New Study Focuses on Post COVID-19 Emerging Disease in Children

A multisystem hyperinflammatory condition has emerged in children associated with prior exposure or infection to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), according to a press release from the Radiological Society of North America.

The new case series, published in the journal Radiology, examines the spectrum of imaging findings in children with the post-coronavirus disease 2019 (COVID-19) inflammatory condition, known as the multisystem inflammatory syndrome in children (MIS-C).

The findings include airway inflammation and rapid development of pulmonary edema, coronary artery aneurysms, and extensive intra-abdominal inflammatory changes, according to the study authors.

Researchers performed a retrospective review of clinical, laboratory, and imaging findings of the first 35 children under 17 years of age who were admitted to the pediatric hospital and who met the case definition of MIS-C. The children were admitted from April 14, 2020, to May 9, 2020, and included 27 boys and 8 girls with a median age of 11 years.

The most common clinical presentations found in the children were fever (94%), gastrointestinal symptoms including abdominal pain, vomiting, and diarrhea (86%), rash (37%), and conjunctivitis (26%), according to the study authors.

Although 60% of the children were in shock, the clinical status was severe enough to warrant management in the pediatric intensive care unit in 69% of children, with 20% requiring mechanical ventilation and 57% requiring inotropic support.

Lab tests revealed that all of the children had abnormal white blood cell counts. Further, 2 children required extracorporeal membrane oxygenation due to severe myocardial dysfunction.

The study identified a pattern of imaging findings in post COVID-19 MIS-C, including airway inflammation, rapidly progressive pulmonary edema, coronary artery aneurysms, and extensive abdominal inflammatory changes within the right iliac fossa.

According to the study authors, all 35 children underwent chest X-ray due to fever, sepsis, or features of multisystem inflammation. The most common finding in the 19 abnormal X-rays analyzed were bronchial wall thickening.

The main findings on the chest were basal consolidation, or part of the lung filling with fluid and collapsed lung with pleural effusions. Abdominal ultrasound findings included inflammatory changes within the right iliac fossa, with mesenteric fat stranding, lymphadenopathy, and bowel wall thickening, 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,” said lead study author Shema Hameed, MBBS, in a press release. “Our intention is to bring these findings to the attention of the wider radiological community.”

REFERENCE

New study looks at post-COVID-19 emerging disease in children. Radiological Society of North America. https://press.rsna.org/timssnet/media/pressreleases/14_pr_target.cfm?ID=2194. Published June 24, 2020. Accessed June 29, 2020.