Chest CT imaging of pediatric COVID-19 infection: a case report CURRENT STATUS: POSTED

Background: Coronavirus Disease 2019 (COVID-19) outbreak in Wuhan, China spreading rapidly worldwide. Over 100 countries have reported surpassing 100,000 laboratory-confirmed cases of COVID- 19, and in which 2.1% were under aged 19 years. However, little is known about the imaging features about pediatric COVID-19 patients. Herein, we report two cases about COVID-19 involving the clinical data as well as chest images. Case presentation: Two pediatric patients admitted to hospital because of high fever or dry cough. Both children had been recent exposure to the COVID-19 confirmed patients of their family members. Real-time polymerase chain reaction(RT-PCR) test of these two patients’ sputum were positive for SARS-CoV-2 nucleic acid, and diagnosed as COVID-19 infection. Laboratory tests indicate normal white cell count (5.02 x10^9/L) and neutrophils (40.8%) in one case, and slightly increased white cell count (11.86 x10^9/L) and normal neutrophils (16.1%)in the other one. CRP of both cases were within the normal range. Computed tomography (CT) was used to evaluate the novel coronavirus pneumonia (NCP) of these two pediatric patients. Small nodule was found in the upper right lobe of one case; and bilateral peripheral ground-glass opacities were observed in the other patient. Conclusion: In summary, clinical symptoms and signs, laboratory tests and chest CT images of pediatric patients were untypical. Epidemic exposure history and RT-PCR results still play an important role in the precise diagnosis of COVID-19 children.

SARS-CoV-2 nucleic acid, and diagnosed as COVID-19 infection. Laboratory tests indicate normal white cell count (5.02 x10^9/L) and neutrophils (40.8%) in one case, and slightly increased white cell count (11.86 x10^9/L) and normal neutrophils (16.1%)in the other one. CRP of both cases were within the normal range. Computed tomography (CT) was used to evaluate the novel coronavirus pneumonia (NCP) of these two pediatric patients. Small nodule was found in the upper right lobe of one case; and bilateral peripheral ground-glass opacities were observed in the other patient.  [3] . Little attention has been paid to the pediatric COVID-19 infection. Clinical data and image characteristics of children are still lacking, which should be made more effort on the investigations.
Herein, we reported the clinical features as well as the chest computed tomography (CT) imaging characters of novel coronavirus pneumonia (NCP) in two pediatric COVID-19 patients to fill the blanks.

Case Presentation
A ten-year-old child presented to hospital at February 13,2020 for 10 day's high fever and dry cough.
He has been traveled in Wuhan for 11 days (from January 14 to 25,2020) recently, and two of his family members were already confirmed with COVID-19 infection. Laboratory tests showed that The second case is a 3-month-old infant admitted to hospital at February 09, 2020 for coughing and polypnea one week. Before the onset of symptoms, one of his family member came from Wuhan, and living with them for ten days. Two of his family members were diagnosed as COVID-19. His body temperature was 36.2 °C on admission. CRP showed in normal range (<0.8mg/L, normal range:0-5mg/L). Laboratory test showed 16.1% neutrophils and 72.6% lymphocytes; white cell count (11.86 x10^9/L; normal range: 3.50-9.50 x10^9/L) was slightly increased. Unenhanced CT manifested that bilateral peripheral ground-glass opacities with patchy area of emphysema, epically in the lower lobes (Figure2 A-B). RT-PCR of SARS-CoV-2 nucleic acid was tested positive and confirmed as COVID-19.

Discussion And Conclusion
Pediatric COVID-19 infection is commonly family clustering with clearly epidemiologic characteristics [4] . Nevertheless, the clinical manifestations, chest images and laboratory tests of a few children are unspecific, which are similar with influenza or other infections frequently happened in children and been overlooked from the COVID-19 infection. Positive RT-PCR of SARS-CoV-2 nucleic acid and epidemiologic history seems still the most important diagnosis modalities for pediatric patients. Thus, children who have infected family member should be highly mentioned to ensure timely diagnosis.
Since the children are as susceptible as adult suggested by previous study, home care must be more careful to avoid children being exposed to the virus [4,5] . Meanwhile, wearing mask and increased handwashing are necessary for children even infant; isolating from the suspected and confirmed family member are also suggested.
In summary, chest CT images as well as clinical features and laboratory tests of COVID-19 pediatric were nonspecific, which may should give more attention and care to these children who had family clustering. RT-PCR and epidemiological history should combine with chest images to diagnose the COVID-19 children. Consent for publication: Written informed consent for their personal or clinical details along with any identifying images to be published in this study was obtained by the guardians of both patients.

List Of Abbreviation
Availability of data and materials: Data and material are available. Author's contributions: YKG and MY had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. KKH and HYX contributed equally to the study. YKG and MY contributed equally as senior authors. The contribution