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Published on: December 19, 2020
Chest radiograph features of multisystem inflammatory syndrome in children (MIS-C) compared to pediatric COVID-19
Bradley S Rostad1,2, Jay H Shah3,4, Christina A Rostad4,5,6
1Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1405 Clifton Rd. NE, Atlanta, GA, 30322, USA. brostad@emory.edu.
Insights
Multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 shows distinct radiographic features, including pleural effusions and lower lung zone opacities. These findings aid in differentiating MIS-C from COVID-19 in pediatric patients.
Area of Science:
- Pediatric Radiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Radiographic features of coronavirus disease 2019 (COVID-19) in children are known, but distinguishing features of multisystem inflammatory syndrome in children (MIS-C) remain unclear.
- MIS-C is a serious condition associated with COVID-19 that requires prompt diagnosis and treatment.
Purpose of the Study:
- To compare chest radiographic findings between children with MIS-C and those with COVID-19.
- To identify distinguishing imaging features of MIS-C.
Main Methods:
- Retrospective case series of 11 children with MIS-C and 16 with COVID-19.
- Review of chest radiographs by two radiologists, recording opacities, pleural effusions, and assigning severity scores.
- Statistical comparison of findings between MIS-C and COVID-19 groups.
Main Results:
- MIS-C patients frequently showed pleural effusions (82%), pulmonary consolidations (73%), and ground-glass opacities (91%).
- Compared to COVID-19, MIS-C was associated with significantly higher rates of pleural effusions (82% vs. 0%) and lower zone pulmonary opacifications (100% vs. 38%).
- Intra-abdominal inflammatory changes were noted in MIS-C patients with abdominal imaging.
Conclusions:
- Key radiographic distinctions for MIS-C include pleural effusions and lower zone pulmonary opacifications.
- Intra-abdominal inflammation is another characteristic finding in MIS-C.
- Identifying these radiographic features can improve MIS-C case definition, diagnosis, and treatment.
Background:
Although the radiographic features of coronavirus disease 2019 (COVID-19) in children have been described, the distinguishing features of multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 are not well characterized.
Objective:
We compared the chest radiographic findings of MIS-C with those of COVID-19 and described other distinguishing imaging features of MIS-C.
Materials And Methods:
We performed a retrospective case series review of children ages 0 to 18 years who were hospitalized at Children's Healthcare of Atlanta from March to May 2020 and who either met the Centers for Disease Control and Prevention (CDC) case definition for MIS-C (n=11) or who had symptomatic, laboratory-confirmed COVID-19 (n=16). Two radiologists reviewed the most severe chest radiographs for each patient. The type and distribution of pulmonary opacities and presence or absence of pleural effusions were recorded. The chest radiographs were categorized based on potential COVID-19 imaging findings as typical, indeterminate, atypical or negative. An imaging severity score was also assigned using a simplified version of the Radiographic Assessment of Lung Edema Score. Findings were statistically compared between patients with MIS-C and those with COVID-19. Additional imaging findings of MIS-C were also described.
Results:
Radiographic features of MIS-C included pleural effusions (82% [9/11]), pulmonary consolidations (73% [8/11]) and ground glass opacities (91% [10/11]). All of the lung opacities (100% [10/10]) were bilateral, and the majority of the pleural effusions (67% [6/9]) were bilateral. Compared to children with COVID-19, children with MIS-C were significantly more likely to develop pleural effusions on chest radiograph (82% [9/11] vs. 0% [0/0], P-value <0.01) and a lower zone predominance of pulmonary opacifications (100% [10/10] vs. 38% [5/13], P-value <0.01). Children with MIS-C who also had abdominal imaging had intra-abdominal inflammatory changes.
Conclusion:
Key chest radiographic features of MIS-C versus those of COVID-19 were pleural effusions and lower zone pulmonary opacifications as well as intra-abdominal inflammation. Elucidating the distinguishing radiographic features of MIS-C may help refine the case definition and expedite diagnosis and treatment.
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