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Thoracic imaging of coronavirus disease 2019 (COVID-19) in children: a series of 91 cases.
Pediatr Radiol. 2020 09; 50(10):1354-1368.PR

Abstract

BACKGROUND

Pulmonary infection with SARS-CoV-2 virus (severe acute respiratory syndrome coronavirus 2; COVID-19) has rapidly spread worldwide to become a global pandemic.

OBJECTIVE

To collect paediatric COVID-19 cases worldwide and to summarize both clinical and imaging findings in children who tested positive on polymerase chain reaction testing for SARS-CoV-2.

MATERIALS AND METHODS

Data were collected by completion of a standardised case report form submitted to the office of the European Society of Paediatric Radiology from March 12 to April 8, 2020. Chest imaging findings in children younger than 18 years old who tested positive on polymerase chain reaction testing for SARS-CoV-2 were included. Representative imaging studies were evaluated by multiple senior paediatric radiologists from this group with expertise in paediatric chest imaging.

RESULTS

Ninety-one children were included (49 males; median age: 6.1 years, interquartile range: 1.0 to 13.0 years, range: 9 days-17 years). Most had mild symptoms, mostly fever and cough, and one-third had coexisting medical conditions. Eleven percent of children presented with severe symptoms and required intensive unit care. Chest radiographs were available in 89% of patients and 10% of them were normal. Abnormal chest radiographs showed mainly perihilar bronchial wall thickening (58%) and/or airspace consolidation (35%). Computed tomography (CT) scans were available in 26% of cases, with the most common abnormality being ground glass opacities (88%) and/or airspace consolidation (58%). Tree in bud opacities were seen in 6 of 24 CTs (25%). Lung ultrasound and chest magnetic resonance imaging were rarely utilized.

CONCLUSION

It seems unnecessary to perform chest imaging in children to diagnose COVID-19. Chest radiography can be used in symptomatic children to assess airway infection or pneumonia. CT should be reserved for when there is clinical concern to assess for possible complications, especially in children with coexisting medical conditions.

Authors+Show Affiliations

Unidad de Radiologia Pediatrica, Servicio de Radiologia, Hospital Universitario Virgen del Rocio, Avenida Manuel Siurot s/n, CP 41013, Sevilla, Spain. pablocaro82@hotmail.com.Department of Clinical Radiology, Great Ormond Street Hospital for Children, NHS Trust, London, UK. UCL Great Ormond Street Institute of Child Health, London, UK. Department of Clinical Radiology, Great Ormond Street Hospital for Children, NHS Trust, London, UK.Department of Diagnostics, Pediatric Radiology, Geneva Children's Hospitals, Geneva, Switzerland.Department of Imaging, IRCCS Ospedale Pediatrico Bambino Gesu, Rome, Italy.Department of Imaging, IRCCS Ospedale Pediatrico Bambino Gesu, Rome, Italy.U.O.C. Radiologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy.Radiología Pediátrica, Servicio de Radiología, Hospital Universitario 12 de Octubre, Madrid, Spain.Radiología Pediátrica, Servicio de Radiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain.Neumología Pediátrica, Servicio de Pediatría, Hospital Universitario Jerez de la Frontera, Cádiz, Spain.Section of Pediatric Radiology, C. S. Mott Children's Hospital, Department of Radiology, Michigan Medicine, Ann Arbor, MI, USA.Department of Medical Imaging, University of Arizona College of Medicine, Tucson, AZ, USA.Department of Imaging, Instituto Nacional de Salud del Niño San Borja, Lima, Peru.Imaging Department, Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico.Radiologia Pediatrica, Sor Maria Ludovica Children's Hospital, La Plata, Argentina.Faculty of Medicine Novi Sad, University of Novi Sad, Institute for Children and Adolescents Health Care of Vojvodina, Novi Sad, Serbia.Paediatric Radiology Section, Children's Hospital Department of Radiology, Kayseri, Turkey.Paediatric Radiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece.Department of Radiology and Nuclear Medicine, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands.Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.Imaging Department, Trousseau Hospital, AP-HP, Sorbonne University, Paris, France.Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.Diagnostic Imaging, University Children's Hospital Zurich, Zurich, Switzerland.Department of Radiology, University Hospital of Heraklion, University of Crete, Crete, Greece.Department of Clinical Radiology, Great Ormond Street Hospital for Children, NHS Trust, London, UK. Department of Clinical Radiology, Sidra Medicine, Doha, Qatar.Paediatric Radiology, University Hospital of Leipzig, Leipzig, Germany.Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

