In recent weeks, a multisystemic hyperinflammatory condition has emerged in children in association with previous exposure or infection to SARS-CoV-2. A new case series published in the journal Radiology examines the spectrum of imaging findings in children with the post-COVID-19 inflammatory condition known in the US as Multisystemic Inflammatory Syndrome in Children (MIS-C).
The set of findings includes inflammation of the airways and rapid development of pulmonary edema, coronary artery aneurysms, and extensive intra-abdominal inflammatory changes.
In April 2020, Evelina London Children’s Hospital in London, UK experienced a sudden increase in children with a multi-system hyperinflammatory syndrome.
The children had a variety of symptoms, including fever, headaches, abdominal pain, skin rash, and conjunctivitis. The clinical features and laboratory findings shared some similarities with those of Kawasaki disease, which causes inflammation of the walls of the blood vessels, Kawasaki disease shock syndrome, or toxic shock syndrome, although atypical and more severe.
“Our hospital saw an unprecedented group of children presenting with MIS-C, a new hyperinflammatory syndrome in children related to the current COVID-19 pandemic, the recognition of which led to a national alert,” said study lead author Shema Hameed . , MBBS, pediatric radiologist consultant at Evelina London Children’s Hospital.
For the study, the researchers conducted a retrospective review of the clinical, laboratory, and imaging findings of the first 35 children younger than 17 years admitted to the pediatric hospital that met the case definition for MIS-C. The boys were admitted from April 14 to May 9, 2020 and included 27 boys and eight girls, with an average age of 11 years.
The most common clinical presentation was fever, found in 33 (94 percent) of children, gastrointestinal symptoms including abdominal pain, vomiting, and diarrhea in 30 (86 percent) of children, rash (13 or 37 percent). cent) and conjunctivitis. (9 or 26 percent).
Twenty-one children (60 percent) were in shock. The clinical status was severe enough to warrant management in the pediatric intensive care unit in 24 of 35 children (69 percent), of whom 7 (20 percent) required mechanical ventilation and 20 (57 percent) support. inotropic.
Two children required extracorporeal membrane oxygenation (ECMO) due to severe myocardial dysfunction. Laboratory tests revealed that all of the children had abnormal white blood cell counts.
The study identified a pattern of imaging findings on post-COVID-19 MIS-C, including inflammation of the airways, rapidly progressive pulmonary edema, aneurysms of the coronary arteries, and extensive abdominal inflammatory changes within the right iliac fossa.
All 35 children underwent chest radiography due to fever, sepsis, or features of multisystemic inflammation. Nineteen x-rays were abnormal, the most common finding being that of thickening of the bronchial wall.
The predominant findings on chest CT were basal consolidation, or part of the fluid-filled lung, and lung collapse with pleural effusions, or fluid accumulation in the outer membranes of the lungs.
Abdominal ultrasound findings included inflammatory changes within the right iliac fossa, with mesenteric fat strands, lymphadenopathy and thickening of the intestinal wall, as well as free fluid in the pelvis.
“As pediatric radiologists, we were interested in the emerging pattern of imaging findings that we observed in these children. Our intention is to bring these findings to the attention of the general radiology community, “said Dr. Hameed.
The authors advise that future studies should include a larger group of patients, ideally using multicenter databases to assess radiological findings along with the complex clinical course of these young patients.
(This story has been published from a cable agency feed without modification in the text. Only the headline has been changed).
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