Novel coronavirus disease 2019 (COVID-19) outbreak in children in Iran: Atypical CT manifestations and mortality risk of severe COVID-19 infection

Abstract

Background: During the coronavirus disease 2019 (COVID-19) pandemic, Iran reported its first confirmed cases of syndrome coronavirus 2 (SARS-CoV-2) infections on 19 February 2020 in Qom. Although the numbers of cases are increasing, no report about clinical manifestations, laboratory results, and imaging findings of the children infected with COVID-19 in Iran has been published. The aim of this study was to evaluate the epidemiological, clinical, and radiological and laboratory findings of 24 children who had proven SARS-CoV-2 infection and performed chest computed tomographic (CT) in Qom, Iran.

Methods: Demographic information and clinical characteristics of the patients including signs and symptoms, chest CT scan manifestation, laboratory findings and clinical outcomes were collected. Diagnosing of the confirmed case was based on positive real-time reverse-transcriptase-polymerase-chain-reaction test for SARS-CoV-2.

Findings: During the first 3 months of the epidemic in Qom, Iran, 24 children with confirmed diagnosis of COVID-19 were included. The median age of the cases was 6 years [inter-quartile range 3.5-9.5 years]. The most common presenting symptoms were fever (100%), dry cough (62.5%), tachypnea (29%), abdominal pain (21%), and vomiting (21%). Three cases (12.5%) presented with a history of diarrhea in addition to fever and cough. According to the chest CT findings, 2 cases (8%) showed no abnormality. Typical CT findings were found in 6 patients (25%), 2 patients showed indeterminate appearance, and 14 patients (58%) showed atypical findings. Two children with SARS-CoV-2 infection manifested as a hyperinflammatory syndrome with multi-organ involvement similar to Kawasaki disease shock syndrome. Seventy-one percent of the patients showed severe SARS-CoV-2 infection and the mortality of 12.5% (3 cases) were reported.

Interpretation: High frequency of atypical chest CT finding in children should raise concern for pediatricians. Early recognition of patients with SARS-CoV-2 infection is of crucial importance in controlling of the outbreak and atypical imaging features should be interpreted with caution.

Keywords: Atypical CT appearance; COVID-19; CT scan; Children; Iran.

Fig. 1

Atypical CT scan findings: a) complete lobar consolidation in left upper lobe (arrow) with left side pleural effusion (asterisk); b) A small cavity (arrow) with adjacent consolidation (thin solid arrow) in right lower lobe, c) A large area of cavitation/bronchiectasis with surrounding consolidation in right lower lobe (arrow). Diffuse ground glass opacity (asterisk) is seen in left lower lobe, which later progresses to air space opacity (not shown); d) A small nodule with surrounding ground glass halo in upper portion of pulmonary right lower lobe; e) Ground glass/patchy air space opacities are seen in bilateral lower lobes. Reticular opacities are also seen in lower aspects of the lungs, with bilateral pleural effusion; f) Mid pleural effusion is seen posterior to lower aspect of right lung with adjacent small parenchymal band/atelectasis in right lower lobe.