32749530

Citation

Caro-Dominguez, Pablo, et al. "Thoracic Imaging of Coronavirus Disease 2019 (COVID-19) in Children: a Series of 91 Cases." Pediatric Radiology, vol. 50, no. 10, 2020, pp. 1354-1368.
Caro-Dominguez P, Shelmerdine SC, Toso S, et al. Thoracic imaging of coronavirus disease 2019 (COVID-19) in children: a series of 91 cases. Pediatr Radiol. 2020;50(10):1354-1368.
Caro-Dominguez, P., Shelmerdine, S. C., Toso, S., Secinaro, A., Toma, P., Damasio, M. B., Navallas, M., Riaza-Martin, L., Gomez-Pastrana, D., Ghadimi Mahani, M., Desoky, S. M., Ugas Charcape, C. F., Almanza-Aranda, J., Ucar, M. E., Lovrenski, J., Gorkem, S. B., Alexopoulou, E., Ciet, P., van Schuppen, J., ... van Rijn, R. R. (2020). Thoracic imaging of coronavirus disease 2019 (COVID-19) in children: a series of 91 cases. Pediatric Radiology, 50(10), 1354-1368. https://doi.org/10.1007/s00247-020-04747-5
Caro-Dominguez P, et al. Thoracic Imaging of Coronavirus Disease 2019 (COVID-19) in Children: a Series of 91 Cases. Pediatr Radiol. 2020;50(10):1354-1368. PubMed PMID: 32749530.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Thoracic imaging of coronavirus disease 2019 (COVID-19) in children: a series of 91 cases. AU - Caro-Dominguez,Pablo, AU - Shelmerdine,Susan Cheng, AU - Toso,Seema, AU - Secinaro,Aurelio, AU - Toma,Paolo, AU - Damasio,Maria Beatrice, AU - Navallas,María, AU - Riaza-Martin,Lucia, AU - Gomez-Pastrana,David, AU - Ghadimi Mahani,Maryam, AU - Desoky,Sarah M, AU - Ugas Charcape,Carlos F, AU - Almanza-Aranda,Judith, AU - Ucar,Maria Elena, AU - Lovrenski,Jovan, AU - Gorkem,Sureyya Burcu, AU - Alexopoulou,Efthymia, AU - Ciet,Pierluigi, AU - van Schuppen,Joost, AU - Ducou le Pointe,Hubert, AU - Goo,Hyun Woo, AU - Kellenberger,Christian J, AU - Raissaki,Maria, AU - Owens,Catherine M, AU - Hirsch,Franz Wolfgang, AU - van Rijn,Rick R, AU - ,, Y1 - 2020/08/04/ PY - 2020/04/13/received PY - 2020/05/25/accepted PY - 2020/05/14/revised PY - 2020/8/5/pubmed PY - 2020/9/17/medline PY - 2020/8/5/entrez KW - COVID-19 KW - Children KW - Computed tomography KW - Coronavirus KW - Imaging KW - Lower respiratory tract infection KW - Pneumonitis KW - Radiography SP - 1354 EP - 1368 JF - Pediatric radiology JO - Pediatr Radiol VL - 50 IS - 10 N2 - BACKGROUND: Pulmonary infection with SARS-CoV-2 virus (severe acute respiratory syndrome coronavirus 2; COVID-19) has rapidly spread worldwide to become a global pandemic. OBJECTIVE: To collect paediatric COVID-19 cases worldwide and to summarize both clinical and imaging findings in children who tested positive on polymerase chain reaction testing for SARS-CoV-2. MATERIALS AND METHODS: Data were collected by completion of a standardised case report form submitted to the office of the European Society of Paediatric Radiology from March 12 to April 8, 2020. Chest imaging findings in children younger than 18 years old who tested positive on polymerase chain reaction testing for SARS-CoV-2 were included. Representative imaging studies were evaluated by multiple senior paediatric radiologists from this group with expertise in paediatric chest imaging. RESULTS: Ninety-one children were included (49 males; median age: 6.1 years, interquartile range: 1.0 to 13.0 years, range: 9 days-17 years). Most had mild symptoms, mostly fever and cough, and one-third had coexisting medical conditions. Eleven percent of children presented with severe symptoms and required intensive unit care. Chest radiographs were available in 89% of patients and 10% of them were normal. Abnormal chest radiographs showed mainly perihilar bronchial wall thickening (58%) and/or airspace consolidation (35%). Computed tomography (CT) scans were available in 26% of cases, with the most common abnormality being ground glass opacities (88%) and/or airspace consolidation (58%). Tree in bud opacities were seen in 6 of 24 CTs (25%). Lung ultrasound and chest magnetic resonance imaging were rarely utilized. CONCLUSION: It seems unnecessary to perform chest imaging in children to diagnose COVID-19. Chest radiography can be used in symptomatic children to assess airway infection or pneumonia. CT should be reserved for when there is clinical concern to assess for possible complications, especially in children with coexisting medical conditions. SN - 1432-1998 UR - https://www.unboundmedicine.com/medline/citation/32749530/Thoracic_imaging_of_coronavirus_disease_2019__COVID_19__in_children:_a_series_of_91_cases_ L2 - https://dx.doi.org/10.1007/s00247-020-04747-5 DB - PRIME DP - Unbound Medicine ER -