Imaging Findings of SARS-CoV-2 infection in Pediatrics: A Systematic Review of Coronavirus Disease 2019 (COVID-19) in 850 Patients

Katal, Sanaz; Johnston, Sean; Johnston, Jennifer; Gholamrezanezhad, Ali

RATIONALE AND OBJECTIVES: Children with COVID-19 infection seem to have a relatively milder illness and a better prognosis; however, severe illness or death could still occur in this age group. Although the information on the epidemiology of COVID‐19 in pediatric patients is being accumulated, relevant comprehensive reports on its radiological manifestations are lacking. The present article reviews the radiological characteristics of COVID‐19 in pediatrics, based on the previous studies. MATERIALS AND METHODS: We conducted a systematic literature search for published articles by using Medline, Scopus, Google Scholar and Embase online databases. All studies describing CT findings of COVID-19 in pediatrics (<18years) were included. RESULTS: A total of 39 studies with 850 pediatric patients were reviewed. 225 (26.5%) of patients had normal CT findings. Ground-glass opacities and consolidations were the most common CT abnormalities (384/625, 61.5%). Other findings were halo sign, interstitial opacities, bronchial pneumonia-like changes, bronchial wall thickening, and crazy-paving sign. Approximately 55% of patients had unilateral pulmonary findings. Most studies found peripheral and lower-lobe distribution to be a prominent finding. CONCLUSION: Our study showed that imaging findings in children were often milder and more focal than adults, typically as ground-glass opacities and consolidations with unilateral lower-lobe predominance, which have been regressed during the recovery time. A balance must be struck between the risk of radiation and the need for chest CT. If still necessary, low-dose CT is more appropriate in this age group. Albeit, due to the limited number of reported pediatrics with COVID-19, and the lack of consistency in CT descriptors, further work is still needed in this regard.