Clinical and CT features in pediatric patients with COVID-19 infection: Different points from adults

Abstract

Purpose: To discuss the different characteristics of clinical, laboratory, and chest computed tomography (CT) in pediatric patients from adults with 2019 novel coronavirus (COVID-19) infection.

Methods: The clinical, laboratory, and chest CT features of 20 pediatric inpatients with COVID-19 infection confirmed by pharyngeal swab COVID-19 nucleic acid test were retrospectively analyzed during 23 January and 8 February 2020. The clinical and laboratory information was obtained from inpatient records. All the patients were undergone chest CT in our hospital.

Results: Thirteen pediatric patients (13/20, 65%) had an identified history of close contact with COVID-19 diagnosed family members. Fever (12/20, 60%) and cough (13/20, 65%) were the most common symptoms. For laboratory findings, procalcitonin elevation (16/20, 80%) should be pay attention to, which is not common in adults. Coinfection (8/20, 40%) is common in pediatric patients. A total of 6 patients presented with unilateral pulmonary lesions (6/20, 30%), 10 with bilateral pulmonary lesions (10/20, 50%), and 4 cases showed no abnormality on chest CT (4/20, 20%). Consolidation with surrounding halo sign was observed in 10 patients (10/20, 50%), ground-glass opacities were observed in 12 patients (12/20, 60%), fine mesh shadow was observed in 4 patients (4/20, 20%), and tiny nodules were observed in 3 patients (3/20, 15%).

Conclusion: Procalcitonin elevation and consolidation with surrounding halo signs were common in pediatric patients which were different from adults. It is suggested that underlying coinfection may be more common in pediatrics, and the consolidation with surrounding halo sign which is considered as a typical sign in pediatric patients.

Keywords: COVID-19; child; clinical features; infection; tomography.

Figure 1

A, Female, 14 years old. Chest CT showed scattered ground‐glass opacities in the inferior lobe of the right lung, located subpleural or extended from subpleural lesions. B, Male, 10 years old. Chest CT showed consolidation with halo sign in the inferior lobe of the left lung surrounded by ground‐glass opacities. C, Male, 1 year old. Chest CT showed diffused consolidations and ground‐glass opacities in both lungs, with a "white lung" appearance of the right lung. CT, computed tomography

Figure 2

A, Male, 3 years old. On admission, chest CT showed consolidation in the posterior segment of the upper lobe of the left lung with a surrounded halo sign. B, Female, 8 years old. On admission, chest CT showed patchy consolidation with halo sign in the basal segment of the inferior lobe of the right lung, and ground‐glass opacities in the inferior lobe of the left lung. C, Male, 14 years old. On admission, chest CT showed consolidation with halo sign in the lingular segment of the left lung, and fibrous cords in both lungs. D, The same patient of (A), 11 days after admission, chest CT showed that the consolidation in the posterior segment of the upper lobe of the left lung was disappeared. E, The same patient of (B), 4 days after admission, chest CT showed shrunken lesions with lower density in the inferior lobes of both lungs. F, The same patient of (C), 3 days after admission, chest CT showed a contraction of consolidation in lingular segment of the left lung, the disappearance of halo sign, and fibrous cords left in both lungs. CT, computed tomography