Paediatric inflammatory bowel associated with Covid-19

There is evidence that some paediatric patients, testing positive for Covid-19, are presenting with Multisystem Inflammatory Syndrome in Children (MIS-C) or terminal ileitis. Ultrasound may be used in the diagnosis or triaging of these children. Below are some resources to support your learning, if you undertake paediatric ultrasound examinations.

The Royal College of Paediatrics and Child Health suggest that ultrasound might be used to detect inflammatory bowel, hepatosplenomegaly, ascites and/or enlarged lymph nodes. 

Ultrasound appearances of inflamed bowel include:

  • bowel wall thickening
  • increased vascularity in the bowel wall (hyperaemia)
  • fat 'wrapping' (thick layer of hyperechoic fat around the bowel)
  • enlarged lymph nodes |(lymphademopathy)

Image 1: terminal ileitis in a teenager testing positive for Covid-19

terminal ileitis - Covid 19

Image 2a and 2b: appendicitis in a young child testing positive for Covid-19

appendicitis covid-19 LS  appendicitis - Covid19 TS

For additional images of a range of inflammatory bowel ultrasound appearances, see the article by Lederman et al (2000)


European Centre for Disease Prevention and Control (2020) Paediatric inflammatory multisystem syndrome and SARS-CoV-2 infection in children. Rapid risk assessment

Ledermann, H. et al (2000) Bowel Wall Thickening on Transabdominal Sonography
American Journal of Roentgenology, 174 (1), 107-115

Royal College of Paediatrics and Child Health Guidance: Paediatric multisystem inflammatory syndrome temporally associated with COVID-19

Tullie, L. et al. (2020) Gastrointestinal features in children with COVID-19: an observation of varied presentation in eight children. The Lancet Child & Adolescent Health, 0 (0).

World Health Organisation (2020) Multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19