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array:24 [ "pii" => "S2173510721000756" "issn" => "21735107" "doi" => "10.1016/j.rxeng.2021.03.005" "estado" => "S300" "fechaPublicacion" => "2021-07-01" "aid" => "1284" "copyright" => "SERAM" "copyrightAnyo" => "2021" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Radiologia. 2021;63:334-44" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0033833821000680" "issn" => "00338338" "doi" => "10.1016/j.rx.2021.03.001" "estado" => "S300" "fechaPublicacion" => "2021-07-01" "aid" => "1284" "copyright" => "SERAM" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Radiologia. 2021;63:334-44" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Actualización</span>" "titulo" => "Revisión de los hallazgos clínicos y radiológicos del nuevo síndrome inflamatorio multisistémico pediátrico vinculado a la COVID-19" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "334" "paginaFinal" => "344" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Clinical and radiological findings for the new multisystem inflammatory syndrome in children associated with COVID-19" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figura 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1352 "Ancho" => 1207 "Tamanyo" => 161073 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Adenopatías. Adenopatías en fosa inferior izquierda de morfología similar a las observadas en la adenitis mesentérica.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Sánchez-Oro, M.L. Fatahi Bandpey, E. García Martínez, M.Á. Edo Prades, E.M. Alonso Muñoz" "autores" => array:5 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Sánchez-Oro" ] 1 => array:2 [ "nombre" => "M.L." "apellidos" => "Fatahi Bandpey" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "García Martínez" ] 3 => array:2 [ "nombre" => "M.Á." "apellidos" => "Edo Prades" ] 4 => array:2 [ "nombre" => "E.M." "apellidos" => "Alonso Muñoz" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173510721000756" "doi" => "10.1016/j.rxeng.2021.03.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510721000756?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0033833821000680?idApp=UINPBA00004N" "url" => "/00338338/0000006300000004/v2_202106250847/S0033833821000680/v2_202106250847/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173510721000768" "issn" => "21735107" "doi" => "10.1016/j.rxeng.2021.02.006" "estado" => "S300" "fechaPublicacion" => "2021-07-01" "aid" => "1286" "copyright" => "SERAM" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Radiologia. 2021;63:345-57" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Update in Radiology</span>" "titulo" => "Percutaneous management of bone metastases: State of the art" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "345" "paginaFinal" => "357" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Manejo percutáneo de las metástasis óseas" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 3942 "Ancho" => 1667 "Tamanyo" => 587313 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">(A) Patient with lung cancer and multiple bone metastases. Voluminous metastasis in the right scapula with an important soft tissue component. (B) Treatment of said metastasis by cryoablation with multiple cryoprobes. (C) Chest computed tomography with patient in lateral decubitus. The cryoprobes are visualised as well as the formation of a hypodense ice ball around the distal end (arrows).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Chen-Xu, J. Martel-Villagrán, Á. Bueno-Horcajadas" "autores" => array:3 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Chen-Xu" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Martel-Villagrán" ] 2 => array:2 [ "nombre" => "Á." "apellidos" => "Bueno-Horcajadas" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0033833821000710" "doi" => "10.1016/j.rx.2021.02.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0033833821000710?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510721000768?idApp=UINPBA00004N" "url" => "/21735107/0000006300000004/v1_202107080630/S2173510721000768/v1_202107080630/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S217351072100077X" "issn" => "21735107" "doi" => "10.1016/j.rxeng.2021.03.006" "estado" => "S300" "fechaPublicacion" => "2021-07-01" "aid" => "1290" "copyright" => "SERAM" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Radiologia. 2021;63:324-33" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original articles</span>" "titulo" => "Initial findings in chest X-rays as predictors of worsening lung infection in patients with COVID-19: correlation in 265 patients" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "324" "paginaFinal" => "333" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hallazgos iniciales en la radiografía de tórax como predictores de empeoramiento en la infección pulmonar por SARS-CoV-2. Correlación en 265 pacientes" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 411 "Ancho" => 805 "Tamanyo" => 34749 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">48-year-old man with COVID-19-associated pneumonia. A) Posteroanterior chest radiograph showing bilateral and linear alveolar opacities of peripheral distribution (arrows). The score is 3/6 fields and 4/8 fields, which correspond to moderate involvement in the three systems 6A, 6B and 8. B) The anteroposterior X-ray performed 72 h later shows a worsening of the radiological pattern with more extensive involvement and pulmonary consolidations. Quantification: 5/6 fields and 6/8 fields, corresponding to severe involvement in systems 6A and 6B, and moderate in system 8.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D.J. Petite Felipe, M.I. Rivera Campos, J. San Miguel Espinosa, Y. Malo Rubio, J.C. Flores Quan, M.V. Cuartero Revilla" "autores" => array:6 [ 0 => array:2 [ "nombre" => "D.J." "apellidos" => "Petite Felipe" ] 1 => array:2 [ "nombre" => "M.I." "apellidos" => "Rivera Campos" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "San Miguel Espinosa" ] 3 => array:2 [ "nombre" => "Y." "apellidos" => "Malo Rubio" ] 4 => array:2 [ "nombre" => "J.C." "apellidos" => "Flores Quan" ] 5 => array:2 [ "nombre" => "M.V." "apellidos" => "Cuartero Revilla" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0033833821000813" "doi" => "10.1016/j.rx.2021.03.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0033833821000813?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217351072100077X?idApp=UINPBA00004N" "url" => "/21735107/0000006300000004/v1_202107080630/S217351072100077X/v1_202107080630/en/main.assets" ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Update in Radiology</span>" "titulo" => "Clinical and radiological findings for the new multisystem inflammatory syndrome in children associated with COVID-19" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "334" "paginaFinal" => "344" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "R. Sánchez-Oro, M.L. Fatahi Bandpey, E. García Martínez, M.