Computed tomography features of COVID-19 in children

Abstract

Background: There are few reports on the chest computed tomography (CT) imaging features of children with coronavirus disease 2019 (COVID-19), and most reports involve small sample sizes. Objectives: To systematically analyze the chest CT imaging features of children with COVID-19 and provide references for clinical practice. Data sources: We searched PubMed, Web of Science, and Embase; data published by Johns Hopkins University; and Chinese databases CNKI, Wanfang, and Chongqing Weipu. Methods: Reports on chest CT imaging features of children with COVID-19 from January 1, 2020 to August 10, 2020, were analyzed retrospectively and a meta-analysis carried out using Stata12.0 software. Results: Thirty-seven articles (1747 children) were included in this study. The heterogeneity of meta-analysis results ranged from 0% to 90.5%. The overall rate of abnormal lung CT findings was 63.2% (95% confidence interval [CI]: 55.8%–70.6%), with a rate of 61.0% (95% CI: 50.8%–71.2%) in China and 67.8% (95% CI: 57.1%–78.4%) in the rest of the world in the subgroup analysis. The incidence of ground-glass opacities was 39.5% (95% CI: 30.7%–48.3%), multiple lung lobe lesions was 65.1% (95% CI: 55.1%–67.9%), and bilateral lung lesions was 61.5% (95% CI: 58.8%–72.2%). Other imaging features included nodules (25.7%), patchy shadows (36.8%), halo sign (24.8%), consolidation (24.1%), air bronchogram signs (11.2%), cord-like shadows (9.7%), crazy-paving pattern (6.1%), and pleural effusion (9.1%). Two articles reported 3 cases of white lung, another reported 2 cases of pneumothorax, and another 1 case of bullae. Conclusions: The lung CT results of children with COVID-19 are usually normal or slightly atypical. The lung lesions of COVID-19 pediatric patients mostly involve both lungs or multiple lobes, and the common manifestations are patchy shadows, ground-glass opacities, consolidation, partial air bronchogram signs, nodules, and halo signs; white lung, pleural effusion, and paving stone signs are rare. Therefore, chest CT has limited value as a screening tool for children with COVID-19 and can only be used as an auxiliary assessment tool.

Bilateral Spontaneous Pneumothorax in a Child with Multisystem Inflammatory Syndrome Associated with COVID-19

“…Spontaneous pneumothorax is rarely reported in pediatric COVID-19 patients (8,10). A systematic review of 37 articles on CT features in pediatric COVID-19 patients found only two cases of pneumothorax and one case of bullae, none of which was bilateral (10).…”

“…Spontaneous pneumothorax is rarely reported in pediatric COVID-19 patients (8,10). A systematic review of 37 articles on CT features in pediatric COVID-19 patients found only two cases of pneumothorax and one case of bullae, none of which was bilateral (10). Hashemi et al (12) described a two-year-old boy with hyper IgM syndrome and COVID-19 infection who developed unilateral spontaneous pneumothorax during the hospital stay.…”

“…Spontaneous pneumothorax can occur in people without (primary type) or with (secondary type) a pre-existing chronic lung disease or positive history of trauma (7). Although several cases of spontaneous pneumothorax are reported in COVID-19, mostly elderly male patients with underlying conditions (8,9); it is even rarer in pediatric COVID-19 patients (10) presented in a few case reports (11)(12)(13)(14). Moreover, bilateral spontaneous pneumothorax is reported much less than unilateral cases (11,14,15).…”

Evidence and rationale for vaccinating children and adolescents against SARS-CoV-2: a comprehensive narrative review

“…However, it is associated with unfavorable outcomes, namely the development of acute respiratory distress syndrome (ARDS), requiring invasive mechanical ventilation [23][24][25][26][27]. Regarding pulmonary imaging, the chest computed tomography (CT) scan findings are mild or slightly atypical in most children with real-time reverse transcription-polymerase chain reaction (RT-PCR) confirmed SARS-CoV-2 infection, whereas ground-glass opacities, multiple patchy shadows and consolidations-in either unilateral or bilateral distribution-are indicative of more extensive lung involvement, hence more severe clinical features [21,[28][29][30]. SARS-CoV-2 can also affect the gastrointestinal tract, with consistently elevated incidence in children compared to adults [24].…”

New coronavirus infection (COVID-19) and respiratory diseases / pathological conditions

“…В систематическом обзоре и метаанализе результатов рентгенографии грудной клетки при COVID-19 отмечено, что в отличие от паренхиматозных аномалий пневмоторакс (1%, 95% ДИ: 0-3%) встречается редко [55]. В педиатрической практике при проведении КТ в метаанализе 37 публикаций (1 747 детей) пневмоторакс был отмечен лишь в двух случаях [56].…”