Lung Ultrasound Patterns in Multisystem Inflammatory Syndrome in Children (MIS-C)-Characteristics and Prognostic Value

Abstract

Objective and design: Following COVID-19 infection, children can develop an hyperinflammatory state termed Multisystem Inflammatory Syndrome in Children (MIS-C). Lung Ultrasound (LUS) features of COVID-19 in children have been described, but data describing the LUS findings of MIS-C are limited. The aim of this retrospective observational study conducted between 1 March and 31 December 2020, at a tertiary pediatric hospital in Milano, is to describe LUS patterns in patients with MIS-C and to verify correlation with illness severity. The secondary objective is to evaluate concordance of LUS with Chest X-Ray (CXR). Methodology: Clinical and laboratory data were collected for all patients (age 0–18 years) admitted with MIS-C, as well as LUS and CXR patterns at admission. PICU admission, needed for respiratory support and inotrope administration, hospital, and PICU length of stay, were considered as outcomes and evaluated in the different LUS patterns. An agreement between LUS and CXR evaluation was assessed with Cohen’ k. Results: 24 children, who had a LUS examination upon admission, were enrolled. LUS pattern of subpleural consolidations < or > 1 cm with or without pleural effusion were associated with worse Left Ventricular Ejection Fraction at admission and need for inotropes. Subpleural consolidations < 1 cm were also associated with PICU length of stay. Agreement of CXR with LUS for consolidations and effusion was slight. Conclusion: LUS pattern of subpleural consolidations and consolidations with or without pleural effusion are predictors of disease severity; under this aspect, LUS can be used at admission to stratify risk of severe disease.

Lung Ultrasound in Adults and Children with COVID-19: From First Discoveries to Recent Advances

“…Achievements in pediatric practice include: Confirmation that LUS was able to detect peripheral lung consolidations in children, independent from disease severity [ 28 ]; The optimum correlation between LUS and CT findings, making LUS a safe option to assess children with COVID-19 and spare them from unnecessary radiation, at least in asymptomatic, mild and moderate disease [ 31 ]; Equal or better sensitivity than chest X-ray in detecting lung involvement during SARS-CoV-2 infection [ 32 ]; Usefulness in monitoring lung involvement during follow-up, shown in small studies and supported by previous experience from other viral pediatric respiratory infections [ 33 ]; Application in children with Multisystem Inflammatory Syndrome, one of the most severe post-infective complications of SARS-CoV-2 infection [ 34 , 35 ]. This finding is in agreement with previous pediatric studies that showed how lung ultrasound can detect cardiopulmonary interactions during acute systemic diseases [ 36 ].…”

“…LUS has also been successfully used in MIS-C. Specifically, a team from Rome described the first findings of vertical artifacts and simple pleural effusions, and a team from Northern Italy detected a cutoff of severity, predicting the need for intensive care admission, as well as inotropic or respiratory support [ 34 , 35 ]. Importantly, as MIS-C is a systemic condition, a wider application of point-of-care ultrasound that also assesses free abdominal fluids, the thickening of intestinal walls, and ventricular contraction would allow a better recognition and characterization of a child with suspected MIS-C, as described by two independent teams [ 37 , 38 ].…”

“…Application in children with Multisystem Inflammatory Syndrome, one of the most severe post-infective complications of SARS-CoV-2 infection [ 34 , 35 ]. This finding is in agreement with previous pediatric studies that showed how lung ultrasound can detect cardiopulmonary interactions during acute systemic diseases [ 36 ].…”

The lung ultrasound in children with SARS-COV 2 infection: a national multicenter prospective study

“…Our study confirms, on a larger populations, what initially suggested by smaller pediatric cohorts from Italy, Turkey and Spain, showing that children with LRTI during SARS-CoV-2 infection can have a cohort of LUS findings such as vertical artifacts and subpleural consolidations. [13][14][15][16][17][18][19][20][21][22] Authors from four different hospitals in Italy, in particular, found vertical artifacts and subpleural consolidations to be the most common findings, while pleural effusions were more rare and more described in children with MIS-C. However, cohorts were mostly limited to less than 50 patients.…”

“…8 However, while several adult studies on large cohorts have documented also a prognostic role of LUS in predicting hospitalizations and severe outcomes in infected adults, pediatric studies have provided less conclusive information, as they mostly included a small number of patients from single centers and without enough patients with moderate/severe disease. [9][10][11][12][13][14][15][16][17][18] For these reasons, we performed this multicenter national study in order to better characterize the clinical and prognostic role of LUS in children with Covid-19 assessed in the PED.…”