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World J Radiol. Jan 28, 2021; 13(1): 19-28
Published online Jan 28, 2021. doi: 10.4329/wjr.v13.i1.19
Systemic arterio-venous thrombosis in COVID-19: A pictorial review
Abhinaya Shankar, Baskaran Varadan, Dillibabu Ethiraj, Hemanth Sudarsanam, Abdul Rahman Hakeem, Srinivasan Kalyanasundaram
Abhinaya Shankar, Baskaran Varadan, Dillibabu Ethiraj, Hemanth Sudarsanam, Srinivasan Kalyanasundaram, Department of Radiology, Dr. Rela Institute and Medical Centre, Chennai 600044, India
Abdul Rahman Hakeem, HPB Surgery and Liver Transplantation, The Leeds Teaching Hospitals NHS Trust, Leeds LS97TF, West Yorkshire, United Kingdom
Author contributions: Shankar A, Varadan B, Ethiraj D and Sudarsanam H contributed in writing the article and generating figures; Hakeem AR and Kalyanasundaram S critically revised the article; all authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Srinivasan Kalyanasundaram, MD, Chief Doctor, Department of Radiology, Dr. Rela Institute and Medical Centre, 7, CLC Works Road, Chromepet, Chennai 600044, India. srinivasan.k@relainstitute.com
Received: November 23, 2020
Peer-review started: November 23, 2020
First decision: December 7, 2020
Revised: December 13, 2020
Accepted: December 22, 2020
Article in press: December 22, 2020
Published online: January 28, 2021
Processing time: 64 Days and 21.1 Hours
Abstract

Coronavirus disease 2019 (COVID-19) is caused by the novel coronavirus severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Systemic complications include cardiovascular, neurological, hepatic, renal and altered coagulation. Derangements in haemostasis with SARS-CoV-2 infection have been termed COVID-19 associated coagulopathy (CAC). CAC is postulated to be one of the significant causes for sudden deaths in this pandemic, with infection of endothelial cells and subsequent endotheliitis through angiotensin-converting enzyme-2 receptors playing a key role in the pathogenesis. In this pictorial review, we describe the imaging findings in a multitude of extrapulmonary arterial (aorta, cerebral, mesenteric, renal and peripheral arterial system) and venous thrombotic phenomena detected on contrast-enhanced computed tomography and magnetic resonance imaging of COVID-19 patients which could not be attributed to any other causes. Knowledge of incidence of these complications, lowering the threshold for diagnostic imaging in symptomatic patients and timely radiological detection can play a vital role in subsequent management of these critically ill patients.

Keywords: COVID-19; Coronavirus; Thrombus; Arterial; Aorta; Tomography

Core Tip: Coronavirus disease 2019 (COVID-19) disease is a systemic illness with multi-organ system manifestations. Coagulopathy in the setting of COVID-19 has a unique pathophysiology with a propensity for both arterial and venous thrombosis. These phenomena may be clinically occult with imaging playing a vital role in detection and management. A high degree of clinical suspicion with a low threshold for cross sectional imaging can positively alter outcomes during this ongoing pandemic.