Chest CT imaging characteristics of COVID-19 pneumonia in preschool children: a retrospective study

Abstract

Background: Recently, the World Health Organization has declared the coronavirus disease 2019 (COVID-19) outbreak a public health emergency of international concern. So far, however, limited data are available for children. Therefore, we aimed to investigate the clinical and chest CT imaging characteristics of COVID-19 in preschool children.

Methods: From January 26, 2020 to February 20, 2020, the clinical and initial chest CT imaging data of eight preschool children with laboratory-confirmed COVID-19 from two hospitals were retrospectively collected. The chest CT imaging characteristics, including the distribution, shape, and density of lesions, and the pleural effusion, pleural changes, and enlarged lymph nodes were evaluated.

Results: Two cases (25%) were classified as mild type, and they showed no obvious abnormal CT findings or minimal pleural thickening on the right side. Five cases (62.5%) were classified as moderate type. Among these patients, one case showed consolidation located in the subpleural region of the right upper lobe, with thickening in the adjacent pleura; one case showed multiple consolidation and ground-glass opacities with blurry margins; one case displayed bronchial pneumonia-like changes in the left upper lobe; and two cases displayed asthmatic bronchitis-like changes. One case (12.5%) was classified as critical type and showed bronchial pneumonia-like changes in the bilateral lungs, presenting blurred and messy bilateral lung markings and multiple patchy shadows scattered along the lung markings with blurry margins.

Conclusions: The chest CT findings of COVID-19 in preschool children are atypical and various. Accurate diagnosis requires a comprehensive evaluation of epidemiological, clinical, laboratory and CT imaging data.

Keywords: COVID-19; Child; Multidetector computed tomography; Pneumonia; SARS-CoV-2.

Fig. 1

Chest CT images of a 3-year-old male patient show patchy consolidation located in the subpleural region of the right upper lobe (red box), with thickening in the adjacent pleura (red arrow)

Fig. 2

Chest CT images of a 2-year-old female patient show multiple patchy/nodular ground-glass opacity and consolidation, with blurry margins; the patchy/nodular consolidation is mostly located in the mid and inner zones of the both lower lung lobe (A-D, red boxes and triangles), with high density inside the lesions and relatively low density in the periphery, presenting a “halo sign” appearance; the GGO was located in the outer zone of the left upper lobe (B, red arrow)

Fig. 3

Chest CT images of a 3-year-old female patient show bronchial pneumonia-like changes in the left upper lobe, with multiple high-density nodular shadows and patchy ground-glass opacity along the bronchovascular bundles (A-D, red box). Thickening of the right interlobar pleura is also shown (B, red arrow)

Fig. 4

Chest CT images of a 2-year-old female patient show multiple saccular lucency shadows in bilateral lower lobes with unclear margins (red arrows)

Fig. 5

Chest CT images of a 1-year-old male patient with a coinfection of SARS-CoV-2 and mycoplasma show bronchial pneumonia-like changes in both lungs, especially the left lung, presenting blurred and messy bilateral lung markings and multiple patchy shadows scattered along the lung markings with blurry margins. Air bronchogram is also shown (red arrows)