Á. Edo Prades, E.M. Alonso Muñoz" "autores" => array:5 [ 0 => array:4 [ "nombre" => "R." "apellidos" => "Sánchez-Oro" "email" => array:1 [ 0 => "raquel_sanchez_oro@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M.L." "apellidos" => "Fatahi Bandpey" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "E." "apellidos" => "García Martínez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "M.Á." "apellidos" => "Edo Prades" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "E.M." "apellidos" => "Alonso Muñoz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Radiodiagnóstico, Hospital General de Teruel Obispo Polanco, Teruel, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Radiodiagnóstico, Hospital Arnau de Vilanova de Valencia - Hospital de Llíria, Valencia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Radiodiagnóstico, Hospital General Universitario de Castellón, Castellón, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Revisión de los hallazgos clínicos y radiológicos del nuevo síndrome inflamatorio multisistémico pediátrico vinculado a la COVID-19" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 936 "Ancho" => 1074 "Tamanyo" => 108567 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cardiomegaly and peribronchial interstitial pattern. Chest X-ray showing increased cardiothoracic ratio due to cardiomegaly and peribronchial thickening and perihilar interstitial pattern as signs of heart failure.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">In December 2019, an outbreak of a new coronavirus was reported in Wuhan, Hubei province, China. On 11 February, 2020, the World Health Organization (WHO) renamed the new virus SARS-CoV-2, due to its similarity to the cause of the severe acute respiratory syndrome that broke out in 2003, and the new disease COVID-19 (Coronavirus Infectious Disease 2019). On 11 March, 2020, the WHO declared the outbreak a pandemic.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Since then, COVID-19 has been described as a disease that affects the paediatric population less than the adult population, both in incidence and severity, with a milder clinical picture and a rapid subsequent recovery in the vast majority of children.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> Studies suggest that children have a lower viral load,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> so that while 18.5% of adults with COVID-19 have severe disease, only between 6% and 8% of children present severe symptoms.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–7</span></a> The data indicate that 45% of paediatric patients are asymptomatic,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and when they do show symptoms their most common manifestation is fever in 95%–98% of cases and cough in 86%–95%.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9–11</span></a> Since April 2020, when the COVID-19 pandemic was already widespread in Western countries, more and more cases of children who have developed a multisystem hyper-inflammatory syndrome associated with SARS-CoV-2 infection have been documented. Most of these patients had IgG antibodies against SARS-CoV-2, with a negative PCR result,<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12–18</span></a> that is, laboratory findings that demonstrate that the infection has been overcome.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Affected patients presented a wide spectrum of clinical findings consisting of fever (38–40 °C), headache and pain in limbs; abdominal pain, vomiting and diarrhoea; skin rash, conjunctivitis and peripheral oedema, with variable severity, with a significant percentage evolving to myocardial damage and cardiogenic, septic or toxic shock.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18–23</span></a> Laboratory test abnormalities were similar to those observed in Kawasaki disease (KD), toxic shock syndrome (TSS), or macrophage activation syndrome, although more severe.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18,19</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">This systemic inflammatory syndrome of variable expressiveness has been given several names. In the UK/Europe, it has been called “paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2” (PMIS-TS)<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> and in the USA, SARS-CoV-2-related multisystem inflammatory syndrome in children (MIS-C),<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> coinciding with the name given by the WHO.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> The recent consensus document of the Asociación Española de Pediatría (AEP) [Spanish Paediatric Association] has decided to refer to it as “síndrome inflamatorio multisistémico pediátrico vinculado a SARS-CoV-2” or SIM-PedS [paediatric multisystem inflammatory syndrome associated with SARS-CoV-2].<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In Spain, the paediatric age group is considered to be up to 15 years of age, although several official bodies such as the WHO and the US Centers for Disease Control and Prevention (CDC) have included patients younger than 19 and 21 years, respectively,<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25,26</span></a> in their criteria and some studies also include patients older than 15 years.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Therefore, the authors propose to consider this syndrome not only in children under 15 years of age, who can be cared for by a paediatrician or paediatric radiologist, but also in patients between 15 and 20 years, who will be evaluated by family or emergency physicians and general radiologists or those not specifically dedicated to paediatric radiology. Since the clinical manifestation of SIM-PedS is nonspecific, imaging tests play a very important role in its diagnosis. This article reviews the clinical and radiological findings of this new syndrome.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Definitions and clinical-analytical findings</span><p id="par0030" class="elsevierStylePara elsevierViewall">The inclusion criteria defined by the different health organisations mentioned above to establish the diagnosis of SIM-PedS show slight differences and are summarised in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">As commented above, SIM-PedS is a syndrome described in relation to COVID-19, therefore this new disease should be considered in areas with a high current or recent incidence of COVID-19. Unlike adult COVID-19, which initially presents with respiratory symptoms and pneumonia, SIM-PedS typically manifests with multi-organ damage, predominantly affecting the cardiovascular system. The onset of SIM-PedS is characterised by persistent fever, which is often associated with gastrointestinal weakness and symptoms. Less commonly, patients may also present with a skin rash, conjunctivitis and other mucocutaneous manifestations.