Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, Washington, District Columbia, USA.
Department of Pediatrics, George Washington University School of Medicine, Washington, District Columbia, USA.
Pediatr Pulmonol. 2021 Dec;56(12):3891-3898. doi: 10.1002/ppul.25661. Epub 2021 Sep 15.
Chest radiography (CXR) is a noninvasive imaging approach commonly used to evaluate lower respiratory tract infections (LRTIs) in children. However, the specific imaging patterns of pediatric coronavirus disease 2019 (COVID-19) on CXR, their relationship to clinical outcomes, and the possible differences from LRTIs caused by other viruses in children remain to be defined.
This is a cross-sectional study of patients seen at a pediatric hospital with polymerase chain reaction (PCR)-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (n = 95). Patients were subdivided in infants (0-2 years, n = 27), children (3-10 years, n = 27), and adolescents (11-19 years, n = 41). A sample of young children (0-2 years, n = 68) with other viral lower respiratory infections (LRTI) was included to compare their CXR features with the subset of infants (0-2 years) with COVID-19.
Forty-five percent of pediatric patients with COVID-19 were hospitalized and 20% required admission to intensive care unit (ICU). The most common abnormalities identified were ground-glass opacifications (GGO)/consolidations (35%) and increased peribronchial markings/cuffing (33%). GGO/consolidations were more common in older individuals and perihilar markings were more common in younger subjects. Subjects requiring hospitalization or ICU admission had significantly more GGO/consolidations in CXR (p < .05). Typical CXR features of pediatric viral LRTI (e.g., hyperinflation) were more common in non-COVID-19 viral LRTI cases than in COVID-19 cases (p < .05).
CXR may be a complemental exam in the evaluation of moderate or severe pediatric COVID-19 cases. The severity of GGO/consolidations seen in CXR is predictive of clinically relevant outcomes. Hyperinflation could potentially aid clinical assessment in distinguishing COVID-19 from other types of viral LRTI in young children.
胸部 X 线摄影（CXR）是一种常用于评估儿童下呼吸道感染（LRTI）的非侵入性成像方法。然而，儿科 2019 年冠状病毒病（COVID-19）的 CXR 具体影像学表现、与临床结局的关系以及与儿童其他病毒引起的 LRTI 的可能差异仍有待确定。
这是一项横断面研究，纳入了在一家儿科医院就诊的经聚合酶链反应（PCR）确诊的严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）患者（n=95）。患者分为婴儿组（0-2 岁，n=27）、儿童组（3-10 岁，n=27）和青少年组（11-19 岁，n=41）。还纳入了一组患有其他病毒性下呼吸道感染（LRTI）的幼儿（0-2 岁，n=68），以比较 COVID-19 婴儿组（0-2 岁）与 COVID-19 婴儿组（0-2 岁）的 CXR 特征。
45%的 COVID-19 儿科患者住院，20%需要入住重症监护病房（ICU）。最常见的异常表现为磨玻璃影/实变（35%）和支气管周围标记物增多/袖口征（33%）。GGO/实变在年龄较大的个体中更为常见，而肺门周围标记物在年龄较小的个体中更为常见。需要住院或 ICU 入住的患者在 CXR 中具有更多的 GGO/实变（p<0.05）。非 COVID-19 病毒性 LRTI 病例中更常见典型的儿科病毒性 LRTI 的 CXR 特征（如过度充气），而 COVID-19 病例中则较少见（p<0.05）。
CXR 可能是评估中重度儿科 COVID-19 病例的补充检查。CXR 中见到的 GGO/实变严重程度可预测临床相关结局。在鉴别幼儿的 COVID-19 与其他类型的病毒性 LRTI 时，过度充气可能有助于临床评估。
