First diagnosis of multisystem inflammatory syndrome in children (MIS-C): an analysis of PoCUS findings in the ED

Abstract

Children with multisystem inflammatory syndrome (MIS-C) tend to develop a clinical condition of fluid overload due both to contractile cardiac pump deficit and to endotheliitis with subsequent capillary leak syndrome. In this context, the ability of point-of-care ultrasound (PoCUS) to simultaneously explore multiple systems and detect polyserositis could promote adequate therapeutic management of fluid balance. We describe the PoCUS findings in a case-series of MIS-C patients admitted to the Emergency Department. At admission 10/11 patients showed satisfactory clinical condition without signs and symptoms suggestive for cardiovascular impairment/shock, but PoCUS showed pathological findings in 11/11 (100%). In particular, according to Rapid Ultrasound in SHock (RUSH) protocol, cardiac hypokinesis was detected in 5/11 (45%) and inferior vena cava dilatation in 3/11 (27%). Peritoneal fluid was reported in 6/11 cases (54%). Lung ultrasound (LUS) evaluation revealed an interstitial syndrome in 11/11 (100%), mainly localized in posterior basal lung segments. We suggest PoCUS as a useful tool in the first evaluation of children with suspected MIS-C for the initial therapeutic management and the following monitoring of possible cardiovascular deterioration.

Lung Ultrasound in Adults and Children with COVID-19: From First Discoveries to Recent Advances

“…Specifically, a team from Rome described the first findings of vertical artifacts and simple pleural effusions, and a team from Northern Italy detected a cutoff of severity, predicting the need for intensive care admission, as well as inotropic or respiratory support [ 34 , 35 ]. Importantly, as MIS-C is a systemic condition, a wider application of point-of-care ultrasound that also assesses free abdominal fluids, the thickening of intestinal walls, and ventricular contraction would allow a better recognition and characterization of a child with suspected MIS-C, as described by two independent teams [ 37 , 38 ].…”

Fluid Accumulation Dilemma in the Critically Ill Children, A Retrospective Study

“…Therefore, it may be beneficial to support the cumulative fluid load and weight-based fluid load calculations with objective criteria such as examination of cardiac, lung, and vascular flow models by bedside ultrasound. [21,22] In our study, we observed that RRT was not applied to any patient since urine output did not decrease even though the cumulative fluid loads were high. There are clearer recommendations for RRT in patients with AKI in the literature.…”

Unusual pediatric pleural effusions: A case series and a review of the literature

“…Some authors have reported rare pulmonary involvement in MIS-C, unlike COVID-19, but other authors have suggested how bilateral B-lines and pleural effusions may help PED physicians to recognize systemic inflammatory disease, given the absence of effusion in acute SARS-CoV-2 infection [11]. Our case 3 revealed how a bilateral pleural effusion combined with a pericardial effusion can suggest an inflammatory etiology and therefore lead to targeted therapy; moreover, POCUS has the indisputable advantages to explore at first sight the multi-organ involvement typical of MIS-C and the possibility of being repeated to verify the effects of the therapeutic management [12] While there is no doubt about the superiority of POCUS over physical exam and chest radiography to detect pleural fluid, there is no agreement on its usefulness for the differential diagnosis between transudate and exudates, where POCUS shows its main limit [2]. A transudate pleural effusion is always anechoic but exudates, both malignant and non-malignant, may be anechoic or echogenic, with or without fibrinous septations; therefore, while an echogenic effusion may suggest an exudate, an anechoic pleural effusion does not provide diagnostic evidence of a transudate and should not remove concern that the effusion may be exudative [13,14].…”