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Published on: December 19, 2020
Differences in Clinical and Imaging Presentation of Pediatric Patients with COVID-19 in Comparison with Adults
Amei Chen1, Jun-Xiang Huang1, Yuting Liao1
1Department of Radiology, Guangzhou First Hospital, The Second Affiliated Hospital, South China University of Technology, No. 1 Panfu Road, Guangzhou 510180, China (A.C., Z.L., D.C., R.Y., X.W.); Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China (J.H.); GE Healthcare, Guangzhou, China (Y.L.); and Department of Geriatrics, Guangzhou First People's Hospital, The Second Affiliated Hospital, South China University of Technology, Guangzhou, China (C.Y.).
Insights
Pediatric patients with coronavirus disease 2019 (COVID-19) exhibit milder symptoms and less extensive lung involvement on chest CT scans compared to adults. Bronchial wall thickening is a more frequent finding in children with COVID-19.
Area of Science:
- Radiology
- Infectious Diseases
- Pediatrics
Background:
- Coronavirus disease 2019 (COVID-19) affects both pediatric and adult populations.
- Initial clinical and imaging presentations of COVID-19 can vary between age groups.
Purpose of the Study:
- To characterize and compare the initial clinical and imaging features of COVID-19 in pediatric versus adult patients.
- To identify distinct patterns of COVID-19 presentation in children and adults using chest CT.
Main Methods:
- Retrospective analysis of chest CT scans from 61 laboratory-confirmed COVID-19 patients (14 pediatric, 47 adult).
- Comparison of clinical symptoms, serum markers, and CT findings between pediatric and adult groups.
- Chest CT performed within 3 days of initial RT-PCR testing.
Main Results:
- Pediatric patients presented with less frequent fever (42.9% vs 83%) and milder clinical grades (P = .001).
- COVID-19 patients in both groups showed commonality in certain serum markers, but pediatric patients had fewer positive CT findings (P = .004).
- Chest CT revealed reduced lobe involvement (P = .012) and more frequent bronchial wall thickening (P = .048) in pediatric patients, with overall lower lung involvement scores (P < .001).
Conclusions:
- Pediatric patients with COVID-19 demonstrate distinct clinical and CT imaging features compared to adults.
- Children typically experience milder symptoms, fewer positive CT findings, and less extensive lung disease.
- Bronchial wall thickening is a relatively more common CT finding in pediatric COVID-19 cases.
Purpose:
To characterize and compare the initial clinical and imaging features of coronavirus disease 2019 (COVID-19) in pediatric and adult patients undergoing chest CT.
Materials And Methods:
A total of 61 patients, consisting of 47 adults (aged 18 years or older) and 14 pediatric patients (aged younger than 18 years) with laboratory-confirmed COVID-19 confirmed by real-time reverse-transcription polymerase chain reaction between January 25 and February 15, 2020, were enrolled in this study. All patients underwent chest CT within 3 days after the initial reverse transcription polymerase chain reaction test. The clinical presentation, serum markers, and CT findings were assessed and compared between the adult and pediatric patients.
Results:
Fever was less common in pediatric patients than in adults (six of 14, 42.9% vs 39 of 47, 83%; P = .008). Leukopenia or normal, lymphopenia or normal, and increased or normal C-reactive protein level were common in both groups with no difference (P > .05). Compared with the adults, pediatric patients had a lower rate of positive CT findings and a milder clinical grade (P = .004 and P = .001, respectively). At chest CT, the number of pulmonary lobes involved was found to be reduced in pediatric patients when compared with adults (P = .012). Subpleural distribution of lung opacities was a dominant feature in both groups, whereas bronchial distribution was more common in the pediatric group (P = .048). Among the CT features in adults, ground-glass opacities (GGOs) were the most common finding (24 of 43, 53.5%), followed by GGO with consolidation (14 of 43, 27.9%). In pediatric patients, GGOs accounted for 42.9% (three of seven), bronchial wall thickening occurred in 28.6% (two of seven), and GGOs with consolidations and nodular opacities occurred in 14.3% (one of seven). However, these CT features did not differ in the two groups, except for bronchial wall thickening, which was more commonly found in pediatric patients (P = .048). In addition, the semiquantitative scores of lung involvement were higher in adults than in pediatric patients (8.89 ± 4.54 vs 1.86 ± 2.41; P < .001).
Conclusion:
Compared with adults, pediatric patients with COVID-19 showed distinctive clinical and CT features. Pediatric patients tend to have milder clinical symptoms, fewer positive results at CT, and less extensive involvement at imaging. Bronchial wall thickening was relatively more frequent on CT images from pediatric patients with COVID-19 in comparison with adults.Supplemental material is available for this article.© RSNA, 2020.
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