</p><p id="par0040" class="elsevierStylePara elsevierViewall">It has been reported that some affected paediatric patients may show rapid worsening with onset of hypotension, cardiogenic shock and multi-organ damage. The time interval between the first symptoms and these serious cardiovascular manifestations is approximately one week.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12–15,18,27</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Given the similarity between the various forms of KD and SIM-PedS, and the pandemic context in which we find ourselves, it is recommended that in patients who meet criteria for the various KD variants (classic or complete, incomplete or KD with shock) to consider evaluating a possible diagnosis of SIM-PedS.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18,28,29</span></a> As a brief reminder, KD is a systemic autoimmune disease characterised by a systemic inflammation of the medium-calibre arteries during the acute febrile phase. It usually affects children under 5 years of age, with the appearance of dilatation or coronary aneurysms being a predominant and characteristic finding.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The laboratory findings characteristic of SIM-PedS consist of elevation of inflammatory markers (CRP, ESR, ferritin, fibrinogen, LDH, IL-6), cardiac dysfunction (NT-ProBNP, enzymes), D-dimer and transaminases; hyponatraemia and hypoalbuminaemia.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,16,18</span></a> The clinical pictures that could be compatible and the differential diagnosis proposed by the AEP are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Given that most patients have previous SARS-CoV-2 infection, it has been suggested that SIM-PedS would affect children with a basic genetic susceptibility, not yet characterised,<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27,30</span></a> responsible for a delayed immune response to the virus (both nonspecific and adaptive), in which cytokines would play an important role.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,13,16,20</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> Some authors have described that the findings of patients with SIM-PedS coincide with the cytokine storm, hyperinflammation and multi-organ damage that are observed in the final phase of adults with severe COVID-19.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13,31</span></a> Thus, the SARS-CoV-2 antibodies would be responsible for causing the syndrome,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> with patients with positive IgG and negative IgM antibodies being predominant, and to a lesser extent those with both positive IgG and IgM.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17,32</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Cases of affected patients from less than one year old to 20 years old have been described, although it predominates in children aged between 7.3 and 10 years old.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13,14,32–34</span></a> Some studies have documented a higher frequency of the disease in males, while others show the same affectation in both sexes, and there is no clear predominance in one race or another,<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13,14,16,33</span></a> and no evidence that obesity or asthma are risk factors, despite the results of several studies.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,14,16</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Radiological findings</span><p id="par0065" class="elsevierStylePara elsevierViewall">The most frequent radiological findings on X-ray, ultrasound or computed tomography (CT) scans in patients diagnosed with SIM-PedS are: cardiomegaly, pleural effusion and passive atelectasis, with the incidence of these findings varying depending on the imaging technique used.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,16,27</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">If the findings are analysed according to the imaging technique used, on chest radiograph the following can be observed: cardiomegaly (43%–62.5%) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), signs of congestive heart failure such as peribronchial thickening and perihilar interstitial pattern (34%–56%) (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>), with rapid appearance of perihilar consolidations due to cardiogenic pulmonary oedema (31%–56%) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), baseline opacities due to passive atelectasis (20%–56%) and pleural effusion (11%–44%). Less frequently there are confluent areas of ground-glass opacity and consolidations due to acute respiratory distress syndrome (ARDS), which may be asymmetric, and bibasal consolidations corresponding to pneumonia.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,19</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Several authors have suggested that these findings are the consequence of heart failure, hypoalbuminaemia, fluid overload or a combination of all of these.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> However, it must be taken into account that an initial chest X-ray may be normal in up to 44%–46% of cases.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,19</span></a> Similar findings have also been described in KD, attributable, according to the most accepted theory, to pulmonary arteritis and/or inflammation of the lower respiratory tract.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Among these chest findings, it is worth highlighting the much lower incidence of consolidations corresponding to pneumonia in patients with SIM-PedS compared to patients (both adult and paediatric) with COVID-19. Extensive ground-glass opacities are also less common and of atypical distribution with respect to the characteristics of COVID-19, which predominate in a peripheral location,<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,36–38</span></a> so in patients with SIM-PedS these ground-glass opacities are more suggestive of corresponding to pulmonary oedema.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> The differences between the thoracic manifestations described in SIM-PedS and in COVID-19 in paediatric patients are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>.</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Lung ultrasound is an interesting imaging technique for the study of paediatric patients with COVID-19 and SIM-PedS, given its availability, mobility (it can easily be moved to paediatric ICUs without the need to transfer the patient, sometimes unstable) and safety due to absence of ionising radiation. Pulmonary ultrasound findings are similar to those described in adult patients with COVID-19.