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Introduction - MIS-C is the most relevant complication of SARS-CoV-2 infection and has an incidence of 1 case / 2,200 children and adolescents with previous infection. The clinical picture is characterized by a multiorgan involvement and an insufficiently known response to therapy. Objectives - Retrospective analysis carried out in the Paediatric Department of the Ravenna Hospital from April 2020 to March 2022 of the cases admitted with MIS-C, with description of the presentation characteristics, the differences with respect to Kawasaki disease and the therapeutic strategies adopted also with regard to the clinical response. Results - Thirteen cases diagnosed with MIS-C with an average age of 6 years and four months were hospitalized, 4 cases were of Italian origin, 6 of Balkan and 3 of African. All the cases presented with fever> 39 ° C with severe malaise / irritability, associated with skin rash in 9 cases, conjunctivitis in 7 and cheilitis in 5. The most prominent manifestations of organ involvement were abdominal pain / diarrhoea (N = 9), myocardial dysfunction in the absence of coronary involvement (N = 5), presence of pulmonary thickening (N = 5), painful laterocervical lymphadenitis with reduced neck motility (N = 5), subnephrotic proteinuria (N = 7) and hypertransaminasaemia (N = 8). Two cases with “encephalitic-like” psychomotor slowing, one with important ascites and one with oedema of the para/retropharyngeal tissues were clinically relevant for the severity of the onset. Twelve cases were treated with IVIG and methylprednisolone (2 mg /kg), 4 of them were found to be non-responders and required the use of steroid boluses (4 cases) and anakinra (4 cases), in three of the latter in association with steroid boluses, with rapid and decisive clinical response. Conclusions - The serious clinical manifestations that characterize MIS-C do not concern only cardiac involvement. Therapy with an IL-1 inhibitor, anakinra, must also be envisaged as a possible first-line treatment in case of a particularly severe clinical picture at the onset.

Ultrasound artefacts are ubiquitous; some depend on ultrasound system settings, others are influenced by the position of the probe and the patient, while still others depend solely on the intrinsic characteristics of ultrasounds. Although many artefacts are unwanted, others provide crucial information for interpreting the ultrasound image, and some, such as A- and B-line artefacts, are even essential semiological signs in thoracic ultrasound.

This chapter focuses on thoracic ultrasound as a noninvasive technique for diaphragm morphological and functional assessment, that can be used as an alternative to traditional, more challenging and uncomfortable methods, such as the fluoroscopic sniff test, nerve conduction studies, and electromyography. This chapter firstly focuses attention on the techniques that can be used and on the measurements that can be obtained. Lastly the pathophysiological significance and the potential clinical applications for diagnostic and prognostic purposes are described.

While in order to read an ultrasonic image correctly it is necessary to understand how ultrasounds interact with biological tissues and how the ultrasound system constructs the image, this is even more true when studying the thorax due to pulmonary air and the bones of the ribcage that alter the propagation of ultrasounds.

PURPOSE: In polytraumatized patients with active bleeding, the improvement of survival depends on control/early stoppage of bleeding. The purpose of our study was to define the role of MDCT in patients with hemothorax. MATERIALS AND METHODS: From January 2008 to December 2013, we performed thoraco-abdominal CT to 1352 patients with polytrauma or thoracic blunt trauma. We retrospectively reviewed CT of 93 patients (mean age 65 years) where MDCT showed hemothorax. Basing on CT findings, 12 patients have been treated with interventional radiology, 78 patients with surgical procedures (drainage tube, VATS, thoracotomy). RESULTS: CT showed rib fractures in 85 patients; an active bleeding in arterial phase, with associated hematic pleural effusion in 12 patients;2 pseudoaneurysm in 2 patients. Two patients with flail chest showed bleeding a few days after traumatic event. Nine patients underwent to percutaneous treatment with technical success in 9/10 (90%). CONCLUSIONS: MDCT demonstrates high value in the management of patients with thoracic blunt trauma, identifying and classifying the severity of injuries. It shows high accuracy in the diagnosis of active bleeding and precludes the occurrence of complications. In the detection of active bleeding CT allows correct selection and safe treatment planning. In polytraumatized patients the selective arteriography and transcatheter embolization provide a viable diagnostic and therapeutic alternative in the management of bleeding from arterial lesions.

Dissertação de mestrado em Gestão apresentada à Faculdade de Economia da Universidade de Coimbra.