Imaging of children with COVID-19: experience from a tertiary children's hospital in the United States

Abstract

Background: Imaging of novel coronavirus disease 2019 (COVID-19) has been described in adults, but children have milder forms of disease. Pediatric imaging descriptions are of asymptomatic children, raising the question of whether imaging is needed in this patient group.

Objective: To describe the utilization and imaging findings in children with COVID-19 along with the comorbidities, treatment and short-term outcomes.

Materials and methods: We retrospectively reviewed pediatric patients who had a confirmed positive test for COVID-19 during a 2-month period. We noted symptoms and presence of imaging at presentation. Comorbidities were recorded for children with imaging. Children were categorized as having multisystem inflammatory syndrome in children (MIS-C) if they met criteria for the disorder. For children who were admitted to the hospital, we documented length of hospital stay, need for intensive care unit care/ventilator support, and treatment regimen. We evaluated all imaging for acute/chronic abnormalities including chest radiographs for interstitial or alveolar opacities, distribution/symmetry of disease, zonal predominance, and pleural abnormalities. We performed descriptive statistics and compared children with MIS-C with the cohort using a Fisher exact test.

Results: During the study period, 5,969 children were tested for COVID-19, with 313 (5%) testing positive. Of these, 92/313 (29%) were asymptomatic and 55/313 (18%) had imaging and were admitted to the hospital for treatment. Forty-one of 55 patients (75%) with imaging had comorbidities. Chest radiographs were the most common examination (51/55 patients, or 93%) with most demonstrating no abnormality (34/51, or 67%). Children with MIS-C were more likely to have interstitial opacities and pleural effusions. US, CT or MRI was performed in 23/55 (42%) children, 9 of whom had MIS-C. Only one chest CT was performed.

Conclusion: In our study, most pediatric patients with COVID-19 did not require hospital admission or imaging. Most children with imaging had comorbidities but children with MIS-C were more likely to have no comorbidities. Children with imaging mostly had normal chest radiography. Advanced imaging (US, CT, MRI) was less common for the care of these children, particularly CT examination of the chest and for children without MIS-C.

Keywords: COVID-19; Chest; Children; Computed tomography; Coronavirus; Multisystem inflammatory syndrome in children; Radiography; Utilization.

Fig. 1

Histogram demonstrates the number of positive cases of novel coronavirus disease 2019 (COVID-19) per day at our institution

Fig. 2

Radiography in a 14-year-old boy with a history of sickle cell disease who presented with dry cough. Anteroposterior chest radiograph demonstrates increased prominence of the interstitia of the lung bilaterally. The cardiac silhouette is enlarged, likely related to the boy’s underlying sickle cell disease

Fig. 3

Radiography in a 9-year-old girl who presented with fever. Anteroposterior chest radiograph demonstrates asymmetrical opacities within the right lung (arrows)

Fig. 4

Radiography in a 6-year-old girl with multisystem inflammatory syndrome in children (MIS-C) who presented with fever, vomiting and altered mental status. Anteroposterior chest radiograph demonstrates patchy bilateral interstitial and alveolar opacities within the lung

Fig. 5

Multisystem inflammatory syndrome in children (MIS-C) in a 9-year-old girl who presented with fever, decreased sense of smell, abdominal pain and diarrhea. a Anteroposterior chest radiograph demonstrates bilateral interstitial opacities with consolidation within the lung bases. b Transverse US image of the right lower quadrant demonstrates thickening of the terminal ileum (arrow). c Sagittal reconstruction from a contrast-enhanced CT again shows the thickened terminal ileum (arrow)