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Year : 2021  |  Volume : 19  |  Issue : 4  |  Page : 302-303

Pulmonary nodules on chest imaging - An uncommon finding of pediatric COVID-19 pneumonia

1 Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Mangalagiri, Andhra Pradesh, India
2 Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS), Mangalagiri, Andhra Pradesh, India

Date of Submission26-Apr-2021
Date of Decision10-Jul-2021
Date of Acceptance15-Jul-2021
Date of Web Publication07-Dec-2021

Correspondence Address:
Dr. Thirunavukkarasu Arun Babu
Departments of Pediatrics, All India Institute of Medical Sciences (AIIMS), Mangalagiri, Andhra Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/cmi.cmi_43_21

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How to cite this article:
Babu TA, Reddy PA. Pulmonary nodules on chest imaging - An uncommon finding of pediatric COVID-19 pneumonia. Curr Med Issues 2021;19:302-3

How to cite this URL:
Babu TA, Reddy PA. Pulmonary nodules on chest imaging - An uncommon finding of pediatric COVID-19 pneumonia. Curr Med Issues [serial online] 2021 [cited 2023 Jun 6];19:302-3. Available from: https://www.cmijournal.org/text.asp?2021/19/4/302/331828

Children account for a small proportion of total COVID-19 cases ranging from 1% to 15%.[1] Around 90% of children with COVID-19 were either asymptomatic or had mild-to-moderate disease and only less than 5% had severe disease.[1] Chest imaging plays a vital role not only in diagnosing COVID-19 pneumonia but also in monitoring disease progression and evaluating therapeutic response. However, radiological findings are milder and less specific in children.[2],[3] We report an 11-year-old male child with COVID-19 pneumonia who presented with atypical findings on chest imaging.

An 11-year-old male child presented with fever, cough, cold, and respiratory distress for 3 days duration. His father was recently diagnosed as coronavirus disease (COVID-19) positive. The child was developmentally normal and had no prior history of any respiratory disease. Examination revealed a febrile, tachypneic child with SpO2 of 94% in room air. His pulse was 106/min and respiratory rate was 34/min. Nasopharyngeal swab test for COVID-19 by reverse transcription polymerase chain reaction came as positive. Chest X-ray showed perihilar bronchial wall thickening, bilateral small parenchymal nodules, and lower zone opacification [Figure 1]. Ultrasound chest revealed left-sided minimal pleural effusion. High-resolution computed tomography (CT) of the chest showed multiple ill-defined, pleural-based isodense nodular areas in the right middle lobe, left upper lobe, and lower lobe and multiple, small, subcentimetric-sized well-defined nodular opacities in bilateral lung parenchyma diffusely [Figure 2]. Level of suspicion was estimated as COVID-19 Reporting and Data System-3. He was diagnosed as a case of COVID-19 pneumonia and was treated with supplemental oxygen, antivirals, antibiotics, and low-dose glucocorticoids. Symptoms improved gradually, and he was discharged after 14 days. He is doing well on follow-up at 4 weeks.
Figure 1: Chest posteroanterior radiograph showing small parenchymal nodules in the bilateral mid zones, ill-defined air space opacities in the bilateral lower zones and bilateral perihilar bronchial wall thickening.

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Figure 2: (a) High-resolution computed tomography chest showing multiple ill-defined pleural based isodense nodular areas in the apicoposterior segment of the left upper lobe. (b) High-resolution computed tomography chest showing diffuse, bilateral, multiple, small subcentimetric-sized well-defined nodular opacities.

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Chest radiograph findings in children with COVID-19 infection are nonspecific, which includes common findings such as diffuse interstitial pattern and increase in central peribronchovascular wall thickening.[2],[3] The classic findings of pediatric COVID-19 in noncontrast chest CT imaging includes subpleural lesions, bilateral multifocal ground-glass opacification, patchy consolidation, and halo sign around areas of consolidation.[4],[5] Lesions are frequently wedge shaped, followed by elongated and confluent with ill-defined margins. With increasing severity of lung disease, the consolidations can extend diffusely resulting in “;white-out lung” along with extensive air bronchograms.[4],[5] When compared to adults, children are more likely to demonstrate CT abnormalities but less likely to have bilateral and interstitial involvement.[6] Nodular lesions, though reported in adults, are uncommon in children.[5],[6]

Radiologists should have a sound knowledge of these atypical imaging patterns and a high index of suspicion while dealing with pediatric COVID-19 cases to avoid misdiagnosis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Shankaralingappa A, Arun Babu T. Pathogenesis of COVID-19 and multi-system inflammatory syndrome in children. Int J Contemp Pediatr 2021;8:777-81.  Back to cited text no. 1
Annapureddy PR, Arun Babu T. The role of chest imaging in the management of children with COVID-19. Alex J Pediatr 2021;DOI: 10.4103/ajop.ajop_12_21 (Accepted - In Press)   Back to cited text no. 2
Ilundain López de Munain A, Jimenez Veintemilla C, Herranz Aguirre M, Viguria Sánchez N, Ramos-Lacuey B, Urretavizcaya-Martínez M, et al. Chest radiograph in hospitalized children with COVID-19. A review of findings and indications. Eur J Radiol Open 2021;8:100337.  Back to cited text no. 3
Foust AM, Winant AJ, Chu WC, Das KM, Phillips GS, Lee EY. Pediatric SARS, H1N1, MERS, EVALI, and now coronavirus disease (COVID-19) pneumonia: What radiologists need to know. AJR Am J Roentgenol 2020;215:736-44.  Back to cited text no. 4
Shelmerdine SC, Lovrenski J, Caro-Domínguez P, Toso S; Collaborators of the European Society of Paediatric Radiology Cardiothoracic Imaging Taskforce. Coronavirus disease 2019 (COVID-19) in children: A systematic review of imaging findings. Pediatr Radiol 2020;50:1217-30.  Back to cited text no. 5
Xia W, Shao J, Guo Y, Peng X, Li Z, Hu D. Clinical and CT features in pediatric patients with COVID-19 infection: Different points from adults. Pediatr Pulmonol 2020;55:1169-74.  Back to cited text no. 6


  [Figure 1], [Figure 2]


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