Pablo Caro-Domínguez1, María Navallas2, Lucia Riaza-Martin3, Maryam Ghadimi Mahani4, Carlos F Ugas Charcape5, Israel Valverde6, Felice D'Arco7, Seema Toso8, Susan Cheng Shelmerdine9,10,11, Joost van Schuppen12, Aurelio Secinaro13, Daniel Gräfe14, Marisol Camacho15, Olaf Neth15, Hyun Woo Goo16, Christian J Kellenberger17. 1. Department of Radiology, Section of Pediatric Radiology, Hospital Universitario Virgen del Rocío, Avenida Manuel Siurot s/n., CP 41013, Seville, Spain. pablocaro82@hotmail.com. 2. Department of Radiology, Section of Pediatric Radiology, Hospital Universitario 12 de Octubre, Madrid, Spain. 3. Department of Radiology, Section of Pediatric Radiology, Hospital Universitario Vall d'Hebron, Barcelona, Spain. 4. Department of Radiology, Section of Pediatric Radiology, University of Michigan, Ann Arbor, MI, USA. 5. Department of Imaging, Instituto Nacional de Salud del Niño San Borja, Lima, Peru. 6. Pediatric Cardiology and Cardiovascular Pathology Unit, Virgen del Rocio University Hospital, Institute of Biomedicine of Seville (IBIS), University of Seville, Seville, Spain. 7. Department of Radiology, Neuroradiology Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK. 8. Department of Diagnostic Imaging, Section of Pediatric Radiology, Geneva Children's Hospitals, Geneva, Switzerland. 9. Department of Clinical Radiology, Great Ormond Street Hospital NHS Foundation Trust, London, UK. 10. UCL Great Ormond Street Institute of Child Health, London, UK. 11. NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK. 12. Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. 13. Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy. 14. Department of Pediatric Radiology, University Hospital of Leipzig, Leipzig, Germany. 15. Paediatric Infectious Diseases, Rheumatology and Immunology Unit, Hospital Universitario Virgen del Rocío, Institute of Biomedicine of Seville, Seville, Spain. 16. Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. 17. Diagnostic Imaging, University Children's Hospital Zurich, Zurich, Switzerland.
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.
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.
Authors: Ilko L Maier; Marielle Heide; Sabine Hofer; Peter Dechent; Ingo Fiss; Christian von der Brelie; Veit Rohde; Jens Frahm; Mathias Bähr; Jan Liman Journal: Clin Neuroradiol Date: 2022-04-07 Impact factor: 3.649
Authors: Riwa Meshaka; Fern C Whittam; Myriam Guessoum; Saigeet Eleti; Susan C Shelmerdine; Owen J Arthurs; Kieran McHugh; Melanie P Hiorns; Paul D Humphries; Alistair D Calder; Marina J Easty; Edward P Gaynor; Tom Watson Journal: Radiology Date: 2021-12-07 Impact factor: 11.105