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. 2020 Nov 2;40(7):1866–1892. doi: 10.1148/rg.2020200195

Figure 14a.

Superior mesenteric artery thrombosis complicated by bowel ischemia and perforation in a 54-year-old man who presented to the emergency department with abdominal pain and was diagnosed with COVID-19. (a–c) Coronal (a) and axial (b, c) contrast-enhanced CT images of the abdomen and pelvis show mucosal hyperenhancement involving the small bowel (F in a, white arrow in c), with associated mild wall thickening. There is a long segment of bowel wall hypoenhancement in the distal ileum, with a large focal wall defect (solid white arrows in a). Note the extension of intraluminal bowel contents, fluid, and air through the defect into the peritoneum (dashed arrow in a). The findings are indicative of bowel ischemia with distal ileal bowel wall perforation. There are multiple fluid-filled dilated loops of small bowel proximal to this region, suggestive of an ileus. There are associated thrombi within the proximal superior mesenteric artery (black arrow in a, arrow in b) and in the distal ileal branches (not shown). Mesenteric congestion and trace ascites are noted (* in a and c). However, no organized fluid collection is depicted. Note the enlarged nonenhancing left external iliac vein, compatible with deep vein thrombosis (black arrow in c). (d) Gray-scale (left) and power Doppler (right) US images of the left upper extremity, obtained owing to arm swelling, show a near-occlusive thrombus extending from the forearm to the upper humeral segment of the cephalic vein (Ceph V) (arrows in d).

Superior mesenteric artery thrombosis complicated by bowel ischemia and perforation in a 54-year-old man who presented to the emergency department with abdominal pain and was diagnosed with COVID-19. (a–c) Coronal (a) and axial (b, c) contrast-enhanced CT images of the abdomen and pelvis show mucosal hyperenhancement involving the small bowel (F in a, white arrow in c), with associated mild wall thickening. There is a long segment of bowel wall hypoenhancement in the distal ileum, with a large focal wall defect (solid white arrows in a). Note the extension of intraluminal bowel contents, fluid, and air through the defect into the peritoneum (dashed arrow in a). The findings are indicative of bowel ischemia with distal ileal bowel wall perforation. There are multiple fluid-filled dilated loops of small bowel proximal to this region, suggestive of an ileus. There are associated thrombi within the proximal superior mesenteric artery (black arrow in a, arrow in b) and in the distal ileal branches (not shown). Mesenteric congestion and trace ascites are noted (* in a and c). However, no organized fluid collection is depicted. Note the enlarged nonenhancing left external iliac vein, compatible with deep vein thrombosis (black arrow in c). (d) Gray-scale (left) and power Doppler (right) US images of the left upper extremity, obtained owing to arm swelling, show a near-occlusive thrombus extending from the forearm to the upper humeral segment of the cephalic vein (Ceph V) (arrows in d).