Coronavirus disease 2019 (COVID-19) in children: a systematic review of imaging findings

Abstract

Background COVID-19 is a novel coronavirus infection that can cause a severe respiratory illness and has been declared a pandemic by the World Health Organization (WHO). Because children appear to be less severely affected than adults, their imaging appearances have not been extensively reported. Objective To systematically review available literature regarding imaging findings in paediatric cases of COVID-19. Materials and methods We searched four databases (Medline, Embase, Cochrane, Google Scholar) for articles describing imaging findings in children with COVID-19. We included all modalities, age <18 years, and foreign language articles, using descriptive statistics to identify patterns and locations of imaging findings, and their association with outcomes. Results Twenty-two articles were included, reporting chest imaging findings in 431 children, of whom 421 (97.7%) underwent CT. Criteria for imaging were lacking. At diagnosis, 143/421 (34.0%) had a normal CT. Abnormalities were more common in the lower lobes and were predominantly unilateral. The most common imaging pattern was ground-glass opacification (159/255, 62.4%). None of the studies described lymphadenopathy, while pleural effusions were rare (three cases). Improvement at followup CT imaging (3-15 days later) was seen in 29/100 (29%), remained normal in 25/100 (25%) and progressed in 9/100 (9%). Conclusion CT chest findings in children with COVID-19 are frequently normal or mild. Lower lobes are predominantly affected by patchy ground-glass opacification. Appearances at follow-up remain normal or improve in the majority of children. Chest CT imaging adds little to the further management of the patient and should be reserved for severe cases or for identifying alternative diagnoses.

COVID 19 infection: Pediatric perspectives

“…21 It appears that COVID-19 occurs more often among the 12-to 17-year age group compared to the 5-to 11-year age group in the United States. 22 In a multicenter study of 48 Most children are thought to be exposed to the virus from an adult at home. 29 Currently, no evidence exists of vertical transmission from mother to child.…”

COVID-19 and obesity in childhood and adolescence: a clinical review

“… 3 , 4 , 13 , 31 In a systematic review that analyzed chest computed tomography of under 18 age patients, ‘ground glass’ opacification was observed in 37.8% of examinations, most commonly unilateral in lower lobes, and was considered mild. 32 …”

Chest radiograph features of multisystem inflammatory syndrome in children (MIS-C) compared to pediatric COVID-19

“…They have presented with signs of hyperinflammation and multi-organ dysfunction [ 8 , 9 ], often developing myocarditis [ 10 ] and cardiorespiratory failure, and occasionally dying [ 5 , 6 ]. Although the radiographic features of COVID-19 in children have been characterized [ 11 ], data describing the radiographic findings of MIS-C are limited [ 12 ].…”