Appendiceal involvement in pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) : a diagnostic challenge in the coronavirus disease (COVID) era
© 2022. Crown..
BACKGROUND: Many studies on pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (PIMS-TS) have described abdominal findings as part of multisystem involvement, with limited descriptions of abdominal imaging findings specific to PIMS-TS.
OBJECTIVE: To perform a detailed evaluation of abdominal imaging findings in children with PIMS-TS.
MATERIALS AND METHODS: We performed a single-center retrospective study of children admitted to our institution between April 2020 and January 2021 who fulfilled Royal College of Paediatrics and Child Health criteria for PIMS-TS and who had cross-sectional abdominal imaging. We studied clinical data, abdominal imaging, laboratory markers, echocardiography findings, treatment and outcomes for these children. We also reviewed the literature on similar studies.
RESULTS: During the study period, 60 PIMS-TS cases were admitted, of whom 23 required abdominal imaging. Most (74%) were from a Black, Asian or minority ethnic background and they had an average age of 7 years (range 2-14 years). All children had fever and gastrointestinal symptoms on presentation with elevated C-reactive protein, D-dimer and fibrinogen. Most had lymphopenia, raised ferritin and hypoalbuminemia, with positive severe acute respiratory syndrome coronavirus 2 immunoglobulin G antibodies in 65%. Free fluid (78%), right iliac fossa mesenteric inflammation (52%), and significantly enlarged mesenteric lymph nodes (52%) were the most common imaging findings. Appendiceal inflammation (30%) and abnormal distal ileum and cecum/ascending colon wall thickening (35%) were also common. All children responded well to medical management alone, with no mortality.
CONCLUSION: In addition to free fluid, prominent lymphadenopathy, and inflammatory changes in the right iliac fossa, we found abnormal long-segment ileal thickening and appendicitis to be frequent findings. Recognition of appendiceal involvement as a component of the PIMS-TS spectrum should help clinicians avoid unnecessary surgical intervention as part of a multidisciplinary team approach.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:52 |
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| Enthalten in: |
Pediatric radiology - 52(2022), 6 vom: 14. Mai, Seite 1038-1047 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Kapadia, Tejas H [VerfasserIn] |
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| Links: |
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| Themen: |
Abdomen |
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| Anmerkungen: |
Date Completed 17.05.2022 Date Revised 16.07.2022 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1007/s00247-022-05346-2 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM339238380 |
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| 100 | 1 | |a Kapadia, Tejas H |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Appendiceal involvement in pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) |b a diagnostic challenge in the coronavirus disease (COVID) era |
| 264 | 1 | |c 2022 | |
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| 500 | |a Date Completed 17.05.2022 | ||
| 500 | |a Date Revised 16.07.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2022. Crown. | ||
| 520 | |a BACKGROUND: Many studies on pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (PIMS-TS) have described abdominal findings as part of multisystem involvement, with limited descriptions of abdominal imaging findings specific to PIMS-TS | ||
| 520 | |a OBJECTIVE: To perform a detailed evaluation of abdominal imaging findings in children with PIMS-TS | ||
| 520 | |a MATERIALS AND METHODS: We performed a single-center retrospective study of children admitted to our institution between April 2020 and January 2021 who fulfilled Royal College of Paediatrics and Child Health criteria for PIMS-TS and who had cross-sectional abdominal imaging. We studied clinical data, abdominal imaging, laboratory markers, echocardiography findings, treatment and outcomes for these children. We also reviewed the literature on similar studies | ||
| 520 | |a RESULTS: During the study period, 60 PIMS-TS cases were admitted, of whom 23 required abdominal imaging. Most (74%) were from a Black, Asian or minority ethnic background and they had an average age of 7 years (range 2-14 years). All children had fever and gastrointestinal symptoms on presentation with elevated C-reactive protein, D-dimer and fibrinogen. Most had lymphopenia, raised ferritin and hypoalbuminemia, with positive severe acute respiratory syndrome coronavirus 2 immunoglobulin G antibodies in 65%. Free fluid (78%), right iliac fossa mesenteric inflammation (52%), and significantly enlarged mesenteric lymph nodes (52%) were the most common imaging findings. Appendiceal inflammation (30%) and abnormal distal ileum and cecum/ascending colon wall thickening (35%) were also common. All children responded well to medical management alone, with no mortality | ||
| 520 | |a CONCLUSION: In addition to free fluid, prominent lymphadenopathy, and inflammatory changes in the right iliac fossa, we found abnormal long-segment ileal thickening and appendicitis to be frequent findings. Recognition of appendiceal involvement as a component of the PIMS-TS spectrum should help clinicians avoid unnecessary surgical intervention as part of a multidisciplinary team approach | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Abdomen | |
| 650 | 4 | |a Appendix | |
| 650 | 4 | |a Children | |
| 650 | 4 | |a Coronavirus disease 2019 | |
| 650 | 4 | |a Pediatric inflammatory multisystem disease | |
| 650 | 4 | |a Severe acute respiratory syndrome coronavirus 2 | |
| 700 | 1 | |a Abdulla, Mohammed T |e verfasserin |4 aut | |
| 700 | 1 | |a Hawkes, Rob A |e verfasserin |4 aut | |
| 700 | 1 | |a Tang, Vivian |e verfasserin |4 aut | |
| 700 | 1 | |a Maniyar, Jenny A |e verfasserin |4 aut | |
| 700 | 1 | |a Dixon, Rachel E |e verfasserin |4 aut | |
| 700 | 1 | |a Maniyar, Amit F |e verfasserin |4 aut | |
| 700 | 1 | |a Kind, Kirsten M S |e verfasserin |4 aut | |
| 700 | 1 | |a Willis, Emily |e verfasserin |4 aut | |
| 700 | 1 | |a Riley, Phil |e verfasserin |4 aut | |
| 700 | 1 | |a Alwan, Yousef M |e verfasserin |4 aut | |
| 700 | 1 | |a Stivaros, Stavros Michael |e verfasserin |4 aut | |
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