Clinical and imaging features of pediatric COVID-19

Abstract

Background Pediatric COVID-19 is relatively mild and may vary from that in adults. This study was to investigate the epidemic, clinical, and imaging features of pediatric COVID-19 pneumonia for early diagnosis and treatment. Methods Forty-one children infected with COVID-19 were analyzed in the epidemic, clinical and imaging data. Results Among 30 children with mild COVID-19, seven had no symptoms, fifteen had low or mediate fever, and eight presented with cough, nasal congestion, diarrhea, headache, or fatigue. Among eleven children with moderate COVID-19, nine presented with low or mediate fever, accompanied with cough and runny nose, and two had no symptoms. Significantly (P < 0.05) more children had a greater rate of cough in moderate than in mild COVID-19. Thirty children with mild COVID-19 were negative in pulmonary CT imaging, whereas eleven children with moderate COVID-19 had pulmonary lesions, including ground glass opacity in ten (90.9%), patches of high density in six (54.5%), consolidation in three (27.3%), and enlarged bronchovascular bundles in seven (63.6%). The lesions were distributed along the bronchus in five patients (45.5%). The lymph nodes were enlarged in the pulmonary hilum in two patients (18.2%). The lesions were presented in the right upper lobe in two patients (18.1%), right middle lobe in one (9.1%), right lower lobe in six (54.5%), left upper lobe in five (45.5%), and left lower lobe in eight (72.7%). Conclusions Children with COVID-19 have mild or moderate clinical and imaging presentations. A better understanding of the clinical and CT imaging helps ascertaining those with negative nucleic acid and reducing misdiagnosis rate for those with atypical and concealed symptoms.

COVID-19 Pneumonia in Children: From Etiology to Management

“…In a pediatric series of children with COVID-19, 30.8% presented shortness of breath that required oxygen supplementation and 23.1% were transferred to intensive care unit (ICU) for organ dysfunction (15). In another case series of 41 children hospitalized for COVID-19, 11 of these presented lung lesions compatible with a picture of interstitial pneumonia (16). Furthermore, in one of the largest published pediatric series that studied 585 children with SARS-CoV2 infection, 8% required ICU admission and 4% needed mechanical ventilation (17).…”

The Multifaceted COVID-19: CT Aspects of Its Atypical Pulmonary and Abdominal Manifestations and Complications in Adults and Children. A Pictorial Review

“…As in the adult case series, in pediatric patients COVID-19 pneumonia manifested more frequently with some "typical" features, such as ground glass opacity (GGO), peribronchial thickening, vascular engorgement and airspace consolidation [27][28][29][30]; as stated also by the international consensus [31] regarding pediatric chest imaging. Atypical imaging findings are represented by pleural effusion, atelectasis, nodules, linear opacities, lymphadenopathy, pneumothorax and pneumomediastinum.…”

“…Caro-Dominguez et al [27] found pleural effusion in 7% of their cases, Ugas-Charcape et al [30] described it in 6% and 13% of chest radiographs and CTs, respectively, while Zhang et al [29] reported no cases of pleural effusion.…”

“…It was categorized as an atypical finding in the international consensus statement of chest imaging in pediatric COVID-19 patients [31]. In a subgroup of studies, it has low prevalence: 17% according to Caro-Dominguez et al [27] and 18% according to Zhang et al [29]; other studies did not find any cases of thoracic lymphadenopathy [22,30,32] in children affected by COVID-19.…”

Neumonía por COVID-19 en niños: De su etiología a su manejo

“…En una serie de casos pediátricos de COVID-19, 30.8% de los pacientes presentaron dificultad respiratoria que requirió suplementación de oxígeno, y 23.1% ingresaron en la unidad de cuidados intensivos (UCI) por disfunción orgánica [ 15 ]. En otra serie de casos que incluyó 41 niños hospitalizados por COVID-19, 11 de ellos presentaron lesiones pulmonares compatibles con un cuadro de neumonía intersticial [ 16 ]. Adicionalmente, en una de las series pediátricas más extensas publicadas hasta ahora, que estudió 585 niños con infección por SARS-CoV2, 8% requirieron ingresar a la UCI, y 4% necesitaron ventilación mecánica [ 17 ].…”