<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">39,40</span></a> Patterns of pneumonia, increased lung water or pleural effusion with B lines in the lower and posterior lung segments have been described, which may increase (diffuse ultrasound interstitial syndrome), along with subpleural consolidations, thickening and fraying of the pleural line, as well as pleural effusion in variable amounts in the costophrenic sinuses. Established pneumonia shows images of consolidation with an air bronchogram, especially in the bases and posterior segments of the lungs.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18,39,40</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Routine chest CT is not recommended.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> In several studies, CT was performed, either with a pulmonary angio-CT protocol for suspected pulmonary thromboembolism (PTE)<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> or, less frequently, due to sepsis or fever of unknown cause,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> while in the study by Hameed et al., it was decided to perform CT of the coronary arteries in 80% of the patients to rule out coronary involvement, given the similarity of this syndrome to KD, which causes dilatation and coronary aneurysms. Most of the lung parenchyma was included in this study (excluding only the apical and basal ends).<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">In Blumfield's study in which pulmonary CT angiography was performed, segmental PTE was identified in 25% of the children, without signs of right ventricular overload or pulmonary infarctions.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> This incidence of PTE is similar to that observed in adults with COVID-19, which according to different studies ranges between 22% and 30%.<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">41–44</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Some authors have suggested that the hyperinflammatory state that characterises SIM-PedS, with elevated inflammatory markers such as fibrinogen, D-dimer, ferritin, and IL-6, could predispose to prothrombotic coagulopathy and thromboembolic complications, including PTE, similar to that observed in the later, more serious stages of COVID-19 in adults.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13,31,44</span></a> However, the clinical importance of segmental PTE is unclear, as some researchers have shown that there are no significant differences in the need for ICU admission, intubation or duration of intubation between COVID-19 adult patients who develop segmental PTE and those who do not.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">In the aforementioned work by Hameed et al., in which a CT scan was performed to study the coronary arteries, no incidental PTE was detected despite the fact that all patients had high levels of D-dimer.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">The most frequently observed findings in the lung parenchyma by CT were: lower lobe atelectasis (50%),<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> the association of consolidations and atelectasis (39%), ground-glass opacities associated with patchy consolidations (9%) and only one patient with small foci of consolidations with peripheral ground-glass halo has been described,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> a finding that is considered typical of COVID-19 and most frequently described in children.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> The possibility that these findings may be secondary to KD-like vasculitis has been suggested.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Pleural effusion was observed in 17%–30% of cases. The presence of hilar adenopathies of significant size detected by CT varies between 0% and 15% according to various studies,<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,19</span></a> and no thymic alterations have been identified.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">The most frequent cardiological alterations are those of heart failure (in some series they are described in up to 51% of cases),<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> with acute myocarditis that usually manifests a week after onset of fever and gastrointestinal symptoms.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> In echocardiography, the most common finding is left ventricular systolic dysfunction, observed in several studies in between 25% and 63% of cases.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,13,16,27</span></a> In 71% of these patients, ejection fractions between 30% and 50% are described, and fractions lower than 30% in 28% of cases.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> Other findings detected by echocardiography are dilatation of the coronary arteries observed in between 17% and 25% of cases and pericardial effusion in between 9% and 40% of cases,<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,14,16,17</span></a> as well as signs of pancarditis and mitral regurgitation.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17,19</span></a> A possible cause of the variability in the detection of coronary anomalies in the different studies is the different imaging technique used for their detection - ultrasound, CT or magnetic resonance imaging (MRI) - with the result that, in the studies in which coronary artery CT was performed, aneurysms were detected in 20% of patients,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> while they were not detected by MRI.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">On cardiac MRI, signs of hyperaemia and diffuse myocardial oedema can be observed in T2 and in the native T1 map, without associating late gadolinium enhancement that suggests replacement fibrosis or focal necrosis.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> These data suggest that the cardiovascular involvement of SIM-PedS is more aggressive than that observed in KD<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13,14,19,20</span></a> and more frequent than in COVID-19, although it has also been described in severe acute infection by SARS-CoV-2, both in adults and in children, with the development of myocardial damage and heart failure.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17,45,46</span></a> The most widely accepted explanation for these findings is that viral myocarditis causes damage by viral infiltration and an immune response to it,<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">47,48</span></a> while postinfectious myocarditis related to SIM-PedS would correspond to an inflammatory infiltration of the myocardial interstitium in response to the immunological cascade triggered against an antigen and not against SARS-CoV-2 itself.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> Cytokines (cytokine storm syndrome) would play an important role in this,<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a> similar to what occurs in KD, in which histopathological analyses of the heart demonstrate a predominance of infiltration by macrophages and neutrophils in the myocardial interstitium with little myocardial cell degeneration or necrosis.