key: cord-0819752-anouedix
authors: Mathew, Rishi Philip; Jose, Merin; Toms, Ajith
title: The Role of Non-Contrast Chest CT in Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) Pediatric Patients
date: 2020-05-18
journal: Indian J Pediatr
DOI: 10.1007/s12098-020-03338-4
sha: 73bd44cf9fced6e8a2d6bc8eb3e9acef4718245f
doc_id: 819752
cord_uid: anouedix

nan

To the Editor: The Coronavirus disease 2019 (COVID-19) is caused by a recently discovered novel enveloped RNA betacorona virus called severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). COVID-19 is highly contagious, and as of April 26, 2020, approximately 2,900,422 confirmed cases have been reported worldwide with 203,055 related deaths.

COVID-19 is diagnosed by real time reverse transcription polymerase chain reaction (RT-PCR) assay. However, the test has several limitations and a sensitivity of only 30-70% at initial presentation; additionally, a negative RT-PCR does not rule out COVID-19 [1] . Chest radiographs (CXRs) and computed tomography (CT) have been widely used for evaluating COVID-19 patients. However, CXRs have low sensitivity (20%) and may appear normal during the early stage of the disease and therefore are not recommended as the 1st line imaging tool [2] .

Chest CT is now the widely accepted imaging tool for evaluating suspected or confirmed COVID-19 cases, as well as for monitoring therapeutic response and follow-up. When compared to RT-PCR, the reported sensitivity, specificity and accuracy of chest CT are 97%, 25% and 68% respectively, while the positive and negative predictive values are 65% and 83% respectively. Additionally, 60-93% of the patients can have positive CT findings much before the initial RT-PCR tests turn positive [3] .

COVID-19 disease in the pediatric population is mostly mild [4] , with the most common CT findings being unilateral or bilateral subpleural ground-glass opacities, and consolidations with surrounding halo sign [5] . Additional findings include-peribronchial distribution of disease and bronchial wall thickening. As the disease progresses, the consolidations can extend diffusely giving a "white lung" appearance accompanied by air-bronchogram sign. During the recovery stage, following treatment, the consolidations reduce in size and density, having a ground glass appearance. Pleural effusion and lymphadenopathy are rare [5] .

Based on this clinical information, we felt the need to bring to the attention of the pediatric physicians and surgeons, especially those battling against confirmed COVID-19 cases, the potential of chest CT and the valuable information it can provide. We feel a combination of pathogen detection using RT-PCR and early chest CT including follow-up imaging should be incorporated into the protocol when managing symptomatic pediatric COVID-19 patients.

Essentials for radiologists on COVID-19: an update-radiology scientific expert panel

Extension of coronavirus disease 2019 (COVID-19) on chest CT and implications for chest radiograph interpretation

Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases

Differences in clinical and imaging presentation of pediatric patients with COVID-19 in comparison with adults

Clinical and CT features in pediatric patients with COVID-19 infection: different points from adults

Conflict of Interest None.