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

Anna Maria Musolino,Serena Sinibaldi,Valentina Ferro,Paolo Tomà,Danilo Buonsenso,Alberto Villani,Raffaella Nacca,Elena Boccuzzi,Eugenio Pitaro,Paolo Palma,Maria Alessia Mesturino,Maria Chiara Supino

doi:10.3390/jcm11010234

Abstract

Background: To date, there are no data regarding the systematic application of Point-of-Care Lung Ultrasound (PoC-LUS) in children with Multisystem Inflammatory Syndrome in Children (MIS-C). The main aim of this study is to show the role of Point-of-Care Lung Ultrasound as an additional aid in the diagnosis of COVID-19-related Multisystem Inflammatory Syndrome in Children (MIS-C). Methods: Between April 2020 and April 2021, patients aged 0–18 years referred to our emergency department for fever, and later hospitalized without a specific diagnosis, underwent PoC-LUS. Ultrasound images of patients with a final diagnosis of MIS-C were retrospectively evaluated. Results: Ten patients were enrolled. All were described to have pleural irregularities and B-lines. In particular: 8/10 children presented with isolated B-lines in at least half of the lung areas of interest; 8/10 presented with multiple B-lines and 3/8 had them in at least 50% of lung areas; 5/10 had a white lung appearance in at least one lung area and 1/5 had them in half of the areas of interest. Pleural effusion was described in 9/10. Conclusions: During the ongoing COVID-19 pandemic, we suggest performing PoC-LUS in febrile patients with high levels of inflammatory indices and clinical suspicion of MIS-C, or without a certain diagnosis; the finding of many B-lines and pleural effusion would support the diagnosis of a systemic inflammatory disease.

Highlights

Point-of-Care Lung Ultrasound (PoC-lung ultrasound (LUS)) is an increasingly applied tool to be used in the overall assessment of patients in pediatric Emergency Departments (ED)
Ten patients evaluated with Point-ofCare Lung Ultrasound (PoC-LUS) in the ED were later diagnosed to have Multisystem Inflammatory Syndrome in Children (MIS-C)
Gastrointestinal disorders were the most frequent symptom (70%): abdominal pain was present in five children (50%), vomiting in three cases (30%) and diarrhea in the same percentage (30%); analyzing the associations between the above symptoms, two patients presented with both abdominal pain and vomiting, two with pain and diarrhea, one with pain, one with vomiting and one with diarrhea only (Table 1)

Summary

Introduction

Point-of-Care Lung Ultrasound (PoC-LUS) is an increasingly applied tool to be used in the overall assessment of patients in pediatric Emergency Departments (ED). Thanks to its safety profile, simplicity of application (after adequate training), its high sensitivity and specificity, and by limiting exposure to ionizing radiation, lung ultrasound (LUS) may be used at the bedside for detecting many pathological findings. These features, together with the lack of need to transfer the patient to a traditional imaging environment, have allowed LUS to further extend its application, especially in response to the restrictive measures in place due to COVID-19. The main aim of this study is to show the role of Point-of-Care Lung Ultrasound as an additional aid in the diagnosis of COVID-19-related Multisystem Inflammatory Syndrome in Children (MIS-C). Ultrasound images of patients with a final diagnosis of MIS-C were retrospectively evaluated

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