Pediatric coronavirus disease-2019: How to assess chest disease?

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as a serious health problem worldwide. In the pediatric population, currently available epidemiological data seem reassuring as the incidence of coronavirus disease 2019 (COVID-19) is much lower than in adults, with less critical cases and very few deaths. At present, there are no evidence-based studies on chest imaging in pediatric COVID-19. Chest X-rays showed non-specific findings and chest computed tomography (CT) exhibited similar, but fairly less severe CT changes compared to adult. Moreover, in approximately 50% of pediatric patients no correlation was found between chest CT imaging results and clinical characteristics. Lung ultrasound is rarely used, despite its unquestionable benefits as it can be performed at bed-side with a portable device, which minimizes virus transmission, is cheap and can be easily repeated. In conclusion, the chest imaging use in children, who are typically spared from severe infection, deserve recommendations different than adults also considering the increased risk of radiations exposure. In view of this, pediatric comparative studies among different chest imaging techniques, either less or more invasive, are urgently needed possibly after standardization of interpretation criteria of lung ultrasound.