Imaging Findings of SARS-CoV-2 Infection in Pediatrics: A Systematic Review of Coronavirus Disease 2019 (COVID-19) in 850 Patients

Abstract

Rationale and objectives: Children with COVID-19 seem to have a relatively milder disease and better prognosis; however, severe disease or death could still occur in this age group. Although the knowledge on the clinical and epidemiology of COVID-19 in pediatric patients is being accumulated rapidly, relevant comprehensive review on its radiological manifestations is still lacking. The present article reviews the radiological characteristics of COVID-19 in pediatrics, based on the previous studies.

Materials and methods: We conducted a systematic literature search for published articles by using Medline, Scopus, Google Scholar and Embase online databases. All studies describing CT findings of COVID-19 in pediatrics (<18years) were included.

Results: A total of 39 studies with 850 pediatric patients were reviewed. 225 (26.5%) of patients had normal CT findings. Ground-glass opacities and consolidations were the most common CT abnormalities (384/625, 61.5%). Other findings were halo sign, interstitial opacities, bronchial wall thickening, and crazy-paving sign. Approximately 55% of patients had unilateral pulmonary findings. Most studies found peripheral and lower-lobe distribution to be a prominent imaging finding.

Conclusion: Our study showed that imaging findings in children were often milder and more focal than adults, typically as ground-glass opacities and consolidations with unilateral lower-lobe predominance, which have been regressed during the recovery time. A balance must be struck between the risk of radiation and the need for chest CT. If still necessary, low-dose CT is more appropriate in this age group. Albeit, due to the limited number of reported pediatrics with COVID-19, and the lack of consistency in CT descriptors, further work is still needed in this regard.

Keywords: COVID-19; CT-scan; Chest imaging; Children; Lung; Pediatrics; Pneumonia; Radiation; SARS-CoV-2.

Fig. 2

A 14-year-old boy who presented with fever, malaise, and cough for a few days. CT images show small subpleural ground-glass opacifications (GGO) in the left lower lobe.

Fig. 3

A 14-year-old girl with COVID-19. CT image shows focal subpleural Ground-glass opacifications (GGO) with superimposed consolidation in the left lower lobe.

Fig. 4

A 3-week-old boy presented with a 2-day history of tachypnea, nasal congestion, and reduced feeding. Reverse-transcriptase-polymerase-chain-reacting testing of nasal swabs to detect SARS-CoV-2 were positive on day 7 after presentation. Chest radiograph demonstrates partial right upper lobe atelectasis and bilateral central streaky opacities.

Fig. 1

Preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow diagram. Diagram represents the review process and selection of included studies. Embase is a product of Elsevier. WHO = World Health Organization. Adapted from. Moher et al. (doi.org/10.1371/journal.pmed.1000097) ©2009, under terms of Creative Commons Attribution 4.0 International License (creativecommons.org/licenses/by/4.0/legalcode). (Color version of figure is available online.)