<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">50</span></a> The relatively rapid recovery of cardiac function that patients show after receiving the correct treatment, with MRI signal normalisation, supports the theory previously offered and by which several researchers suggest that ventricular systolic dysfunction is due more to myocardial stunning or oedema than myocardial damage.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16,17</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Regarding abdominal involvement, the most frequently observed findings on ultrasound are: ascites (38%–53%) (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>), inflammatory changes in the right iliac fossa (RIF) with lymphadenopathies of morphology similar to those observed in mesenteric adenitis (13%–47%) (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>), hepatomegaly (10%–38%) (<a class="elsevierStyleCrossRef" href="#fig0030">Fig. 6</a>), increased cortical echogenicity of the kidney parenchyma (5%–31%), intestinal parietal thickening (19%–21%) (<a class="elsevierStyleCrossRef" href="#fig0035">Fig. 7</a>), primarily of the distal ileum and secondly of the cecum, increased periportal echogenicity (16%), perivesicular oedema and thickening of the gallbladder walls (16%–19%) (<a class="elsevierStyleCrossRef" href="#fig0040">Fig. 8</a>), biliary sludge (16%), splenic infarcts (10%), splenomegaly (6%) (<a class="elsevierStyleCrossRef" href="#fig0045">Fig. 9</a>), and thickening of the bladder walls (6%).<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,14,16,19</span></a></p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia><elsevierMultimedia ident="fig0035"></elsevierMultimedia><elsevierMultimedia ident="fig0040"></elsevierMultimedia><elsevierMultimedia ident="fig0045"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">It has been hypothesised that gastrointestinal symptoms may be explained by mesenteric lymphadenopathy<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> and by intestinal parietal ischaemia secondary to vasculitis, while heart failure and/or shock would contribute to the thickening of the ileocecal walls as the ileocolic artery is the most distal branch of the superior mesenteric artery.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> One of the theories proposed to explain the pathophysiology of mesenteric lymphadenitis is that it is secondary to lymphoid hyperplasia.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">51</span></a> The RIF would be more frequently affected by its abundant lymphatic tissue and by the presence of Peyer's patches in the distal ileum. In this way, the cases of mesenteric adenitis observed would correspond to the patients described with SIM-PedS who presented with simulating acute appendicitis.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">52</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">In patients with gastrointestinal symptoms and inconclusive ultrasound studies, in whom appendicitis or intra-abdominal collections have not been excluded, it may be decided to perform an abdominal CT scan based on clinical suspicion, preferably with intravenous contrast administration,<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18,19</span></a> with the benefit that the use of oral contrast can provide being more doubtful. In the cases in which CT was performed, the following were observed: ascites (80%), inflammatory changes in RIF with increased attenuation of fat and lymphadenopathy (60%), periportal and perivesicular oedema (40%), thickening of the intestinal wall (20%) and splenic infarction (20%).<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Splenic infarction has been described in patients with KD and other inflammatory vasculitis, which is why in SIM-PedS it is also attributed to inflammation of the splenic artery.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19,53</span></a> The difference in its detection - 10% of the patients through abdominal ultrasound and in up to 20% of the cases in which CT was performed - could justify performing CT only if massive or complicated splenic infarction (abscesses, haemorrhage or rupture) that would need a different therapeutic management is suspected,<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18,54</span></a> which has not been described in the cases of SIM-PedS.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> It is also suggested that ascites, thickening of the gallbladder walls, periportal and perivesicular oedema are secondary to systemic inflammation, hypoalbuminaemia, serositis, fluid overload and/or heart failure.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">In patients with SIM-PedS who underwent imaging tests for presenting neurological manifestations, alterations have been observed in the splenium and genu of the corpus callosum and in the centrum semiovale, with hypodensity on CT, and hyperintensity on MRI in T2 and diffusion restriction in 75% of cases.<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">55</span></a> However, other investigators have reported that no pathological findings were seen on CT or MRI.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Given its similarity to KD, the development of ischaemic infarction as a complication of vasculitis remains a possibility, and it has also been described as a complication in patients with COVID-19 receiving treatment with intravenous immunoglobulins.<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">56</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Evolution and prognosis</span><p id="par0145" class="elsevierStylePara elsevierViewall">Patients with SIM-PedS may develop cardiogenic shock and require admission to the paediatric ICU, with a mean stay of between 4 and 7 days. In this group, between 80% and 100% will require inotropic/vasopressor support, and up to 66%–88% will need mechanical ventilation to achieve cardiovascular stabilisation.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14,16,33</span></a> Approximately 25% of patients with heart failure will require mechanical ventilation with an extracorporeal membrane oxygenation (ECMO) system.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16,34</span></a> Despite this, the vast majority of patients improve clinically with appropriate treatment after a correct diagnosis, and the response of cardiac dysfunction to treatment with intravenous immunoglobulins has been very satisfactory, with complete recovery of ventricular function in 71% of patients.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16,17</span></a> This recovery of cardiac function supports the theory that heart failure is not caused by myocardial damage as in adults with COVID-19. Although pulmonary or neurological sequelae have not been described, more studies are needed to evaluate the possible long-term sequelae that this syndrome could cause.