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It was noted that during the 4-day visit P. Havan will collect information to report on the humanitarian consequences of the Armenian-Azerbaijani conflict. During the visit, he will hold meetings with the Speaker of the Parliament, representatives of various ministries of Armenia dealing with the humanitarian consequences of the conflict.
It was also noted that P. Havan is scheduled to meet with family members of Armenian prisoners of war and missing persons, refugees, religious leaders and the Ombudsman of Armenia, representatives of civil society.
It is reported that P. Havan will pay a visit to Azerbaijan in the summer and collect the necessary information, and will complete work on the report in the fall.Our professionals provide an array of services to the electric transmission and distribution (T&D) industry including transmission line siting and complete support for transmission tower design including structural and civil engineering with a focus on foundation and geotechnical analysis. With significant expertise in underground medium voltage collection systems, we also support design of renewable energy projects direct buried cable systems from the base of a Wind Turbine Generator (WTG) or Solar Inverters to the substation.
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How to Cite: Zamani F, Ghamari A, Darban Hosseini Amirkhiz G, Pak N, Ghaemi O. A Case Series of COVID-19 Respiratory Infection in Hospitalized Children: Clinical and Computed Tomography Challenges, Iran J Radiol. 2021 ; 18(1):e106705. doi: 10.5812/iranjradiol.106705.
Our objective was to evaluate clinical and computed tomographic features in hospitalized children with COVID-19 infection who were admitted to the pediatric center of excellence, children’s medical center. In this case-series, we report twelve patients with clinical symptoms of acute respiratory infections at the beginning or after admission who have PCR-proved (throat swab samples) COVID-19 infection and underwent computed tomography imaging. Six patients had an underlying disease and atypical findings with no clinical suspicion at the beginning. Tachypnea (75%) represented the most common physical finding. Computed tomography was abnormal in 83.3% of patients. Subpleural consolidation, peribronchial thickening, round consolidation, and Halo sign was depicted. The empirical regimen in our hospital included hydroxychloroquine and oseltamivir. Some of the patients managed easily, but others had prolonged hospital stay, especially patients with significant underlying conditions.
On 31 December 2019, an unknown viral pneumonia was reported from Wuhan, China. The causative virus was found to be a new coronavirus. On 11 February 2020, the World Health Organization (WHO) officially named the disease caused by this organism as COVID-19. WHO declared the infection as a global health emergency on January 30, 2020 (1).
The susceptible population are mainly adults and those with a suppressed immune system. The infectious rate of COVID-19 is relatively lower in children (2). A review by the Chinese Center for Disease Control and Prevention demonstrated that among 72,314 cases, less than 1% were children younger than 10 years old (3). The first reported case was a 7-year-old boy with cough and fever confirmed on 19 January 2020 (4). In the pediatric population, the symptoms were initially reported to be absent or mild, but with an increasing number of affected patients more symptomatic children are being encountered (5, 6).
Previously published data are mainly from China, but less than 10% of confirmed cases are now from this country. This emphasizes the need for more data from other parts of the world to discover the potential hidden aspects of the disease in the pediatric population.
This study was conducted in a one-month period from 1 March 2020 until 1 April 2020 according to relevant guidelines and regulations in the Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran. We report these pediatric patients with typical and atypical presentation of COVID-19 infection and heterogeneous unexpected features in their imaging.
All patients were under 18 years old with clinical symptoms of acute respiratory infections at the beginning or after admission who underwent computed tomography imaging and had confirmed COVID-19 infection (nucleic acid test, throat swab samples). We reviewed the clinical assessments, laboratory and imaging findings of these patients from electronic records. It should be noted that all patients had a chest radiograph (CXR) before CT scan examination. All images were reviewed by a pediatric radiologist. CT findings were reported and discrepancies were tackled via discussion.
