Severe acute respiratory syndrome (SARS): chest radiographic features in children.
BACKGROUND
Severe acute respiratory syndrome (SARS) is a recently recognized condition of viral origin associated with substantial morbidity and mortality rates in adults. Little information is available on its radiologic manifestations in children.


OBJECTIVE
The goal of this study was to characterize the radiographic presentation of children with SARS.


METHODS
We abstracted data (n=62) on the radiologic appearance and course of SARS in pediatric patients with suspect (n=25) or probable (n=37) SARS, diagnosed in five hospital sites located in three cities: Toronto, Singapore, and Hong Kong. Available chest radiographs and thoracic CTs were reviewed for the presence of the following radiographic findings: airspace disease, air bronchograms, airways inflammation and peribronchial thickening, interstitial disease, pleural effusion, and hilar adenopathy.


RESULTS
A total of 62 patients (suspect=25, probable=37) were evaluated for SARS. Patient ages ranged from 5.5 months to 17 years and 11.5 months (average, 6 years and 10 months) with a female-to-male ratio of 32:30. Forty-one patients (66.1%) were in close contact with other probable, suspect, or quarantined cases; 10 patients (16.1%) had recently traveled to WHO-designated affected areas within 10 days; and 7 patients (11.2%) were transferred from other hospitals that had SARS patients. Three patients, who did not have close/hospital contact or travel history to affected areas, were classified as SARS cases based on their clinical signs and symptoms and on the fact that they were living in an endemic area. The most prominent clinical presentations were fever, with a temperature over 38 degrees C (100%), cough (62.9%), rhinorrhea (22.6%), myalgia (17.7%), chills (14.5%), and headache (11.3%). Other findings included sore throat (9.7%), gastrointestinal symptoms (9.7%), rigor (8.1%), and lethargy (6.5%). In general, fever and cough were the most common clinical presentations amongst younger pediatric SARS cases (age<10 years), whereas, in addition to these symptoms, headache, myalgia, sore throat, chills, and/or rigor were common in older patients (age>/=10 years). The chest radiographs of 35.5% of patients were normal. The most prominent radiological findings that were observed in the remaining patients were areas of consolidation (45.2%), often peripheral with multifocal lesions in 22.6%. