Morgan Stanley Children's Hospital-New York Presbyterian Hospital, Columbia University Irving Medical Center, 3959 Broadway, W. 165th St., New York, NY, 10032, USA.
Pediatr Radiol. 2021 May;51(5):831-839. doi: 10.1007/s00247-020-04929-1. Epub 2021 Jan 12.
Coronavirus disease 2019 (COVID-19)-associated multisystem inflammatory syndrome in children (MIS-C) is an emerging syndrome that presents with a Kawasaki-like disease and multiorgan damage in children previously exposed to COVID-19.
To review the extracardiac radiologic findings of MIS-C in a group of children and young adults with a confirmed diagnosis of MIS-C.
In a retrospective study from April 1, 2020, to July 31, 2020, we reviewed the imaging studies of 47 children and adolescents diagnosed with MIS-C, 25 females (53%) and 22 males (47%), with an average age of 8.4 years (range 1.3-20 years). Forty-five had chest radiographs, 8 had abdominal radiographs, 13 had abdominal US or MRI, 2 had neck US, and 4 had brain MRI.
Thirty-seven of 45 (82%) patients with chest radiographs had findings, with pulmonary opacities being the most common finding (n=27, 60%), most often bilateral and diffuse, followed by peribronchial thickening (n=26, 58%). Eight patients had normal chest radiographs. On abdominal imaging, small-volume ascites was the most common finding (n=7, 54%). Other findings included right lower quadrant bowel wall thickening (n=3, 23%), gallbladder wall thickening (n=3, 23%), and cervical (n=2) or abdominal (n=2) lymphadenopathy. Of the four patients with brain MRI, one had bilateral parieto-occipital abnormalities and another papilledema.
The diagnosis of MIS-C and its distinction from other pathologies should be primarily based on clinical presentation and laboratory evidence of inflammation because imaging findings are nonspecific. However, it should be considered in the setting of bilateral diffuse pulmonary opacities, peribronchial thickening, right lower quadrant bowel inflammation or unexplained ascites in a child presenting with Kawasaki-like symptoms and a history of COVID-19 infection or recent COVID-19 exposure.
儿童 2019 冠状病毒病（COVID-19）相关的多系统炎症综合征（MIS-C）是一种新出现的综合征，表现为川崎病样疾病和先前接触过 COVID-19 的儿童多器官损伤。
回顾一组确诊为 MIS-C 的儿童和青少年的 MIS-C 心脏外放射学表现。
在 2020 年 4 月 1 日至 7 月 31 日的回顾性研究中，我们对 47 例诊断为 MIS-C 的儿童和青少年的影像学检查进行了回顾，其中 25 例为女性（53%），22 例为男性（47%），平均年龄为 8.4 岁（范围 1.3-20 岁）。45 例有胸部 X 线片，8 例有腹部 X 线片，13 例有腹部超声或 MRI，2 例有颈部超声，4 例有脑部 MRI。
45 例胸部 X 线片中，有 37 例（82%）有发现，最常见的发现是肺部混浊（n=27，60%），最常见的是双侧弥漫性，其次是支气管周围增厚（n=26，58%）。8 例胸部 X 线片正常。腹部影像学检查中，小量腹水是最常见的发现（n=7，54%）。其他发现包括右下象限肠壁增厚（n=3，23%）、胆囊壁增厚（n=3，23%）和颈（n=2）或腹部（n=2）淋巴结肿大。4 例脑部 MRI 中，1 例双侧顶枕叶异常，另 1 例视乳头水肿。
MIS-C 的诊断及其与其他病理学的鉴别应主要基于临床表现和炎症的实验室证据，因为影像学表现是非特异性的。然而，在出现川崎病样症状且有 COVID-19 感染或近期 COVID-19 接触史的儿童中，出现双侧弥漫性肺部混浊、支气管周围增厚、右下象限肠炎症或不明原因腹水时，应考虑到这种疾病。
