Impact of COVID-19 on CT-diagnosed acute appendicitis and diverticulitis: was there collateral damage?

AIM: To evaluate the change in diagnosis rates, disease severity at presentation, and treatment of acute appendicitis and diverticulitis during the COVID-19 shutdown. MATERIALS AND METHODS: Following institutional review board approval, 6,002 CT examinations performed at five hospitals for suspected acute appendicitis and/or diverticulitis over the 12 weeks preceding and following the shutdown were reviewed retrospectively. Semi-automated language analysis (SALA) of the report classified 3,676 CT examinations as negative. Images of the remaining 2,326 CT examinations were reviewed manually and classified as positive or negative. Positive cases were graded as non-perforated; perforated, contained; and perforated, free. RESULTS: CT examinations performed for suspected appendicitis and/or diverticulitis decreased from 3,558 to 2,200 following the shutdown. The rates of positive diagnoses before and after shutdown were 4% (144) and 4% (100) for appendicitis and 8% (284) and 7% (159) for diverticulitis (p>0.2 for both). For positive CT examinations, the rates of perforation, hospitalisation, surgery, and catheter drainage changed by -2%, -3%, -2%, and -3% for appendicitis (n=244, p>0.3 for all) and +6% (p=0.2) +9% (p=0.06), +4% (p=0.01) and +1% (p=0.6) for diverticulitis (n=443). CONCLUSION: CT examinations performed for suspected appendicitis or diverticulitis declined after the shutdown, likely reflecting patients leaving urban centres and altered triage of non-COVID-19 patients. The diagnosis rates, disease severity at presentation, and treatment approach otherwise remained mostly unchanged.

Retinal findings on OCT in a convalescent COVID-19 Patient Cohort

Purpose : Possible retinal involvement by COVID-19 has been a topic of recent debate. We performed a prospective study to determine whether retinal abnormalities can be identified on OCT in convalescent fully recovered patients following COVID-19 infection. Methods : This is a prospective, case-controlled study that recruited COVID19 patients who were admitted to the United Christian Hospital Hong Kong, China. At 2 months postrecovery, patients' visual acuity, refraction were measured. Spectral-domain OCT of the macula and retinal nerve fiber layer and enhanced depth imaging were performed. Agematched and refraction-matched healthy individuals that were not infected with COVID-19 were enrolled as controls. Qualitative and quantitative assessment of retinal abnormalities on structural OCT and retinal and choroidal layer thickness are the main outcomes. Principal component analysis (PCA), partial least squares discriminant analysis (PLS-DA), and volcano plot were applied to data analysis. Results : 20 subjects (40 eyes) with COVID-19 and 25 (50 eyes) age-matched asymptomatic healthy controls were enrolled. Structural OCT abnormalities could be observed in 24% of control eyes and in 25% of COVID-19 subjects. No differences were observed between the post-COVID-19 cohort and the healthy controls for any qualitative retinal abnormalities. PCA and the PLS-DA demonstrated a substantial overlap in the 95% confidence region between the two groups. Further analysis showed there are no significant differences in any quantitative feature including retinal volume, choroidal thickness, retinal layer thicknesses in various macular regions, and peripapillary nerve fiber layer thickness with the exception of the retinal outer temporal quadrant region. However, the impact this quantitative feature has on the dataset is miniscule given that its fold change impact was below 1.0. Conclusions : Following full recovery from symptomatic COVID 19 infection no significant abnormalities were evident on structural OCT. Although long-term damage to the retina appears to be uncommon after COVID-19 infection, this study provides valuable insight into the recovery process after COVID-19 and provides potential retinal features that should be considered in the larger population to separate between these groups.

Abstract No. 156 Incidence and outcomes of cholecystostomy tubes in COVID-19 patients

Purpose: Our goal was to review the incidence and outcomes of cholecystostomy tube placement during the COVID pandemic as compared to matched controls. Materials and Methods: Monthly interventional radiology (IR) case volume was evaluated during the COVID pandemic through July 30, 2020, and was compared to monthly IR case volume during the same time period in 2019. A retrospective review of 40 patients who received percutaneous cholecystostomy tubes between March 2020 and July 2020 (first COVID pandemic peak in Boston, MA) was compared in a propensity matched controlled study. 14 COVID-positive patients were matched to 26 control patients who received a cholecystostomy tube. Outcomes such as positive cholecystostomy tube microbiology, pre-procedural ICU status, and death were evaluated. Results: During March to July 30, 2020, cholecystostomy tube placement constituted 0.43%, average 6 (range 2-10) cases/month of 1389 (range 672-1777) cases/month, whereas in the year prior for the same period it constituted 0.28%, 5.8 (range 4-8) cases/month of 2103 (range 1998-2146) cases/month. We find the average age was 66.5 ± 17.7 (SD) for COVID-negative and 66.0 ± 17.7 (SD) years for COVID-positive patients. Pre-procedure 19% (5/26) of COVID-negative patients and 50% (7/14) of COVID-positive patients were intubated at the time of placement, P = 0.04. Post-procedure, 54% (14/26) of COVID-negative patients and 50% (7/14) of COVID-positive patients had positive cholecystostomy tube fluid microbiology cultures, P = 0.82. 38% (10/26) of COVID-negative patients and 57% (8/14) of COVID-positive patients were in the ICU at the time of placement, P = 0.26. 23% (6/26) of the COVID-negative patients and 36% (5/14) of COVID-positive patients died post-procedure, P = 0.41. 15.4% (4/26) COVID-negative and 14.3% (2/14) of COVID-positive patients had any complications reported, P = 0.93. Conclusions: During the COVID-19 pandemic, we observed a relative increase in the number of cholecystostomy tube referrals despite a drop in total IR case volume. There were no significant differences in post-procedure long-term outcomes and the microbial culture results in our matched control review. Our study suggests that this perceived increase in cholecystostomy tube placements is not secondary to unique COVID pathophysiology, but rather a persistent incidence of acalculous cholecystitis in the setting of chronic ICU stays seen during the COVID pandemic. With the continuation of the pandemic, cholecystostomy tube placement incidence may increase with continued COVID patient care and chronic ICU stays for these patients.