The outbreak of Covid-19 started in Wuhan city, Hubei province, China, where the firstly announced cases in adults with pneumonia of unexplained etiology on December 31, 2019. A local seafood and animal market was defined to be as a potential source. Afterwards; main transmission route to cause outbreak was defined through respiratory droplets or direct contact from symptomatic and asymptomatic humans infected with Covid-19. Covid-19 has spread to other Chinese cities and internationally and caused a global pandemic.
COVID- 19 viral pneumonia is an acute infectious respiratory disease caused by a coronavirus subtype SARS-CoV-2. From december 2019 to this moment, 24.355.000 total comfirmed cases, 830.155 deaths and 16.889.000 recovered cases had been confirmed worldwide as WHO (World Health Organization) up to date records, while the actual number would be larger with noncofimed asymptmatic cases. [8
] The virus is a highly contagious disease andcan be transmitted by an infected person or an asymptomatic carrier through respiratory droplets. Respiratory droplets are the main route of transmission, but can also be transmitted by contact and digestive tract. [9
] After contact to infected person; The incubation period is about 1 to 14 days, and is supposed could be up to 24 days. Even most of the cases are mild, especially people over 60 years old or those with underlying diseases are more likely to develop the severe disease of lower repiraturary system involvement. [10
] The clinical manifestations of children patients are similar to those of adults, such as fever and cough. A few children have diarrhea and runny nose, but the overall symptoms are relatively mild. Its think to be that the COvid-19 infection have a mild and weak clinical progress in childeren. Conversly to this data; in this study we presented 17 cases those all are under 17 years old with 3 of them under 2 years old cases of Covid-19 infection with severe diseases.
In previous literatüre Chest CT findings in children were similar to those in adults, and most of them were mild cases. [11
] In our study; the typical manifestations were unilateral or bilateral subpleural ground-glass opacities, and consolidations with surrounding halo sign. As bilatarelly consolidations of lungs sign account for up to 70% cases, they should be considered as typical signs in pediatric patients. Pleural effusion was seen in 4 cases. In Wei and et al study; the data for pleural effusion account zero. [13
] Lesions could be still visible on chest CT when two consecutive nucleic acid tests were negative. The CT imaging of COVID‐19 infection should be differentiated with other virus pneumonias, such as respiratory syncytial virus, influenza virus, parainfluenza virus, and adenovirus with its spesific radiological signs. [14
] In addition, it should be differentiated from atypic bacterial pneumonia such as mycoplasma pneumonia and chlamydia pneumonia. However, multiple agents can overlap chest CT manifestations of pneumonia caused by COVID‐19 presenting more serious and complex imaging manifestations which could not be diagnostic, so epidemiological and etiological examination should be combined to make the final decision.
|Recently; only a few studies have conducted on chest CT signs of COVID-19 in children age group. [15, 16, 17] Even normal findings on chest CT; some of pediatric patients manifest a severe clinical disease of COVID-19 pneumonia.|
|The CT manifestations of COVID-19 in pediatric patients are diverse and lack specificity. Some mild pediatric patients with COVID-19 show [18, 19].|
|In pulmunary involvement cases; focal unilateral or bilateral diffuse, subpleural lesions, nonspesific consalidation, ground-glass opacification and nodules are the most presentations.|
|Pediatric patients with COVID-19 tend to present less lobular involvement with an increase in subpleural ground glass density in the left lower lobe posterior segments (Fig. 1a,2a). Additionally;some other findings like nodular ground-glass opacification consolidation, consolidation with ground-glass opacification and interlobular septal thickening can also be observed in the pediatric patients . All radiological findings have been summarized in Table 3.|
|Overall, rarely in pediatric cases, bilateral diffuse lung consolidation can occur and is called as “white lung” . In resolving stage, lung lesions will be completely resolved or only remain minimal linear opacities (Fig. 2d,3d). In some cases either can be a presentation of similiar to those other viral agents|
|With patchy opacity along the bronchial vasculer structure manisfasting as bronchopneumonia. |
|Case differantial diagnosis should be more carefully done while pediatric patients have definite epidemiological history but atypical CT findings. Xia et al reported, underlying coinfection is very common in pediatric patients (9 of 20, 45%), Pleural effusion was reported in several pediatric patients .|
|Even the gold standart is nucleic acid detection in diagnosis of COVİD-19, in suspecious cases those initial RT-PCR results show negative, chest CT may be supporttive for diagnosis and management especially in pediatric age group. Additionally Chest Ct can suggest the healing and resolve findings of lung involvement regarding the disease severness and follow up options. In this study the chest ct findings in 14th day of follow up have been completely recovered. (Fig. 2d,3d). Sure the nucleic acid comfirmation test negativity can be used in follow up; unfourtanetly it will not suggest any idea in those cases with pulmunary symptoms in childhood.|