• Pablo Caro-Domínguez, María Navallas, Lucia Riaza-Martin, Maryam Ghadimi Mahani, Carlos F Ugas Charcape, Israel Valverde, Felice D'Arco, Seema Toso, Susan Cheng Shelmerdine, Joost van Schuppen, Aurelio Secinaro, Daniel Gräfe, Marisol Camacho, Olaf Neth, Hyun Woo Goo, and Christian J Kellenberger.
• Department of Radiology, Section of Pediatric Radiology, Hospital Universitario Virgen del Rocío, Avenida Manuel Siurot s/n., CP 41013, Seville, Spain. pablocaro82@hotmail.com.
• Pediatr Radiol. 2021 Aug 1; 51 (9): 1608-1620.

BackgroundA 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).ObjectiveTo describe typical imaging findings in children with multisystem inflammatory syndrome associated with COVID-19.Materials And MethodsDuring 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.ResultsWe 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.ConclusionChildren 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.© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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