RADIOLOGY, from Pediatrics Team COVID-19/MIS-C

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RADIOLOGY from Pediatrics Team

by Michael R. Aquino, MD, MHSc

1-p1-1-radiology-peds — Frontal radiograph in a 14-year-old patient with shortness of breath & fever demonstrates hazy & patchy bilateral pulmonary opacities.

2-p1-2-radiology-peds — Axial CECT in the same patient shows bilateral lower lung zone-predominant ground-glass & consolidative densities . The patient tested positive for COVID-19 on nasopharyngeal RT-PCR. Other features seen in pediatric cases of COVID-19 include bronchial wall thickening & the halo sign (not shown).

3-p1-3-radiology-peds — Axial CECT from a 17 year old demonstrates bilateral symmetric lower lung zone-predominant ground-glass & patchy densities. Bronchial wall thickening is also noted.

4-p1-4-radiology-peds — Axial T1 C+ FS MR in 9 year old with left-sided weakness shows a right cerebral lesion with cortical enhancement & hemorrhagic necrosis (confirmed on T2 & SWI with minimal precontrast T1 shortening) due to COVID-19-associated vasculitis & infarction.

5-p4-1-radiology-peds — Short-axis T2 STIR cardiac MR in a 16 year old with 10 days of fever & abdominal pain shows high signal intensity of the left ventricular (LV) myocardium vs. skeletal muscle (ratio of 2.5, with > 1.9 being abnormal), consistent with edema. COVID-19 IgG was positive, consistent with MIS-C.

6-p4-2-radiology-peds — Axial CECT in the same patient shows diffuse pancreatic thickening & homogeneous enhancement with surrounding edema, consistent with acute interstitial edematous pancreatitis in MIS-C.

7-p4-3-radiology-peds — Axial CECT of a 15 year old with pain demonstrates inflammatory stranding at the right lower quadrant & multiple prominent lymph nodes , some with low density. The appendix was normal (not shown).

8-p4-4-radiology-peds — Frontal radiograph in the same patient shows diffuse interstitial opacities compatible with pulmonary edema. Echocardiography showed LV dysfunction & ↓ LVEF. Inflammatory markers were elevated, & COVID-19 RT-PCR test was positive. The patient was diagnosed with MIS-C.

9-p4-5-radiology-peds — Coronal CECT in a 10 year old with right lower quadrant pain, fever, rash, & conjunctivitis shows multiple enlarged lymph nodes & fluid-filled bowel .

10-p4-6-radiology-peds — Transverse US in the same patient shows distal ileal wall thickening & hyperechogenicity with adjacent fat induration . Serology was positive for COVID-19 exposure. Decreased systolic LV function & coronary artery ectasia were seen on echocardiography. The patient met the criteria for MIS-C & also had elevated inflammatory markers.

d1-radiology-peds — Axial CECT from an 18-year-old patient with fever & cough shows bilateral ground-glass densities at the lower lobes. A nasopharyngeal swab RT-PCR test for COVID-19 was positive. Pulmonary nodules, pleural effusions, & cavitation are atypical for COVID-19 & should prompt consideration of other diagnoses.

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