Department of Radiology, Section of Pediatric Radiology, Hospital Universitario Virgen del Rocío, Avenida Manuel Siurot s/n., CP 41013, Seville, Spain.
Department of Radiology, Section of Pediatric Radiology, Hospital Universitario 12 de Octubre, Madrid, Spain.
Pediatr Radiol. 2021 Aug;51(9):1608-1620. doi: 10.1007/s00247-021-05065-0. Epub 2021 Apr 27.
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).
To describe typical imaging findings in children with multisystem inflammatory syndrome associated with COVID-19.
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.
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.
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.
在接触严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）的儿童中，已认识到一种过度炎症性免疫介导的休克综合征，该病毒是导致 2019 年冠状病毒病（COVID-19）的原因。
描述与 COVID-19 相关的多系统炎症综合征儿童的典型影像学表现。
在 COVID-19 大流行的第一波期间，从多个中心收集了接受多系统炎症综合征治疗的儿童的影像学研究和临床数据。参与中心填写标准化病例模板，包括人口统计学、生化和影像学信息，并由儿科放射科医生和儿科医生进行审查。
我们纳入了 37 名儿童（21 名男孩；中位年龄 8.0 岁）。37 名儿童中 15 名（41%）PCR 检测 SARS-CoV-2 阳性，19 名儿童中 13 名（68%）免疫球蛋白阳性。常见的临床表现为发热（100%）、腹痛（68%）、皮疹（54%）、结膜炎（38%）和咳嗽（32%）。33 名（89%）儿童有心脏受累的实验室或影像学表现。37 名儿童中有 30 名（81%）需要入住重症监护病房，所有病例均康复良好。胸部 X 线片显示 54%有心增大，73%有肺静脉高压/淤血征象。最常见的胸部 CT 异常为磨玻璃影和间质性混浊（83%）、肺泡实变（58%）、胸腔积液（58%）和支气管壁增厚（42%）。超声心动图显示 51%的病例有心脏功能障碍，14%的病例有冠状动脉异常。心脏 MRI 显示 58%有心肌水肿，42%有心包积液，25%有左心室功能下降。20 名儿童因腹部症状行影像学检查，最常见的异常为游离液体（71%）和末端回肠壁增厚（57%）。12 名儿童行脑部影像学检查，有 2 例异常。
多系统炎症综合征儿童表现出肺部、心脏、腹部和脑部影像学表现，反映出多系统炎症性疾病。对这种疾病的影像学特征的认识对于早期诊断和治疗很重要。
