P0756 / #2111: ABDOMINAL IMAGING FINDINGS IN CRITICALLY ILL CHILDREN WITH MIS-C

Abstract

AIMS & OBJECTIVES: We sought to describe abdominal imaging findings on ultrasound and computed tomography on children presenting with abdominal symptoms and multisystem inflammatory syndrome (MIS-C) related to coronavirus disease (COVID-19). METHODS: We report findings on abdominal imaging in 7 critically ill children admitted with MIS-C to a tertiary, urban intensive care unit. All children had clinical and laboratory criteria of MIS-C including positive antibody testing to COVID-19. RESULTS: Of 23 children diagnosed with MIS-C, 7 children (30%) had abdominal imaging, including ultrasound (all 7) and CT (3/7). Indications for abdominal imaging included concern for acute abdomen, gall bladder inflammation and intestinal obstruction. Hepatomegaly was the most common finding, while nephromegaly, gall bladder wall edema, ascites, intestinal inflammation and mesenteric lymphadenopathy were also seen on ultrasound. Two children had incidental finding of bilateral lower lobe consolidations on CT abdomen. One child had a thickened, enlarged appendix with diffuse inflammation of intestinal wall of descending colon and ileum on CT. Another patient with severe MIS-C had fluidfilled small bowel loops, terminal ileal inflammation, diffuse lymphadenopathy and moderate ascites on abdominal CT. This patient also had large vessel vasculitis involving the junction of the aortic arch and brachiocephalic trunk. CONCLUSIONS: Common with abdominal imaging findings in Kawasaki disease, our patients had reactive lymphadenopathy, abdominal free fluid, bowel wall thickening and vasculitis. Gall bladder hydrops, intestinal pseudo-obstruction or dilated bowel loops, commonly found in Kawasaki disease with prominent abdominal symptoms were not seen in our patients.