Abdominal Imaging Findings in Critically Ill Children With Multisystem Inflammatory Syndrome Associated With COVID-19

Morparia, Kavita; Park, Min Jung; Kalyanaraman, Meena; McQueen, Derrick; Bergel, Maria; Phatak, Tej

doi:10.1097/inf.0000000000002967

Cited by 30 publications

(31 citation statements)

References 9 publications

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“…Other findings on chest radiography in this population included pleural effusions (44–82%), pulmonary consolidations (6–73%), and radiographic findings of acute respiratory distress syndrome (13%) [ 50 , 51 ]. If obtained, abdominal imaging may demonstrate small volume ascites, bowel wall thickening, gallbladder wall thickening, or abdominal lymphadenopathy [ 52 , 53 ]. Echocardiograms are performed in the majority of patients with MIS-C due to both concern for coronary artery aneurysmal dilation as well as cardiac dysfunction due to myocarditis [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Multisystem inflammatory syndrome in children with COVID-19

Gottlieb

Bridwell

Ravera

et al. 2021

The American Journal of Emergency Medicine

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Background Multisystem inflammatory syndrome in children (MIS-C) is a dangerous pediatric complication of COVID-19. Objective The purpose of this review article is to provide a summary of the diagnosis and management of MIS-C with a focus on management in the acute care setting. Discussion MIS-C is an inflammatory syndrome which can affect nearly any organ system. The most common symptoms are fever and gastrointestinal symptoms, though neurologic and dermatologic findings are also well-described. The diagnosis includes a combination of clinical and laboratory testing. Patients with MIS-C will often have elevated inflammatory markers and may have an abnormal electrocardiogram or echocardiogram. Initial treatment involves resuscitation with careful assessment for cardiac versus vasodilatory shock using point-of-care ultrasound. Treatment should include intravenous immunoglobulin, anticoagulation, and consideration of corticosteroids. Interleukin-1 and/or interleukin-6 blockade may be considered for refractory cases. Aspirin is recommended if there is thrombocytosis or Kawasaki disease-like features on echocardiogram. Patients will generally require admission to an intensive care unit. Conclusion MIS-C is a condition associated with morbidity and mortality that is increasingly recognized as a potential complication in pediatric patients with COVID-19. It is important for emergency clinicians to know how to diagnose and treat this disorder.

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Section: Discussionmentioning

confidence: 99%

Multisystem inflammatory syndrome in children with COVID-19

Gottlieb

Bridwell

Ravera

et al. 2021

The American Journal of Emergency Medicine

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“…The most common abdominal imaging features were intestinal imaging findings (24%), including colorectal (5%) and small bowel thickening (12%), intestinal distension (18%), pneumatosis (1%), and intestinal perforation (1%)[ 79 ]. Morparia et al [ 80 ] reported abdominal imaging findings in critically ill children admitted with multisystem inflammatory syndrome associated with COVID-19. Hepatomegaly, nephromegaly, gallbladder wall edema, ascites, intestinal inflammation, and mesenteric lymphadenopathy were seen on sonography, while CT showed fluid-filled small bowel loops, mural thickening of the terminal ileum, diffuse lymphadenopathy, and moderate ascites.…”

Section: Abdominal Imaging Findings In Covid-19 Patientsmentioning

confidence: 99%

COVID-19 and the digestive system: A comprehensive review

Wang¹,

Yue²,

Cai³

et al. 2021

WJCC

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The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is spreading at an alarming rate, and it has created an unprecedented health emergency threatening tens of millions of people worldwide. Previous studies have indicated that SARS-CoV-2 ribonucleic acid could be detected in the feces of patients even after smear-negative respiratory samples. However, demonstration of confirmed fecal-oral transmission has been difficult. Clinical studies have shown an incidence rate of gastrointestinal (GI) symptoms ranging from 2% to 79.1% in patients with COVID-19. They may precede or accompany respiratory symptoms. The most common GI symptoms included nausea, diarrhea, and abdominal pain. In addition, some patients also had liver injury, pancreatic damage, and even acute mesenteric ischemia/thrombosis. Although the incidence rates reported in different centers were quite different, the digestive system was the clinical component of the COVID-19 section. Studies have shown that angiotensin-converting enzyme 2, the receptor of SARS-CoV-2, was not only expressed in the lungs, but also in the upper esophagus, small intestine, liver, and colon. The possible mechanism of GI symptoms in COVID-19 patients may include direct viral invasion into target cells, dysregulation of angiotensin-converting enzyme 2, immune-mediated tissue injury, and gut dysbiosis caused by microbiota. Additionally, numerous experiences, guidelines, recommendations, and position statements were published or released by different organizations and societies worldwide to optimize the management practice of outpatients, inpatients, and endoscopy in the era of COVID-19. In this review, based on our previous work and relevant literature, we mainly discuss potential fecal-oral transmission, GI manifestations, abdominal imaging findings, relevant pathophysiological mechanisms, and infection control and prevention measures in the time of COVID-19.

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“…Bowel wall thickening, lymphadenopathy, and mesenteric changes can occur anywhere in the abdomen but are most commonly located in the right lower quadrant (130) (Figure 32). A minority of patients has also demonstrated hepatosplenomegaly, splenic infarction, and increased renal echogenicity (114,116,131). Acute hepatitis, defined as elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels, was found in 43% of subjects in a single-center report, and may account for some of the abdominal ultrasound findings in MIS-C such as hepatomegaly, gallbladder wall thickening, and ascites (132).…”

Section: Abdominal Manifestations Of Mis-cmentioning

confidence: 99%

Review of COVID-19, part 1: Abdominal manifestations in adults and multisystem inflammatory syndrome in children

et al. 2021

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Abdominal Imaging Findings in Critically Ill Children With Multisystem Inflammatory Syndrome Associated With COVID-19

Cited by 30 publications

References 9 publications

Multisystem inflammatory syndrome in children with COVID-19

Multisystem inflammatory syndrome in children with COVID-19

COVID-19 and the digestive system: A comprehensive review

Review of COVID-19, part 1: Abdominal manifestations in adults and multisystem inflammatory syndrome in children

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