Objective: To study image findings in covid pediatric patients, both in the first diagnosis images and follow-up images to see disease progression over time.

Materials and Methods: The present research was conducted in all pediatric patients aged 0 to 18 years diagnosed as Covid-19 infection and admitted at Phramongkutklao Hospital during the study period. Image findings were retrospectively reviewed by an experienced pediatric radiologist and Brixia score was given. The maximum severity score and timing to reach this score were calculated and recorded in all patients.

Results: During the study period, 428 films were collected from 170 patients. Most patients were male with a mean age of 9.89 years. Most common presenting symptom was fever. One-fourth of the studied patients had underlying illnesses. Most patients were symptomatic patients with 156 out of 170 (91.8%). The first X-ray showed abnormalities in 64.7% of symptomatic group and 42.9% in asymptomatic group. Common lobes of lungs involved were middle and lower lobes, which was slightly right-side predominate. Mean Brixia score was 2.79 (0 to 12) and 2.97 (0 to 14) in asymptomatic and symptomatic patients, respectively, which was not statistically significant. Time to reach maximum severity score was phase 1 (0 to 4 days) for symptomatic patients and phase 2 (5 to 8 days) for asymptomatic ones. For patients with normal first X-ray, abnormalities could be detected on later films, mostly in phase 1 and 2.

Conclusion: Screening X-ray at the first diagnosis had high rates of abnormality detection regardless of symptom. For patients with normal first X-ray, abnormalities could be detected on later films, mostly in phase 1 and 2. Therefore, even with the fear of unnecessary exposure to radiation in children, X-ray should be performed at the first diagnosis regardless of symptom. Appropriate timing to follow-up X-ray was phase 2, at day 5 to 8 of disease.

Keywords: Covid 19 X-ray; Covid in children; X-ray of pediatric covid

DOI: 10.35755/jmedassocthai.2023.06.13854

Received 3 October 2022 | Revised 27 April 2023 | Accepted 2 May 2023