Multiple pneumatoceles and diffuse ground‐glass opacities in a 20‐month‐old boy with COVID‐19 pneumonia

Abstract

The coronavirus disease 2019 (COVID‐19) pandemic has various radiological imaging findings. Although paediatric cases are generally asymptomatic, they may be affected by the disease. Here, we aimed to discuss a case with atypical imaging findings.

CLINICAL IMAGE

The coronavirus disease 2019 (COVID‐19) pandemic has various radiological imaging findings. Although paediatric cases are generally asymptomatic, they may be affected by the disease. Here, we aimed to discuss a case with atypical imaging findings. A 20‐month‐old boy presented with a complaint of cough. The patient had 6 days of intermittent, non‐productive cough that was worse in the mornings. Two days after hospitalization, the cough symptom resolved. There was no history of immunosuppression or glucocorticosteroid use, pneumonia or other disorder. His family was diagnosed with COVID‐19 15 days before admission. The reverse transcriptase‐polymerase chain reaction of the patient was positive for COVID‐19. Blood culture tests were negative. Centrally located opacities were observed in the upper zone of both lungs and the left retrocardiac region in the chest x‐ray (Figure 1). Thoracic computed tomography (CT) was performed for the patient due to symptoms. Thoracic CT images showed bilateral central and peripheral diffuse ground‐glass opacities (GGO) and multiple randomly located thin‐walled air cysts without consolidation (Figure 2). It was thought that artefact‐related densities may accompany infection‐related GGO in different degrees. However, GGO were spreading over a wide area that could not be explained by only artefacts especially in the lower lobes of the lung. Pneumatocele is described as round air‐containing cysts with a thin wall structure. Causes include pneumonia, trauma or aspiration of hydrocarbon fluid.¹ To our knowledge, pneumatocele has not been identified in paediatric COVID‐19 pneumonia cases in the literature. The frequency of pneumatocele in paediatric COVID‐19 cases is not known. Physicians should be familiarized with atypical imaging findings of COVID‐19.

FIGURE 1.

Initial chest x‐ray shows centrally located opacities in the upper zone of both lungs and the left retrocardiac region

FIGURE 2.

Thoracic computed tomography (CT) images of the index case. (A) Coronal images of the thorax showing bilateral diffuse ground‐glass opacities (arrows). (B–D) Sagittal and axial CT images showing multiple randomly located thin‐walled air cysts (asterisk)

CONFLICT OF INTEREST

None declared.

AUTHOR CONTRIBUTION

Dr Cihan Özgür conceptualized and designed the study, drafted the initial manuscript and reviewed and revised the manuscript. Dr Caner Doğan took part in obtaining clinical data and accessing resources.

ETHICS STATEMENT

Appropriate written informed consent was obtained for publication of this case report and accompanying images.

Özgür C, Doğan C. Multiple pneumatoceles and diffuse ground‐glass opacities in a 20‐month‐old boy with COVID‐19 pneumonia. Respirology Case Reports. 2021;9:e0842. 10.1002/rcr2.842