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,16,55</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Limitations</span><p id="par0150" class="elsevierStylePara elsevierViewall">The studies published up to the time of this work have limitations. The most significant is the small number of paediatric patients presented in many of them, so generalisation of the results can lead to error. The clinical manifestations of this syndrome vary in severity, and in published studies there may be an over-representation of the most severe cases.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> Future studies would need to include a greater number of patients and ideally be multicentre, to be able to correlate the radiological findings with the complex clinical course of these patients and pinpoint their specificity and the underlying pathogenesis.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19,57</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="par0155" class="elsevierStylePara elsevierViewall">SIM-PedS is a postviral multisystem inflammatory syndrome in which patients present with sustained high fever, gastrointestinal and mucocutaneous symptoms, with rapid progression to cardiogenic shock and multisystem damage.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12–15</span></a> Given that the clinical manifestation of SIM-PedS is not specific, imaging tests play a very important role in its diagnosis,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> and radiological findings correlate well with the clinical presentation of SIM-PedS and with laboratory data. Gastrointestinal symptoms, including abdominal pain, vomiting and diarrhoea, are probably a reflection of the multi-organ involvement of SIM-PedS.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> In this group of patients, abdominal ultrasound may be the first imaging technique requested, aimed at excluding appendicitis or some other acute abdominal pathology.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Although the imaging findings are not specific and the initial chest X-ray is often normal, the presence of hepatomegaly, hyperechoic kidneys, ascites, pleural effusion, thickening of the intestinal walls or of the gallbladder, or mesenteric lymphadenopathy in patients with a previous history of exposure to SARS-CoV-2, should alert radiologists to a possible diagnosis of SIM-PedS, as patients can quickly worsen.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Both paediatric and non-paediatric radiologists should be aware of and suspect this syndrome since cases have been described in young people between 15 and 20 years of age.</p><p id="par0160" class="elsevierStylePara elsevierViewall">Although many children with SIM-PedS are seriously ill and require admission to the paediatric ICU, a large majority improve clinically with appropriate treatment after correct diagnosis. However, the possible long-term sequelae of this syndrome are yet to be determined.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Authorship</span><p id="par0165" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1</span><p id="par0170" class="elsevierStylePara elsevierViewall">Responsible for study integrity: RSO, MLFB, EGM.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2</span><p id="par0175" class="elsevierStylePara elsevierViewall">Study concept: RSO, MLFB.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3</span><p id="par0180" class="elsevierStylePara elsevierViewall">Study design: RSO, MLFB, EGM, MÁEP, EMAM.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4</span><p id="par0185" class="elsevierStylePara elsevierViewall">Data collection: N/A.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5</span><p id="par0190" class="elsevierStylePara elsevierViewall">Data analysis and interpretation: N/A.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6</span><p id="par0195" class="elsevierStylePara elsevierViewall">Statistical processing: N/A.</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">7</span><p id="par0200" class="elsevierStylePara elsevierViewall">Literature search: RSO, EGM, MÁEP, EMAM.</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">8</span><p id="par0205" class="elsevierStylePara elsevierViewall">Drafting of the work: RSO, MLFB, EGM, MÁEP, EMAM.</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">9</span><p id="par0210" class="elsevierStylePara elsevierViewall">Critical review of the manuscript with intellectually relevant contributions: RSO, MLFB, EGM, MÁEP, EMAM.</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">10</span><p id="par0215" class="elsevierStylePara elsevierViewall">Approval of the final version: RSO, MLFB, EGM, MÁEP, EMAM.</p></li></ul></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflicts of interest</span><p id="par0220" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:14 [ 0 => array:3 [ "identificador" => "xres1546444" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1397666" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1546445" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1397667" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Definitions and clinical-analytical findings" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Radiological findings" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Evolution and prognosis" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Limitations" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusions" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Authorship" ] 11 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflicts of interest" ] 12 => array:2 [ "identificador" => "xack544554" "titulo" => "Acknowledgements" ] 13 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-12-09" "fechaAceptado" => "2021-03-01" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1397666" "palabras" => array:3 [ 0 => "Multisystem inflammatory syndrome in children" 1 => "COVID-19" 2 => "SARS-CoV-2" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1397667" "palabras" => array:3 [ 0 => "Síndrome inflamatorio multisistémico pediátrico" 1 => "COVID-19" 2 => "SARS-CoV-2" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">The World Health Organization defines the multisystem inflammatory syndrome in children (MIS-C) as a new syndrome reported in patients aged <19 years old who have a history of exposure to SARS-CoV-2. The onset of this syndrome is characterized by persistent fever that is associated with lethargy, abdominal pain, vomiting and/or diarrhea, and, less frequently, rash and conjunctivitis. The course and severity of the signs and symptoms vary; in some children, MIS-C worsens rapidly and can lead to hypotension, cariogenic shock, or even damage to multiple organs. The characteristic laboratory findings are elevated markers of inflammation and heart dysfunction. The most common radiological findings are cardiomegaly, pleural effusion, signs of heart failure, ascites, and inflammatory changes in the right iliac fossa. In the context of the current COVID-19 pandemic, radiologists need to know the clinical, laboratory, and radiological characteristics of this syndrome to ensure the correct diagnosis.