Myopericarditis Associated with COVID-19 in a Pediatric Patient with Kidney Failure Receiving Hemodialysis

Figures

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  Figure 1. Serial radiological progression seen in a pediatric patient with COVID-19, CKD, and myopericarditis. (A) 15 July 2020—Chest X-ray (CXR) of COVID-19 patient on anterior–posterior projection shows patchy basal bilateral ground-glass opacities (GGOs), associating right reactive pleural effusion, and loss of lung markings in the mid and lower zones (white arrow). Increased transverse cardiac diameter possible by pericardial fluid effusion (grey arrow). Central venous catheter with right jugular insertion, paravertebral descending path, and internal extremity in the right atrium (black arrow). (B) 22 September 2020—Regression of alveolar infiltrates maintaining the consolidation from right inferior lobe; reduction of the pleural fluid reaction (white arrow), the globular enlargement of the heart shadow persists giving a water bottle configuration/cardio-mediastinal silhouette with increased transverse diameter (grey arrow), not significantly modified compared to the previous. Tunneled central venous catheter with right jugular insertion, paravertebral descending path and internal extremity at the level of inferior vena cava (black arrow). (C) 28 September 2020—Shows radiological…

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  Figure 2. Echocardiography—apical 4-chamber view: a large amount of pericardial fluid (arrow), severe left ventricle hypertrophy (LVH).

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  Figure 3. Echocardiography—parasternal short-axis view. A large amount of pericardial fluid (arrow), LVH.

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  Figure 4. Echocardiography—parasternal long axis view. Posterior left ventricle pericardial fluid (arrow); severe LVH (LV mass index 185 g/m2).

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  Figure 5. Echocardiography—apical 4-chamber view (M-mode). LV systolic dysfunction (MAPSE reduction).

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  Figure 6. Echocardiography—apical 4-chamber view. HVS and restrictive diastolic pattern.

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  Figure 7. Suggested Pediatric diagnostic and management algorithm in myopericarditis associated with COVID-19 and CKD stage 5 treated by dialysis (CKD 5D).

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  Figure 8. Longitudinal correlation of markers of cardiac injury (echocardiographic parameters and NT-proBNP values).