Purpose or Case Report: The radiologic findings of SARS-CoV-2 infection have been well described in the literature over the past several years. Although the myriads of acute disease processes have also been extensively documented, the long-term complications of SARS-CoV-2 infection and multisystem inflammatory syndrome in children (MIS-C) are unknown, including conditions carrying potentially significant morbidity, such as pediatric post-acute sequelae of COVID-19 (PASC). This study establishes a prospective, longitudinal cohort of SARS-CoV-2 infected individuals versus uninfected controls to characterize long-term outcomes following pediatric SARS-CoV-2 infection, including cardiopulmonary imaging evaluation with chest radiography (CXR) or chest computed tomography (CT). This study was funded by the National Institute of Allergy and Infectious Diseases (NIAID), NIH.
Methods & Materials: As of June 30, 2023, 654 individuals (0-21 years) have completed a baseline visit, including 541 infected and 133 uninfected controls, and participants will be followed on a regular basis for a total of 3 years. CXR and CT were evaluated for known radiological manifestations of COVID-19 including, but not limited to, ground glass opacities, nodules, perihilar thickening, effusions, septal thickening and cystic changes.
Results: Overall, there was a low incidence of radiographic abnormalities detected at baseline in both cohorts. Infected participants were more likely than uninfected to have CXR abnormalities (OR 3.15; 95%CI 1.34-7.42; p=0.009), primarily increased incidence of perihilar peribronchial thickening (20% vs.10%), more common in younger participants (< 4 years) and often associated with a history of respiratory infections or asthma. In contrast, chest CT findings, including ground glass opacities (GGO), reticular/linear opacities, and bronchial wall thickening, were similar in both groups. Nodules were the most common finding in both cohorts (29% overall), were clinically insignificant in size (<4mm), and not different between cohorts.
Conclusions: This study establishes a well characterized, large, longitudinal cohort of children who have recovered from SARS-CoV-2 infection and uninfected controls. While infected participants were more likely than uninfected controls to have chest radiographic abnormalities at baseline, this was limited to perihilar peribronchial thickening, and often associated with a history of respiratory infections or asthma. There was no significant difference in CT abnormalities between the two cohorts.