Imaging findings of multisystem inflammatory syndrome in children associated with COVID-19

Abstract

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. Supplementary Information The online version contains supplementary material available at 10.1007/s00247-021-05065-0.

Cardiovascular Magnetic Resonance for Patients With COVID-19

“…There have been several small studies to date evaluating CMR findings in patients with MIS-C, encompassing more than 130 patients. CMRs that were performed during the initial hospitalization or soon after discharge frequently identified myocardial edema on T 2 -weighted images, hyperemia and capillary leak (using T 1 -weighted images before and immediately after gadolinium administration), and LGE ( 72 , 73 , 74 , 75 , 76 , 77 ). However, in a few studies evaluating CMRs closer to 2 to 3 months after discharge, there were frequently no abnormalities ( 78 , 79 ).…”

The Multifaceted COVID-19: CT Aspects of Its Atypical Pulmonary and Abdominal Manifestations and Complications in Adults and Children. A Pictorial Review

“…Affected patients present a wide spectrum of clinical findings consisting of fever, headache, pain at the extremities, abdominal pain, vomiting and diarrhea, skin rash, conjunctivitis and peripheral oedema, with variable severity, with a significant percentage evolving to myocardial damage and cardiogenic, septic or toxic shock [37]. Laboratory data measured in affected children show a marked pro-inflammatory state [38].…”

“…The multisystem inflammatory syndrome in children (MIS-C), already mentioned above [35][36][37][38], reported in patients under 19 years old who have a history of exposure to SARS-CoV-2, has features that extensively involve the abdomen.…”

“…In regard to abdominal MIS-C, Caro-Dominguez et al [38] found that the most common abnormalities in US, CT and MRI were free fluid (71%) and terminal ileum wall thickening (57%) (Figure 16); other less common findings were hepatomegaly, right iliac fossa lymphadenopathy, gallbladder wall oedema, gallbladder sludge, periportal oedema, splenomegaly and haemorrhagic cystitis. According to Palabiyik et al [40] the most conventional US and CT findings were hepatomegaly and hepatosplenomegaly, followed by periportal and pericholecystic wall oedema, mesenteric lymph nodes in the right lower quadrant, free fluid in the abdomen, temporary invagination, echogenic kidneys and a case of pancreatic alterations.…”

Abdominal US in Pediatric Inflammatory Multisystem Syndrome Associated with SARS-CoV-2 (PIMS-TS)

“…There are limited reports to date regarding abdominal abnormalities as part of wider reviews of PIMS-TS 5,[10][11][12][13][14][15] , the largest study including 19 patients 10 . Bowel wall thickening, particularly terminal ileitis, and right iliac fossa inflammation with enlarged local mesenteric lymph nodes have been described 5,[10][11][12][13][14][15] I n p r e s s enlarged kidneys, and gallbladder fossa oedema.…”