Review of COVID-19, part 2: Musculoskeletal and neuroimaging manifestations including vascular involvement of the aorta and extremities

Imaging of lower extremity infections: predisposing conditions, atypical infections, mimics, and differentiating features

Imaging evaluation for lower extremity infections can be complicated, especially in the setting of underlying conditions and with atypical infections. Predisposing conditions are discussed, including diabetes mellitus, peripheral arterial disease, neuropathic arthropathy, and intravenous drug abuse, as well as differentiating features of infectious versus non-infectious disease. Atypical infections such as viral, mycobacterial, fungal, and parasitic infections and their imaging features are also reviewed. Potential mimics of lower extremity infection including chronic nonbacterial osteomyelitis, foreign body granuloma, gout, inflammatory arthropathies, lymphedema, and Morel-Lavallée lesions, and their differentiating features are also explored.

The Impact of COVID-19 Pandemic on Clinical Findings in Medical Imaging Exams: An Observational Study in a Nationwide Israeli Health Organization (Preprint)

BACKGROUND

The outbreak of the COVID-19 pandemic had a major effect on consumption of healthcare services. Changes in the use of routine diagnostic exams, increased incidences of post-acute COVID-19 syndrome (PCS), and other pandemic-related factors, may have influenced detected clinical conditions.

OBJECTIVE

The study aimed to analyze the impact of COVID-19 on the use of outpatient medical imaging services and clinical findings therein, specifically focusing on the time period after the launch of the Israeli COVID-19 vaccination campaign. In addition, the study tested whether the observed gains in abnormal findings may be linked to PCS or COVID-19 vaccination.

METHODS

Our dataset included 572,480 ambulatory medical imaging patients in a national health organization, from January 1, 2019 to August 31, 2021. We compared different measures of medical imaging utilization and clinical findings therein, before and after the surge of the pandemic, to identify significant changes. We also inspected the changes in the rate of abnormal findings during the pandemic after adjusting for changes in medical imaging utilization. Finally, for imaging classes that showed increased rates of abnormal findings, we measured the causal associations between COVID-19 infection, hospitalization (indicative of COVID-19 complications), and vaccination and future risk for abnormal finding. To allow adjustment for a multitude of confounding factors, we used causal inference methodologies.

RESULTS

After the initial drop in the utilization of routine medical imaging due to the first COVID-19 wave, the number of these exams has increased, but with lower proportions of older patients, patients with comorbidities, women, and vaccine-hesitant patients. Furthermore, we observed significant gains in the rate of abnormal findings, specifically in musculoskeletal magnetic resonance (MR-MSK) and brain computed tomography (CT-brain) exams. These results also persisted after adjusting for the changes in medical imaging utilization. Demonstrated causal associations included: COVID-19 infection increasing the risk for an abnormal finding in a CT-brain exams (odds ratio [OR] of 1.4, with 95% confidence interval [CI] 1.1 to 1.7); and COVID-19-related hospitalization increasing the risk for abnormal findings in an MR-MSK exam (OR 3.1, 95% CI 1.9 to 5.3).

CONCLUSIONS

COVID-19 impacted the use of ambulatory imaging exams, with greater avoidance among patients at higher risk for COVID-19 complications: older patients, patients with comorbidities, and non-vaccinated patients. Causal analysis results imply that PCS may have contributed to the observed gains in abnormal findings in MR-MSK and CT-brain exams, respectively.

CLINICALTRIAL

What Do We Need to Know About Musculoskeletal Manifestations of COVID-19?: A Systematic Review

»

COVID-19 is a disease that is challenging science, health-care systems, and humanity. An astonishingly wide spectrum of manifestations of multi-organ damage, including musculoskeletal, can be associated with SARS-CoV-2.

»

In the acute phase of COVID-19, fatigue, myalgia, and arthralgia are the most common musculoskeletal symptoms.

»

Post-COVID-19 syndrome is a group of signs and symptoms that are present for >12 weeks. The associated musculoskeletal manifestations are fatigue, arthralgia, myalgia, new-onset back pain, muscle weakness, and poor physical performance.

»

Data on COVID-19 complications are growing due to large absolute numbers of cases and survivors in these 2 years of the pandemic. Additional musculoskeletal manifestations encountered are falls by the elderly, increased mortality after hip fracture, reduced bone mineral density and osteoporosis, acute sarcopenia, rhabdomyolysis, Guillain-Barré syndrome, muscle denervation atrophy, fibromyalgia, rheumatological disease triggering, septic arthritis, adhesive capsulitis, myositis, critical illness myopathy, onset of latent muscular dystrophy, osteonecrosis, soft-tissue abscess, urticarial vasculitis with musculoskeletal manifestations, and necrotizing autoimmune myositis.

»

A wide range of signs and symptoms involving the musculoskeletal system that affect quality of life and can result in a decrease in disability-adjusted life years. This powerful and unpredictable disease highlights the importance of multimodality imaging, continuing education, and multidisciplinary team care to support preventive measures, diagnosis, and treatment.

The Musculoskeletal Involvement After Mild to Moderate COVID-19 Infection

COVID-19, a disease caused by the novel coronavirus SARS-CoV-2, has been drastically affecting the daily lives of millions of people. COVID-19 is described as a multiorgan disease that affects not only the respiratory tract of infected individuals, but it has considerable effects on the musculoskeletal system, causing excessive fatigue, myalgia, arthralgia, muscle weakness and skeletal muscle damage. These symptoms can persist for months, decreasing the quality of life of numerous individuals. Curiously, most studies in the scientific literature focus on patients who were hospitalized due to SARS-CoV-2 infection and little is known about the mechanism of action of COVID-19 on skeletal muscles, especially of individuals who had the mild to moderate forms of the disease (non-hospitalized patients). In this review, we focus on the current knowledge about the musculoskeletal system in COVID-19, highlighting the lack of researches investigating the mild to moderate cases of infection and pointing out why it is essential to care for these patients. Also, we will comment about the need of more experimental data to assess the musculoskeletal manifestations on COVID-19-positive individuals.