These two 9-year-old patients were monozygotic twin boys (Table 1). They did not have any underlying diseases. They had continuous exposure to their infected grandfather. Their clinical presentation was atypical. They suffered fever, headache, nausea, vomiting, and diarrhea. They did not have any respiratory symptoms. Laboratory data revealed leukopenia and positive reverse transcription polymerase chain reaction (RT-PCR). Elevated C-reactive protein (CRP) was detected in one of them (Table 2). The chest computed tomography findings were similar ground-glass opacities in lower lobes in both patients (Figure 1). They received supportive care, antiviral drugs, and appropriate antibiotics. They were finally discharged from the hospital after six days, without need for ICU admission.
Figure 1. Axial chest CT scan in a 9-year-old boy with COVID-19 infection shows sub-pleural alveolar consolidations in lower lobes (white arrows) (patient no. 1).

An 11-year-old cirrhotic girl in whom epistaxis was preceding respiratory symptoms (Table 1). She did not experience any close contact with an infected person. The peribronchial thickening and diffuse reticular pattern were seen in CXR. Ground glass opacities (GGO) and sub-pleural consolidation were evident in the chest CT scan. Her management protocol is summarized in Table 3. She was discharged after 6 days.
Abbreviations: Amp, ampicillin; AVM, arteriovenous malformation; Azt, azithromycin; Cef, ceftriaxone; Cfm, cefotaxim; COVID-19, corona virus disease 2019; G6PD, glucose-6-phosphate dehydrogenase; Hcq, hydroxychloroquine; Levo, levofloxacin; Mer, meropenem; Met, metronidazole; N/A, not applicable; ND, not discharge; Oselta, oseltamivir; Vanco, vancomycin; Vor, voriconazole.
These cases had no underlying disease. Two of them (patients 6 and 9) had household contact with a COVID-19 infected person. Most of them had fever and cough. Three of them (patients 5, 6, and 9) suffered abdominal pain. Their RT-PCR test results were positive. In chest CT collapse-consolidation in lower lobes in patient 4, patchy ground glass opacities in both lobes and interlobular septal thickening in lower lobes in patient 5, solid nodules with peripheral ground glass opacities in the right lower lobe in patient 9 were seen. Chest CT of patient 6 was normal. Their management protocol was based on supportive care and empiric regimen. For the 6-year-old girl, cefotaxime and vancomycin were added to our hospital empirical regimen. All patients were treated successfully.
This case was an 11-year-old boy with heart failure who presented with fever resistance to the standard treatment. Other symptoms are mentioned in Table 1. CXR and chest CT scan were normal, but he had a positive RT-PCR of COVID-19. Laboratory tests are shown in Table 2. He was managed with an empirical regimen after 6 days.
A 6-year-old boy with newly diagnosed Wilson’s disease came with a comprehensive set of abdominal symptoms for one week. His presenting symptoms were as follows: mild umbilical abdominal pain, one episode of bloody vomiting, mildly decreased urine output, and progressive abdominal distension. One day before admission, fever, rhinorrhea, respiratory distress, and cough were added to his symptoms. Bilateral pleural effusion and alveolar consolidation in the right lower lobe were detected in chest CT. His management and treatment are illustrated in Table 3. He was discharged after 19 days of hospital admission.
She was a known case of acute lymphoblastic leukemia (ALL) for 3 years who underwent human stem cell transplantation 19 days ago. She had no close contact with an infected person. Her presentation symptoms were fever, cough, and diarrhea. The patchy alveolar consolidations with peripheral ground glass halo in the right lung and left lower lobe were seen in her chest CT. One antifungal agent was also added to her empirical regimen.
She was a 9-month-old floppy baby. She was admitted because of poor feeding, fever, respiratory distress, and low oxygen saturation. In her chest CT, collapse-consolidation in the apical segment of the right upper lobe with secondary elevated right diaphragm and reticular pattern in the left lung were detected. She critically needed intensive care and mechanical ventilation. She died after 13 days.
This patient was a 14-year-old boy with multiple congenital heart anomalies (suspicious of William’s syndrome) who was on the waiting list for Brom’s surgery. In the beginning, he had squeezing, chest pain, severe respiratory distress, left