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[CT Presentations of Adult and Pediatric SARS-COV-2 Patients: A Review of Early COVID-19 Data]
J V Waller1, K K Lin2, M J Diaz3
1Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.
Insights
Chest CT scans show different COVID-19 patterns in adults and children. Early adult CT findings suggest limited diagnostic utility, while pediatric CT is less sensitive than RT-PCR, advising against its routine use.
Area of Science:
- Radiology
- Infectious Diseases
- Pediatrics
Context:
- COVID-19 presents with varied clinical symptoms.
- Chest CT findings in COVID-19 differ between adult and pediatric populations.
- Early research focused on characterizing these differences.
Purpose:
- To summarize early chest CT findings in COVID-19 for adults and children.
- To determine the frequency of specific COVID-19 manifestations on CT in each age group.
- To assess the diagnostic sensitivity and utility of CT in pediatric COVID-19.
Summary:
- Adults more frequently showed ground-glass opacities (GGOs) and bilateral abnormalities on initial CT scans compared to children.
- CT scans in adults showed improvement over time but slow resolution, while pediatric patients sometimes developed additional nodular GGOs.
- Early adult CT findings indicate limited supplemental diagnostic value, focusing on lower lobe abnormalities and GGOs.
Impact:
- Findings suggest limited utility of CT as a primary diagnostic tool for adult COVID-19, emphasizing specific radiological signs.
- For pediatric COVID-19, CT is less sensitive than RT-PCR, and its use is cautioned against due to radiation exposure.
- This information aids healthcare providers in judiciously applying CT imaging for COVID-19 diagnosis in different age groups.
Objective:
Initial COVID-19 reports described a variety of clinical presentations, but lower respiratory abnormalities are most common and chest CT findings differ between adult and pediatric patients. We aim to summarize early CT findings to inform healthcare providers on the frequency of COVID-19 manifestations specific to adult or pediatric patients, and to determine if the sensitivity of CT justifies its use in these populations.
Methods:
PubMed was searched for the presence of the words "CT, imaging, COVID-19" in the title or abstract, and 17 large-scale PubMed and/or Scopus studies and case reports published between January 1, 2020 and April 15, 2020 were selected for data synthesis.
Results:
Initial CT scans identified ground-glass opacities and bilateral abnormalities as more frequent in adults (74%, n = 698, and 89%, n = 378, respectively) than children (60%, n = 25, and 37%, n = 46). At 14+ days, CT scans evidenced varied degrees of improvement in adults but no resolution until at least 26 days after the onset of flu-like symptoms. In pediatric patients, a third (n = 9) showed additional small nodular GGOs limited to a single lobe 3-5 days after an initial CT scan.
ConclusióN:
Early adult CT findings suggest the limited use of CT as a supplemental tool in diagnosing COVID-19 in symptomatic adult patients, with a particular focus on identifying right and left lower lobe abnormalities, GGOs, and interlobular septal thickening. Early pediatric CT findings suggest against the use of CT if RT-PCR is available given its significantly lower sensitivity in this population and radiation exposure.
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