Purpose or Case Report:

Chest radiograph (CXR) is a valuable tool, especially in children owing to its low cost, availability, portability and easy disinfection along with less radiation as compared to Computed Tomography (CT). In this study, we evaluate the spectrum of CXR findings and patterns in pediatric COVID-19 patients.
Methods & Materials:

CXR done at the time of diagnosis of patients upto 20 years of age, diagnosed with COVID-19 between Oct 2020-July 2021 was retrospectively evaluated. CXR was assessed for: pulmonary opacities, disease laterality, distribution (central/peripheral/apical/basal), pleural effusion and pneumothorax. CXR was assigned to one of the six patterns: 1-Peripheral airspace opacities, 2-Bilateral lower zone opacities, 3-Peribronchial consolidation, 4-Multifocal air-space opacities, 5-Large nodule or ‘mass-like’ opacities, 6-Diffuse mid and lower zone opacities. A radiographic semiquantitative visual severity score was calculated by dividing lungs into 3 zones each and scoring each zone on the basis of percentage of lung involved (Maximum of 4 per zone and maximum total of 24).
Results: A total of 57 (32 male, 25 female; mean age 10.9 years) COVID-positive pediatric patients were included. Pulmonary opacities were present in 38 CXR; more commonly bilateral (n=29) and had central predominance (n=16). Unilateral involvement was seen in significant proportion of cases (n=9; 23.7%) which is atypical for COVID infection. Pattern 3 (Peribronchial consolidations, n=14), pattern 4 (multifocal air-space opacities, n=12) were the most common patterns. Bilateral lower zones (n=5) and peripheral airspace opacities (n=1) were much less common, contrary to their frequent occurrence described in adult COVID patients. The calculated severity scores ranged from 2 to 15 (median-5); most cases had mild disease. Pleural effusion (n=3), pneumothorax (n=1) were infrequent.
Conclusions: Radiographic pattern 3 (peribronchial consolidation) and 4 (multifocal air-space opacities) were more commonly seen in pediatric patients along with higher percentage of unilateral lung involvement. Knowledge of these patterns may prove helpful in screening children for COVID infection, especially in emergency settings. Radiographic severity scores showed mild disease in most cases. Severity score can be used for assessing extent of lung involvement and for follow-up of patients and may obviate the need for a CT.