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">El síndrome inflamatorio multisistémico pediátrico vinculado a la COVID-19 (SIM-PedS) es, según la Organización Mundial de la Salud, un nuevo síndrome descrito en pacientes menores de 19 años con historia previa de exposición a SARS-CoV-2. La presentación inicial de este síndrome se caracteriza por fiebre persistente que asocia debilidad, dolor abdominal, vómitos y/o diarrea. Menos frecuentemente los pacientes pueden presentar también erupción cutánea y conjuntivitis. El cuadro clínico tiene expresividad y evolución variables, por lo que algunos pacientes pediátricos afectados pueden empeorar rápidamente, desarrollando desde hipotensión y shock cardiogénico a daño multiorgánico. Los hallazgos analíticos característicos del síndrome consisten en elevación de marcadores inflamatorios y disfunción cardíaca. Los hallazgos radiológicos más frecuentes son cardiomegalia, derrame pleural, signos de insuficiencia cardíaca, ascitis y cambios inflamatorios en la fosa ilíaca derecha. En la pandemia actual por COVID-19 es necesario que el radiólogo conozca las características clínico-analíticas y radiológicas de este síndrome para realizar un correcto diagnóstico.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Sánchez-Oro R, Fatahi Bandpey ML, García Martínez E, Edo Prades MÁ, Alonso Muñoz EM. Revisión de los hallazgos clínicos y radiológicos del nuevo síndrome inflamatorio multisistémico pediátrico vinculado a la COVID-19. Radiología. 2021;63:334–344.</p>" ] ] "multimedia" => array:12 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 936 "Ancho" => 1074 "Tamanyo" => 108567 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cardiomegaly and peribronchial interstitial pattern. Chest X-ray showing increased cardiothoracic ratio due to cardiomegaly and peribronchial thickening and perihilar interstitial pattern as signs of heart failure.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1088 "Ancho" => 1207 "Tamanyo" => 80586 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Peribronchial thickening and perihilar interstitial pattern (arrows), as signs of heart failure.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 990 "Ancho" => 1207 "Tamanyo" => 80868 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Perihilar consolidations (arrows) corresponding to cardiogenic pulmonary oedema.</p>" ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 961 "Ancho" => 1207 "Tamanyo" => 86933 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Ascites. Abdominal ultrasound image showing free fluid (asterisk) located posterior to the bladder (V).</p>" ] ] 4 => array:8 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1352 "Ancho" => 1207 "Tamanyo" => 161073 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Lymphadenopathy. Lymphadenopathy in the left inferior fossa with a morphology similar to that seen in mesenteric adenitis.</p>" ] ] 5 => array:8 [ "identificador" => "fig0030" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 805 "Ancho" => 1207 "Tamanyo" => 80641 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Hepatomegaly. Diffuse hepatomegaly and small volume of right pleural effusion (arrow).</p>" ] ] 6 => array:8 [ "identificador" => "fig0035" "etiqueta" => "Figure 7" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr7.jpeg" "Alto" => 750 "Ancho" => 1674 "Tamanyo" => 166168 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0035" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Thickening of the descending colon wall. Ultrasound image showing thickening of the descending colon walls (arrows) with increased echogenicity of the pericolonic fat (asterisks) due to inflammatory changes.</p>" ] ] 7 => array:8 [ "identificador" => "fig0040" "etiqueta" => "Figure 8" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr8.jpeg" "Alto" => 1312 "Ancho" => 1207 "Tamanyo" => 142793 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0040" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Thickening of the gallbladder walls. Ultrasound image showing marked thickening of the walls (arrows) of the gallbladder (V).</p>" ] ] 8 => array:8 [ "identificador" => "fig0045" "etiqueta" => "Figure 9" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr9.jpeg" "Alto" => 935 "Ancho" => 1207 "Tamanyo" => 115403 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0045" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Splenomegaly. Ultrasound image showing splenomegaly of 156 mm.</p>" ] ] 9 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0050" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">aPTT: activated partial thromboplastin time; CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; IL-6: interleukin 6; KD: Kawasaki disease; PCT: procalcitonin; PT: prothrombin time; TSS: toxic shock syndrome.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">World Health Organization (WHO)<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Royal College of Paediatrics and Child Health (RCPCH UK)<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">United States Centers for Disease Control and Prevention (CDC)<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patient <19 years with fever ≥3 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Child with persistent fever \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patient <21 years with fever ≥24 h \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">And two of the following: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">And signs of an inflammatory response (neutrophilia, elevated CRP and lymphopaenia) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">And evidence of severe disease requiring hospitalisation, with multi-organ (>2) involvement (cardiac, respiratory, haematologic, gastrointestinal, dermatologic or neurologic) and with signs of an inflammatory response, elevation of more than two of the following: CRP, ESR, fibrinogen, PCT, D-dimer, ferritin, LDH or IL-6, neutrophilia, lymphopaenia or decreased albumin \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1. Rash or bilateral non-purulent conjunctivitis or signs of mucocutaneous inflammation (mouth, hands or feet) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2. Hypotension or shock \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">And evidence of organ or multi-organ dysfunction (shock, cardiac, respiratory, renal, gastrointestinal or neurological dysfunction), with additional characteristics<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">And exclusion of other alternative diagnoses \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3. Evidence of myocardial dysfunction, pericarditis, valvulitis or coronary abnormalities (including echocardiographic findings or elevated troponin/NT-proBNP values) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">And evidence of recent or current COVID-19 (positive RT-PCR, antigen tests or serology) or contact with a COVID-19 case in the last 4 weeks \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4. Evidence of coagulopathy (alteration of PT, aPTT or elevated D-dimer values). \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">May include complete or incomplete KD diagnosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5. Acute gastrointestinal symptoms (diarrhoea, vomiting or abdominal pain) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Recommends that patients who meet KD criteria in whole or in part be considered for SIM-PedS if they meet the definition. And consider SIM-PedS in deceased paediatric patients with evidence of SARS-CoV-2 infection. