Introduction:
The emergence of a novel coronavirus (SARS-CoV-2) from Wuhan, China, has spread rapidly across the globe and on March 11th, 2020 World Health Organization (WHO) proclaimed pandemic.1-2 By May 27th, 2020, a total of 231,030 coronavirus disease 19 (COVID-19) cases were confirmed in Italy. Of the affected patients, 2,1% were children under 18 years of age with 4 associated deaths.3 While data are available for adult patients with COVID-19, limited reports analyze pediatric patients infected with SARS-CoV-2.1,2Children comprise a small fraction of COVID-19 cases, and their symptoms are often mild. Frequent clinical manifestations include fever, dry cough, and fatigue accompanied by other upper respiratory symptoms. In a few cases, nausea, vomiting and diarrhea were reported, particularly in infants. In general, pediatric COVID-19 has a good prognosis with recovery within 1 to 2 weeks after disease onset, although, at present, there is lack of data on the role of comorbidities.1-2,4-6 Some children may progress to severe disease, and initial atypical presentations may delay the diagnosis leading to unfavorable outcomes.5-6
Chest imaging is in the front door in the diagnostic approach to any patient with respiratory symptoms during this COVID-19 outbreak.7 Over the last weeks, there has been a considerable amount of publications on the possible use of lung ultrasound in adults with COVID-19,7-11 but limited data on a small samples of 8 and 10 patients are available about its use in affected children.12-13 Indeed, point of care ultrasound (POCUS) of the lung may inform the diagnosis, prognostic stratification and disease evolution, thus guiding the clinical decision-making and management of patients with COVID-19.8-9 In adults, SARS-CoV-2 typically induces an interstitial diffuse bilateral pneumonia with asymmetric and patchy lesions distribution, mainly involving the lung periphery, represented by bilateral separate or coalescent B-lines. B-lines are interstitial artifactual signs, described as hyperechoic vertical artifacts arising from the pleural line or small peripheral consolidations, moving in concert with lung sliding and erasing A-lines. Confluent B-lines appearing as a “white lung” are equivalent to ground-glass opacities on computed tomography (CT) scan, suggesting a more severe loss of lung aeration. With disease progression, these patterns subsequently extend to multiple areas of the lung surface.7-10 Whether pediatric COVID-19 shares the same imaging pattern of adults is an important issue but, to our knowledge there is just one report describing ultrasonographic features of pediatric patients with COVID-19.12
We present a series of 13 hospitalized confirmed COVID-19 pediatric cases in which lung US was performed aiming to describe lung US features in children and discuss the potential applications of lung US in COVID-19 children considering the usual asymptomatic/mild disease course.