Published: 2022-01-29

Imaging spectrum of extrapulmonary manifestations of COVID-19 infection- a multi-centre descriptive study from Southern India

Harshavardhan Mahalingam, Lokesh Murali, Ashwini Govisetty, Senthil Kumar Aiyappan, Karthik Krishna Ramakrishnan, Seena Cheppala Rajan, Rajeswaran Rangasami, Vinayagam Shanmugham


Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) is the causative agent for coronavirus disease 2019 (COVID-19) pandemic. While the primary organ of involvement in this disease is the lung, multiple other organ systems can be involved either due to direct viral cytopathic effects or due to thrombo-inflammation and immune system dysregulation. In this study we describe the spectrum of extrapulmonary imaging findings encountered in our patients with COVID-19.

Methods: This was a retrospective observational study conducted in three tertiary care hospitals in the city of Chennai in southern India. All cross-sectional imaging studies (other than lung imaging studies) performed in patients who had proven COVID-19 infection by RT-PCR testing during the period from April 2020 to March 2021 were included as part of the study. Extrapulmonary findings in these imaging studies were recorded and collated system-wise.

Results: A total of 96 non-lung imaging studies were performed in patients who had RT-PCR positivity for COVID-19 infection. Among these a total of 30 studies had extrapulmonary imaging findings. Vascular involvement was seen in 14 patients, central nervous system involvement in 13 patients, abdomen involvement in 2 patients, and cardiac involvement in 1 patient. Vascular manifestations included arterial and venous thrombosis. Neurological manifestations included stroke, encephalitis and demyelination. Abdominal manifestations included enteritis and acute kidney injury. Cardiac manifestation was in form of myocarditis.

Conclusions: Extrapulmonary imaging findings in COVID-19 are uncommon but not rare. Multisystem thrombotic manifestations and central nervous system involvement account for majority of extrapulmonary imaging findings in COVID-19.


Computed tomography, COVID-19, Extrapulmonary, Magnetic resonance imaging, SARS-CoV2, Ultrasonography

Full Text:



WHO Coronavirus (COVID-19) Dashboard. Available from: Accessed on 13 May 2021.

Gupta A, Madhavan MV, Sehgal K, Nair N, Mahajan S, Sehrawat TS, et al. Extrapulmonary manifestations of COVID-19. Nat Med. 2020;26(7):1017-32.

Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood. 2020;135(23):2033-40.

Omar SF, Habib RM, Motawea AM. Radiological findings of COVID-19-related thromboembolic complications. Egypt J Radiol Nucl Med. 2021;52(1):99.

Siddiqi HK, Libby P, Ridker PM. COVID-19- a vascular disease. Trends Cardiovasc Med. 2021;31(1):1-5.

Egbert AR, Cankurtaran S, Karpiak S. Brain abnormalities in COVID-19 acute/subacute phase: a rapid systematic review. Brain Behav Immun. 2020;89:543-54.

Revzin MV, Raza S, Srivastava NC, Warshawsky R, D’Agostino C, Malhotra A, et al. Multisystem imaging manifestations of COVID-19, part 2: from cardiac complications to pediatric manifestations. RadioGraphics. 2020;40(7):1866-92.

Bhayana R, Som A, Li MD, Carey DE, Anderson MA, Blake MA, et al. Abdominal imaging findings in COVID-19: preliminary observations. Radiology. 2020;297(1):E207-15.

Lui K, Wilson MP, Low G. Abdominal imaging findings in patients with SARS-CoV-2 infection: a scoping review. Abdom Radiol N Y. 2020;1-7.

Shafi AMA, Shaikh SA, Shirke MM, Iddawela S, Harky A. Cardiac manifestations in COVID-19 patients- a systematic review. J Card Surg. 2020;35(8):1988-2008.

Paliwal VK, Garg RK, Gupta A, Tejan N. Neuromuscular presentations in patients with COVID-19. Neurol Sci. 2020;1-18.

Ramani SL, Samet J, Franz CK, Hsieh C, Nguyen CV, Horbinski C, et al. Musculoskeletal involvement of COVID-19: review of imaging. Skelet Radiol. 2021:1-1.