of reverse transcription polymerase chain reaction (RT-PCR) (98 versus 71 per cent).

In this severe acute pandemic scenario, patients who come to the emergency department with acute abdomen must also be considered for COVID-19 infection, even in the absence of respiratory symptoms. In the clinical investigation of this patient, abdominal CT is common for surgical decision-making; adding a cCT seems sensible ().

Fig. 1

Flow chart for acute abdomen cases in emergency settings

PPE, personal protective equipment; cCT, chest CT.