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. 2021:8:100337.
doi: 10.1016/j.ejro.2021.100337. Epub 2021 Mar 11.

Chest radiograph in hospitalized children with COVID-19. A review of findings and indications

Andrea Ilundain López de Munain  1 , Cristina Jimenez Veintemilla  2 , Mercedes Herranz Aguirre  3   4   5 , Natividad Viguria Sánchez  5   6 , Beatriz Ramos-Lacuey  1 , María Urretavizcaya-Martínez  1 , Laura Echeverría Esandi  1 , María Del Mar Pina López  1 , Marcos García Howard  1 , Alejandro Fernández-Montero  5   7   8 , Laura Moreno-Galarraga  5   6
Affiliations

Chest radiograph in hospitalized children with COVID-19. A review of findings and indications

Andrea Ilundain López de Munain et al. Eur J Radiol Open. 2021.

Abstract

Purpose: Many articles have been published regarding chest-imaging in COVID-19, but fewer studies have been published in pediatric populations. COVID-19 symptoms in children are generally milder and radiological tests have fewer positive findings. Indications for chest imaging in pediatric COVID-19 patients remain unclear. This study aims to describe the chest radiographs performed in COVID-19 patients in a pediatric hospital, to review the current chest X-ray indications and to develop an specific age-adjusted protocol for chest-imaging in children with COVID-19.

Methods: Retrospective study in hospitalized pediatric COVID-19 patients in Navarre, Spain. Between March and December 2020, 44 children were included (mean age 3.8-year-old, 50 % males). Demographic information, cause of admission, symptoms, and clinical evolution were described. Chest imaging technique performed, indications and findings were analyzed. A literature review was performed searching for current COVID-19 pediatric chest-imaging indications.

Results: Chest X-rays were performed in 35 patients (80 % of admissions) and most common indications were fever and respiratory symptoms. 53 % of the chest X-rays were considered "normal" and the classical bilateral diffuse interstitial pattern, described in adults, was only present in 22 %. All patients with pathological chest X-rays were symptomatic and reported fever (100 %) and fever tended to be longer (fever duration: 4.25 vs. 2.46 days p:0.048) in patients with pathological radiographs. We present a specific protocol for chest-imaging in pediatric COVID-19 cases.

Conclusions: COVID-19 clinical manifestations and radiological findings are milder and less specific in children. Imaging should not be used as a screening tool or a routine complementary test in pediatric COVID-19 patients, not even in hospitalized cases.

Keywords: COVID-19; Chest X-ray indications; Children; Paediatric radiology; SARS-CoV-2; Thoracic imaging.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
includes anteroposterior chest radiographs of two pediatric COVID-19 patients with the classical COVID-19 pneumonia, with a bilateral diffuse interstitial pattern.
Fig. 2
Fig. 2
shows an anteroposterior chest radiograph of a 3-year-old pediatric patient with COVID-19, with unliteral interstitial pattern in the right lower lobe.
Fig. 3
Fig. 3
is from a 13-year-old girl with fever, dyspnea and cough, diagnosed of COVID-19 pneumonia. Anteroposterior chest radiograph shows a focal consolidation in the left upper lobe.
Fig. 4
Fig. 4
Progression of parenchyma lesions. Bilateral interstitial infiltrates that change in location and distribution in the successive chest X-rays performed during hospital admission in a 5-year-old girl with fever, cough, and progressive dyspnea (Fig. 4A was performed at admission and Fig. 4B 48 h later).
Fig. 5
Fig. 5
shows a chest radiograph of a 4-year-old pediatric patient with COVID-19, presenting with prolonged fever. A perihilar bronchial wall thickening was detected.
See this image and copyright information in PMC

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