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Imaging findings of multisystem inflammatory syndrome in children associated with COVID-19
Pablo Caro-Domínguez1, María Navallas2, Lucia Riaza-Martin3
1Department of Radiology, Section of Pediatric Radiology, Hospital Universitario Virgen del Rocío, Avenida Manuel Siurot s/n., CP 41013, Seville, Spain. pablocaro82@hotmail.com.
Insights
Multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 presents with diverse imaging findings affecting the heart, lungs, and abdomen. Early recognition of these imaging features is crucial for prompt diagnosis and effective treatment of this hyperinflammatory condition.
Area of Science:
- Pediatric Radiology
- Infectious Diseases
- Pediatric Cardiology
Background:
- A hyperinflammatory immune-mediated shock syndrome, multisystem inflammatory syndrome in children (MIS-C), has been identified in children exposed to SARS-CoV-2.
- This condition is associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for coronavirus disease 2019 (COVID-19).
Purpose of the Study:
- To delineate the characteristic imaging manifestations in pediatric patients diagnosed with MIS-C.
- This study aims to enhance the understanding of MIS-C's radiological features for improved clinical management.
Main Methods:
- Retrospective analysis of imaging studies and clinical data from 37 children treated for MIS-C during the initial COVID-19 pandemic wave.
- Data were collected from multiple centers using standardized templates and reviewed by pediatric radiologists and physicians.
Main Results:
- Cardiac involvement was prevalent (89%), with findings including cardiomegaly, impaired function, and coronary artery abnormalities on echocardiography and MRI.
- Pulmonary abnormalities on chest CT scans included ground-glass opacities, consolidation, and pleural effusion.
- Abdominal imaging revealed free fluid and terminal ileum wall thickening in a significant proportion of cases.
Conclusions:
- MIS-C in children presents with multi-organ imaging findings consistent with a systemic inflammatory process.
- Familiarity with these diverse imaging features is essential for the early and accurate diagnosis and management of MIS-C.
Background:
A hyperinflammatory immune-mediated shock syndrome has been recognised in children exposed to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19).
Objective:
To describe typical imaging findings in children with multisystem inflammatory syndrome associated with COVID-19.
Materials And Methods:
During the first wave of the COVID-19 pandemic, imaging studies and clinical data from children treated for multisystem inflammatory syndrome were collected from multiple centres. Standardised case templates including demographic, biochemical and imaging information were completed by participating centres and reviewed by paediatric radiologists and paediatricians.
Results:
We included 37 children (21 boys; median age 8.0 years). Polymerase chain reaction (PCR) testing was positive for SARS-CoV-2 in 15/37 (41%) children and immunoglobulins in 13/19 children (68%). Common clinical presentations were fever (100%), abdominal pain (68%), rash (54%), conjunctivitis (38%) and cough (32%). Thirty-three children (89%) showed laboratory or imaging findings of cardiac involvement. Thirty of the 37 children (81%) required admission to the intensive care unit, with good recovery in all cases. Chest radiographs demonstrated cardiomegaly in 54% and signs of pulmonary venous hypertension/congestion in 73%. The most common chest CT abnormalities were ground-glass and interstitial opacities (83%), airspace consolidation (58%), pleural effusion (58%) and bronchial wall thickening (42%). Echocardiography revealed impaired cardiac function in half of cases (51%) and coronary artery abnormalities in 14%. Cardiac MRI showed myocardial oedema in 58%, pericardial effusion in 42% and decreased left ventricular function in 25%. Twenty children required imaging for abdominal symptoms, the commonest abnormalities being free fluid (71%) and terminal ileum wall thickening (57%). Twelve children underwent brain imaging, showing abnormalities in two cases.
Conclusion:
Children with multisystem inflammatory syndrome showed pulmonary, cardiac, abdominal and brain imaging findings, reflecting the multisystem inflammatory disease. Awareness of the imaging features of this disease is important for early diagnosis and treatment.
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