Hospital alerts radiologists of new post-COVID-19 disease appearing in children

A new and concerning hyperinflammatory condition was recently spotted in children infected or exposed to SARS-CoV-2. Researchers detailed the imaging findings from these patients Thursday, hoping to make radiologists aware of the novel inflammatory syndrome.

Evelina London Children's Hospital in London recently experienced a surge of children with Multisystem Inflammatory Syndrome in Children or MIS-C, which involves airway inflammation and rapidly developing pulmonary edema and coronary artery aneurysms, among others changes. The group described the x-ray, CT and ultrasound findings in these children June 26 in Radiology.

"Our hospital saw an unprecedented cluster 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," lead author, Shema Hameed, MBBS, a consultant pediatric radiologist at the London hospital, said in a statement.

The clinicians retrospectively reviewed the clinical, lab and imaging findings of the first 35 patients under age 17 who met the criteria for MIS-C at their hospital. That included 27 boys and nine girls, with a median age of 11 years old.

Most commonly, the children checked in with a fever (94%), followed by gastrointestinal symptoms such as abdominal pain, vomiting and diarrhea (86%), rash (37%), and conjunctivitis (26%). Twenty-four of the patients were sent to the intensive care unit, seven of whom required ventilation.

The clinical features and lab results of MIS-C were similar to those seen in Kawasaki disease, the authors noted, which causes inflammation in the blood vessels’ walls.

In the current group of patients, imaging patterns revealed airway inflammation, rapidly progressive pulmonary edema, coronary artery aneurysms and extensive abdominal inflammatory changes within the right “iliac fossa.” Each child also came back with abnormal white blood cell counts.

Among the 35 who underwent a chest x-ray, 19 came back abnormal, most commonly showing bronchial wall thickening. On chest CT, most showed basal consolidation, or part of the lung filling with fluid. Collapsed lung with pleural effusions or buildup of fluid in the outer membranes of the lungs was also prevalent.

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, the authors wrote.

Further testing performed across a larger number of patients from multiple institutions is required, Hameed noted.

“As pediatric radiologists, we were interested in the emerging pattern of imaging findings that we observed in these children," Hameed added. "Our intention is to bring these findings to the attention of the wider radiological community."