Fig 1.
Procedure for research subject selection of cohort 1.
All patients positively tested for SARS Coronavirus RNA were screened for elevated liver enzymes. ALT, alanine aminotransferase; UNL, upper normal limit.
Fig 2.
Procedure for research subject selection of cohort 2.
The local radiology information system (RIS) was screened for abdominal sonographies at the intensive care unit for diagnostic workup of elevated liver enzymes. ALT, alanine aminotransferase; UNL, upper normal limit.
Table 1.
Summary of patient characteristics and laboratory results.
Fig 3.
(A) Pronounced thickening of the gallbladder wall, filled with sludge. This represents a typical sonographic finding in our study. (B) Indicated starry sky appearance of the liver with decreased echogenicity of liver parenchyma and pronounced bile ducts.
Fig 4.
Vascular complications in the liver.
In this patient with severe deterioration of liver function only residual arterial Doppler signal could be found in the porta hepatis. The patient died the same day.
Fig 5.
Vascular complications in the liver.
In two cases, inhomogeneous echogenicity of the liver parenchyma was found. Autopsy confirmed the suspected diagnosis of liver necrosis in this case.
Table 2.
Summary of ultrasound findings matched for cohorts 1 and 2.
Fig 6.
Histologic specimen of the liver.
Progressive centroacinar hypoxic damage (right) and conspicuous cholestasis in adjacent portal field. HE x200.
Table 3.
Summary of histologic findings with corresponding ultrasound findings.
Fig 7.
Patient of group 3 with persistent severe elevation of liver enzymes and GGT.
(A) Whereas sonography was normal, (B) MRCP revealed irregular bile ducts leading to the suspected diagnosis of secondary sclerosing cholangitis (SSC). (C, D): Histologic specimen of the same patient showing signs of vascular- (C) and bile duct-associated (D) inflammation, which is typical for misguided immunoreaction like in rejection reaction. The diagnosis of SSC could not be confirmed.