Background Atypical manifestations of COVID-19 are being encountered as the pandemic unfolds, leading to non-chest CT scans that may uncover unsuspected pulmonary disease. Purpose To investigate patients with primary non-respiratory symptoms who underwent abdomen/pelvis or cervical spine/neck CT with unsuspected findings highly suspicious for pulmonary COVID-19. Materials and Methods This retrospective study from March 10, 2020 to April 6, 2020 involved three institutions, two in a region considered a hotspot (area of high prevalence) for COVID-19. Patients without known COVID-19 were included who presented to the emergency room (ER) with primary non-respiratory [gastrointestinal (GI) or neurological] symptoms, had lung parenchymal findings suspicious for COVID-19 on a non-chest CT but no concurrent chest CT and had COVID-19 testing in the ER. Group 1 patients had RT PCR obtained pre-CT read (COVID-19 suspected on presentation); Group 2 had RT PCR obtained post-CT read (COVID-19 not suspected). Presentation and imaging findings were compared and outcomes were evaluated. Descriptive statistics and Fisher exact tests were used for analysis. Results Group 1 comprised 62 patients [31 men, 31 women, mean age 67(SD ±17) years] and group 2 comprised 57 patients [28 men, 29 women, mean age 63(SD ± 16) years). Cough and fever were more common in group 1 (37/62, 60%, 29/62, 47%) than group 2 (9/57, 16%, 12/57, 21%) respectively, with no significant difference in the remaining symptoms. There were 101 abdomen/pelvis and 18 cervical spine/neck CTs. In Group 1, non-chest CT findings provided the initial evidence of COVID-19 related pneumonia in 32/62 (52%); for Group 2, it was 44/57 (77%). Overall, the most common CT findings were ground glass opacity (114/119, 96%) and consolidation (47/119,40%). 29/119 (24%) patients required major interventions (vasopressor medication or intubation) and 27/119 (23%) died. Patients who underwent cervical spine/neck CT had worse outcomes than those with abdominal/pelvic CT (p =0.01). Conclusion In a substantial percentage of patients with primary non-respiratory symptoms who underwent non-chest CT, the CT provided the first evidence of COVID-19 related pneumonia.

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