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.