Pediatric chest x-ray in covid-19 infection

Abstract

Background: The outbreak of COVID-19 has become pandemic. Pediatric population has been less studied than adult population and prompt diagnosis is challenging due to asymptomatic or mild episodes. Radiology is an important complement to clinical and epidemiological features.

Objective: To establish the most common CXR patterns in children with COVID-19, evaluate interobserver correlation and to discuss the role of imaging techniques in the management of children.

Materials and methods: Forty-four patients between 0 and 16 years of age with confirmed SARS-Cov-2 infection and CXR were selected. Two paediatric radiologists independently evaluated the images and assessed the type of abnormality, distribution and evolution when available.

Results: Median age was 79.8 months (ranging from 2 weeks to 16 years of age). Fever was the most common symptom (43.5 %). 90 % of CXR showed abnormalities. Peribronchial cuffing was the most common finding (86.3 %) followed by GGOs (50 %). In both cases central distribution was more common than peripheral. Consolidations accounted for 18.1 %. Normal CXR, pleural effusion, and altered cardiomediastinal contour were the least common.

Conclusion: The vast majority of CXR showed abnormalities in children with COVID-19. However, findings are nonspecific. Interobserver correlation was good in describing consolidations, normal x-rays and GGOs. Imaging techniques have a role in the management of children with known or suspected COVID-19, especially in those with moderate or severe symptoms or with underlying risk factors.

Keywords: COVID 19; Outbreak; Paediatric; Paediatric imaging; Pneumonia; Radiology; SARS-CoV-2; Thoracic imaging.

Fig. 1

Two different children with COVID-19. A and B a fourteen-year-old boy with fever and cough. A. Chest x-ray shows diffuse areas of peri-bronchial thickening. There is slight predominance in the parahiliar regions. B. Magnified right lower lobe shows dense cuff surrounding an aerated bronchus. C. corresponds to a ten-year-old girl with patchy bilateral ground-glass opacities (arrows).

Fig. 2

Distribution of peribronchial cuffing in the lungs.

Fig. 3

Distribution of GGOs in the lungs.

Fig. 4

A. Baseline CXR in a ten-year-old boy with fever, cough, and dyspnoea. There were multifocal GGOs in both lungs and a consolidation in left inferior lobe. The consolidation is depicted as an increased retrocardiac density and loss of the silhouette of the diaphragm. B. Diffuse bilateral coalescent consolidations appeared 24 h after. No pleural effusion was seen on ultrasound. Findings were consistent with acute respiratory distress syndrome. C. In the follow up CXR 24 h later, bilateral progression was seen. D. 8 days after the initial radiograph most of the lung injury had already resolved.

Fig. 5

Six-year-old female with COVID-19 pneumonia. She had previous history of pulmonary involvement of systemic sclerosis. Coronal contrast-enhanced CT-scan (lung window) after bronchoscopy. Extensive pneumomediastinum, right basal pneumothorax and subcutaneous emphysema. Patchy bilateral subpleural GGOs and left lower lobe consolidation.