Imaging Features of Pediatric COVID-19 on Chest Radiography and Chest CT: A Retrospective, Single-Center Study

Abstract

Rationale and Objectives: This study aims to reveal the imaging features of Coronavirus Disease 2019 (COVID-19) in children. Materials and Methods: Sixty-nine chest radiographs and 37 chest CT examinations of 74 children (36 male; median (interquartile range) age:11 (6.25À15) years, 38 female; median (interquartile range) age: 12 (5.75À16) years) with positive real-time reverse transcription-polymerase chain reaction results between March 10 and May 31, 2020, were evaluated in this retrospective study. Differences in 0À<6, 6À<12, and 12À18 years of age groups were assessed with the Fisher's exact test or Kruskal-Wallis tests. Results: Right-sided (3/69, 4.3%) or bilateral (3/69, 4.3%) ground-glass opacities without significant difference in age groups were depicted as radiographic findings related to COVID-19 in children. Opacities were either single (7/37, 18.9%) or bilateral (7/37, 18.9%) around the distal third of the bronchovascular bundle on CT. There was no significant difference in the median size of the largest opacities, total numbers of opacities and involved lobes, and the distance of the closest opacity to the pleura among age groups (p > 0.05). The rate of ground-glass opacities with or without consolidation (17/37, 45.94%) was higher than consolidation alone (6/37, 16.2%). Feeding vessel sign (16/37, 43.2%), halo sign (9/37, 24.3%), pleural thickening (6/37, 16.2%), interlobular interstitial thickening (5/37, 13.5%), and lymphadenopathy (3/37, 8.1%) were other imaging findings. Conclusion: Unilateral or bilateral distributed ground-glass opacities often associated with feeding vessel sign, halo sign, and pleural thickening on chest CT without significant differences between age groups were findings of COVID-19 in children.

Pathophysiology and Imaging Findings of COVID-19 Infection: An Organ-system Based Review

“…A study by Bayramoglu, et al demonstrated that nearly half of children with COVID-19 had ground glass opacities either with or without accompanying consolidation. Further, they identified the feeding vessel sign, halo sign, pleural thickening, interlobular interstitial thickening, and lymphadenopathy as other frequent chest imaging signs in children with COVID-19 ( 107 ). A meta-analysis evaluating imaging findings of COVID-19 in 850 children demonstrated a 61.5% rate of ground glass opacities or consolidation.…”

Cardio-thoracic imaging and COVID-19 in the pediatric population: A narrative review

“…Although the concept that radiological manifestations of COVID-19 vary among different age group, information about sensitivity, specificity and characteristic findings of chest X-ray in the pediatric population are limited and conflicting[ 11 ].…”

“…Peribronchial thickening is however aspecific and can be seen in other variant of viral pneumonia in children, while hyperinflation, which is another recognized hallmark, was not reported. Reason for chest X-ray low sensitivity is the higher prevalence of lower density, smaller size and basal opacities, obscured by the diaphragm and hepatic dome[ 11 ].…”

Mediastinal lymphadenopathy in COVID-19: A review of literature

“…In the case report of 2 cases by of elderly female and male 1/6/10R and 2R/4R/4L respectively on the both their first CT chest and their repeat CT chest after 6 d[ 19 ]. In a retrospective review of CT chest in pediatric patients with COVID-19, mediastinal lymphadenopathy was found in 0%-8.1% of the cases[ 20 , 21 ]. Mediastinal lymphadenopathy was not reported in pregnancy patients with COVID-19[ 22 ].…”