Multisystem inflammatory syndrome in children associated with SARS-CoV-2: extracardiac radiological findings

Abstract

Objective: Multisystem inflammatory syndrome in children (MIS-C) is seen as a serious delayed complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The aim of this study was to describe the most common imaging features of MIS-C associated with SARS-CoV-2. Methods: A retrospective review was made of the medical records and radiological imaging studies of 47 children (26 male, 21 female) in the age range of 25 months–15 years who were diagnosed with MIS-C between August 2020 and March 2021. Chest radiographs were available for all 47 patients, thorax ultrasound for 6, chest CT for 4, abdominal ultrasound for 42, abdomen CT for 9, neck ultrasound for 4, neck CT for 2, brain CT for 1, and brain MRI for 3. Results: The most common finding on chest radiographs was perihilar–peribronchial thickening (46%). The most common findings on abdominal ultrasonography were mesenteric inflammation (42%), and hepatosplenomegaly (38%, 28%). Lymphadenopathy was determined in four patients who underwent neck ultrasound, one of whom had deep neck infection on CT. One patient had restricted diffusion and T2 hyperintensity involving the corpus callosum splenium on brain MRI, and one patient had epididymitis related with MIS-C. Conclusion: Pulmonary manifestations are uncommon in MIS-C. In the abdominal imaging, mesenteric inflammation, hepatosplenomegaly, periportal edema, ascites and bowel wall thickening are the most common findings. Advances in knowledge: The imaging findings of MIS-C are non-specific and can mimic many other pathologies. Radiologists should be aware that these findings may indicate the correct diagnosis of MIS-C.

Retropharyngeal involvement in multisystem inflammatory syndrome in children: Case report and review of literature

“…11 Additional case reports and series demonstrated similar findings. 12–22 Our case and review of other reported cases strengthens the evidence of association between retropharyngeal inflammation and MIS-C. Absence of an association of retropharyngeal inflammation and MIS-C in the literature might have led to a relatively late diagnosis in some patients such as occurred with our patient.…”

Clinical and Laboratory Evaluations of Patients Diagnosed as Having Multisystem Inflammatory Syndrome Associated with Coronavirus Disease 2019 in Children: A Single Center Experience from Konya

“…A systemic review by Ucan et al including 47 patients MIS-C concluded that peribronchial cuffing, perihilar or diffuse infiltration, consolidation, atelectasis, cardiomegaly, and pleural effusion were the most common imaging findings on chest radiography. 15 Three main thoracic imaging findings were observed in pediatric patients with MIS-C in another review including 20 patients: heart failure, acute respiratory distress syndrome pattern, and pulmonary embolus. 16 In our study, eight patients were found to have pulmonary parenchymal infiltration on chest X-ray imaging, and pleural effusion was observed in seven patients.…”

COVID‐19 and pediatric pulmonology: Feedback from an expert center after the first year of the pandemic

“… 25 In PIMS, respiratory involvement is relatively rare or mild (mainly bronchial thickening), whereas extra‐respiratory radiological involvement is more common with cardiomegaly, mesenteric inflammation, hepatosplenomegaly, periportal edema, ascites, or thickening of the digestive walls. 30 , 53 …”

“…It is also important to note that pulmonary embolism must be considered in adolescents, especially in cases of thromboembolic risk factors or suggestive biological markers 25 . In PIMS, respiratory involvement is relatively rare or mild (mainly bronchial thickening), whereas extra‐respiratory radiological involvement is more common with cardiomegaly, mesenteric inflammation, hepatosplenomegaly, periportal edema, ascites, or thickening of the digestive walls 30,53 …”