Chest CT findings of COVID-19-infected patients, are there differences between pediatric and adult patients? A systematic review

Abstract

Background: Purpose of this study was to deliver a report of chest CT findings of COVID-19-infected pediatric and adult patients and to make an age-based comparison. A systematic search was conducted in accordance with PRIS MA guidelines to identify relevant studies in the electronic databases of PubMed, Scopus, ProQuest, ScienceDirect, and Web of Sciences from January 1, 2020 to March 27, 2020 using search terms in the titles and abstracts. Based on our inclusion and exclusion criteria, 762 articles were screened. Finally, 15 eligible articles which had adequate data on chest CT findings of COVID-19-infected patients were enrolled in this systematic review. Results: In pediatric patients (15 years old or younger), peripheral distribution was found in 100% of cases, ground glass opacities (GGO) in 55.2%, bilateral involvement in 50%, halo sign in 50%, unilateral involvement in 30%, consolidation in 22.2%, crazy paving pattern in 20%, nodular opacities in 15%, pleural effusion in 4.2%, lymphadenopathy in none, and normal imaging in 20.8% of cases. On the other hand, in adult patients, bilateral involvement was reported in 76.8%, GGO in 68.4%, peripheral distribution in 62.2%, mixed GGO and consolidation in 48.7%, consolidation in 33.7%, crazy paving pattern in 27.7%, mixed central and peripheral distribution in 25.0%, unilateral involvement in 15.2%, nodular opacities in 9.2%, pleural effusion in 5.5%, central distribution of lesions in 5.4%, lymphadenopathy in 2.4%, and normal imaging in 9.8% of cases. Conclusion: According to the findings of this systematic review, children infected with COVID-19 can present with normal or atypical findings (nodular opacities/unilateral involvement) in chest imaging more frequently than adult patients. Therefore, more caution should be taken to avoid misdiagnosis or missed diagnosis in infected children. Besides, clinical and laboratory findings need to be considered more decision-making for pediatric patients with normal or atypical chest CT scan but high suspicion of COVID-19.

The mean severity score and its correlation with common computed tomography chest manifestations in Egyptian patients with COVID-2019 pneumonia

“…The reverse halo sign (atoll sign) (i.e., areas of GGO with peripheral consolidation) is frequently observed [ 3 ]; in this study, the frequency of the reverse halo sign was 12%. Furthermore, the halo sign, which is a consolidative nodule or mass with peripheral GGO, was found in 11% of the patients in this study; it is uncommon in adults and could reach 50% in children [ 18 ]. The pleural transparent line or subpleural sparing is another CT sign found in 26.5%, whereas in previous studies, the reported frequency of subpleural sparing was 6–53.2% [ 15 , 16 ].…”

Pulmonary Target Sign: A New Finding or a Neglected Feature?

“…We believe that PTS in COVID-19 is more common than expected because; (1) it may still be unfamiliar to radiologists as we saw it in previous published papers where it was not mentioned ( 2 , 3 ), (2) it may be mistaken for the atoll sign (difference is the central part; dense dot vs. central ground glass opacities) ( 4 , 5 ), (3) many pictorial derivatives such as double or incomplete outer dense rings may be seen ( 6 ), and (4) its possible confusion with organizing pneumonia which pathophysiologically makes this appearance possible in the early stages of the disease ( 7 , 8 ). At the early stage of COVID-19 when solitary lobule and its central bronchiole and artery become inflamed and fibrin and secretions began to fill the alveoli, PTS may be initially visible.…”

COVID-19 in Children: Respiratory Involvement and Some Differences With the Adults

“…The more pronounced difference between the groups corresponds to a higher frequency of unilateral lesions (30% of cases) and nodules (15%) in children ( 70 , 71 ); this implies that atypical presentations should be considered more often in pediatrics ( 67 ). Also, ~20% of the pediatric population have normal CT, which reinforces the importance of its performance in selected cases ( 70 ).…”

“…In comparison to adults, children have a generalized peripheral distribution of lesions ( 68 ) and a lower percentage of cases with GGOs, consolidation, crazy paving pattern, pleural effusion, and bilateral compromise ( 70 ). The more pronounced difference between the groups corresponds to a higher frequency of unilateral lesions (30% of cases) and nodules (15%) in children ( 70 , 71 ); this implies that atypical presentations should be considered more often in pediatrics ( 67 ). Also, ~20% of the pediatric population have normal CT, which reinforces the importance of its performance in selected cases ( 70 ).…”