The novel coronavirus pandemic (COVID–19) started in December 2019 in Wuhan (Hubei, China) and spread rapidly, with early detection and isolation as essential measures against this agent [1].
Retrospective studies from Wuhan, China indicated that the most frequent clinical manifestations are fever, cough and dyspnea. Less common symptoms are headache, hemoptysis and gastrointestinal involvement. At the beginning of the pandemic, abdominal symptoms were not usually present, including diarrhea (2%–10.1%), nausea and vomiting (1–3.6%) [4].
However, we observed that, in some patients, respiratory symptoms may be absent and they may present only abdominal manifestations as an initial finding, creating a diagnostic challenge. In this context, imaging exams, especially computed tomography, are important auxiliary tools, especially in the context of emergency care to reach the diagnosis.
Abdominal complaints are frequently assessed by imaging studies and most of the protocols include images of the pulmonary bases, a frequent site of pulmonary involvement in COVID–19. The most frequent findings in the pulmonary parenchyma include ground-glass opacities, consolidation and crazy-paving with multifocal, bilateral distribution, predominantly peripheral and posterior, especially in the lower lobes [3,5]
In conclusion, it is estimated that some patients with COVID–19 infection do not show respiratory symptoms, which makes a diagnostic suspicion more difficult. It is known that abdominal symptoms are not uncommon in patients with COVID–19 and can appear early [4,6]. Thus, in the current context of a pandemic, it is important that radiologists maintain a high degree of suspicion, even in studies not directed at the chest in order to allow an early diagnosis of COVID–19 infection. Such findings also have an impact on the isolation measures that need to be put in order to reduce the transmission of the disease.