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">And exclusion of other infectious causes, including bacterial sepsis, streptococcal or staphylococcal toxic shock, and infections associated with myocarditis such as enterovirus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">And elevated values of inflammation markers (elevated ESR, CRP or PCT) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RT-PCR for SARS-CoV-2 can be positive or negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">And no other obvious microbiological causes of inflammation, including bacterial sepsis and staphylococcal or streptococcal TSS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">And evidence of COVID-19 (positive RT-PCR, antigen tests or serology) or probable contact with a COVID-19 case \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Consider this syndrome in children with typical or atypical findings of KD or TSS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2652482.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Definitions of SIM-PedS by WHO, RCPCH, CDC.</p>" ] ] 10 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0055" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">KD: Kawasaki disease; SIM-PedS: paediatric multisystem inflammatory syndrome linked to SARS-CoV-2.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Clinical pictures compatible with SIM-PedS \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Differential diagnosis \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1. Clinical picture compatible with myocarditis, septic shock or toxic shock \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1. Bacterial sepsis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2. Clinical picture compatible with complete/incomplete KD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2. Other viral infections (adenovirus, enterovirus, measles in non-immunised population) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3. Fever and abdominal pain or exanthema or conjunctivitis, with laboratory alterations (very high acute phase reactants, cardiac enzyme abnormalities) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3. Acute abdomen simulating peritonitis/appendicitis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4. Streptococcal or staphylococcal toxic shock syndrome \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5. Myocarditis due to other microorganisms \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6. KD not related to SARS-CoV-2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7. Drug hypersensitivity reaction (Stevens-Johnson syndrome) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8. Other systemic rheumatological diseases (systemic juvenile idiopathic arthritis and other autoinflammatory or autoimmune diseases) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9. Primary or secondary haemophagocytic lymphohistiocytosis (macrophage activation syndrome) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2652480.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Clinical pictures compatible with SIM-PedS and differential diagnosis proposed by the Asociación Española de Pediatría in its consensus document.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p>" ] ] 11 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0060" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">ARDS: acute respiratory distress syndrome; SIM-PedS: paediatric multisystem inflammatory syndrome linked to SARS-CoV-2.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Findings \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SIM-PedS \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Typical COVID-19 \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lungs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pulmonary oedema \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Peripheral/subpleural ground-glass consolidations and/or opacities predominantly bilateral and lower lobes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ARDS, can be asymmetrical \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Halo sign (early phase) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pleural \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pleural effusion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cardiovascular \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Heart failure/left ventricular systolic dysfunction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pericardial effusion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pulmonary embolism \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Coronary artery dilatation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Abdominal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mesenteric lymphadenopathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hepatomegaly \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Thickening of gallbladder walls \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Splenic infarction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hyperechogenic renal parenchyma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Thickening of bowel loop wall \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ascites \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Neurological \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Involvement of the corpus callosum and centrum semiovale \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2652481.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Differences between SIM-PedS imaging test findings and typical pediatric COVID-19 findings.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:57 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The novel coronavirus originating in Wuhan, China: challenges for Global Health Governance" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.L. 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