Point-of-Care Ultrasound Findings in Multisystem Inflammatory Syndrome in Children

Abstract

Objectives: Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 is a novel pediatric condition with significant morbidity and mortality. The primary objective of this investigation was to describe the point-of-care ultrasound (POCUS) findings in patients evaluated in the emergency department (ED) who were diagnosed with MIS-C. Methods:A retrospective cross-sectional study was conducted including patients <21-years-old who had POCUS performed for clinical care in a pediatric ED and were diagnosed with MIS-C. Point-of-care ultrasound studies were performed by pediatric emergency medicine attending physicians or fellows. Data abstracted by chart review included patient demographics, clinical history, physical examination findings, diagnostic test results, the time POCUS studies and echocardiograms were performed, therapies administered, and clinical course after admission.Results: For the 24 patients included, 17 focused cardiac ultrasound, 9 lung POCUS, 7 pediatric modified rapid ultrasound for shock and hypotension, 1 focused assessment with sonography for trauma, 1 POCUS for suspected appendicitis, and 1 ocular POCUS were performed by 13 physicians. Point-of-care ultrasound identified impaired cardiac contractility in 5 patients, large intraperitoneal free fluid with inflamed bowel in 1 patient, and increased optic nerve sheath diameters with elevation of the optic discs in 1 patient. Trace or small pericardial effusions, pleural effusions, and intraperitoneal free fluid were seen in 3 patients, 6 patients, and 4 patients, respectively.Conclusions: This study demonstrates the spectrum of POCUS findings in MIS-C. Prospective studies are needed to help delineate the utility of incorporating POCUS into an ED management pathway for patients with suspected MIS-C.

The Role of Lung Ultrasound in Diagnosing COVID-19-Related Multisystemic Inflammatory Disease: A Preliminary Experience

“…In conclusion, based on our experience and data of literature [ 11 ], we are confident of the potential role of LUS for MIS-C patients. As previously suggested [ 12 ], during the ongoing COVID-19 pandemic we propose to perform PoC-LUS in all febrile patients with high levels of inflammatory indices and a clinical suspicion of MIS-C, or in the absence of a diagnostic orientation at ED.…”

“…To the best of our knowledge, only one article reports data on lung PoCUS performed on pediatric MIS-C patients [ 11 ]. It describes US pathological images in 7/9 patients with MIS-C, and reports pleural effusion as the most frequent pathological finding.…”

“…Moreover, all the published works refer to traditional tools, i.e., chest X-ray (CXR) and chest Computed-Tomography (CT) [ 8 , 9 , 10 ]. Only Kennedy et al, as far as we know, have currently reported the PoC-LUS findings in MIS-C [ 11 ]. Others have only speculated on its application based on the experiences of COVID-19-patients [ 12 ].…”

First diagnosis of multisystem inflammatory syndrome in children (MIS-C): an analysis of PoCUS findings in the ED

“…To the best of our knowledge, for the first time we report here a detailed analysis on the PoCUS findings in the ED patients with confirmed MIS-C [ 7 ].…”

“…The usefulness of point-of-care ultrasound (PoCUS) in assessing adult and pediatric shock has already been reported [ 5 , 6 ]. During the recent pandemic, PoCUS performed by pediatricians in ED has also been demonstrated as a useful method to detect lung abnormalities in children with MIS-C and COVID-19 [ 7 , 8 ].…”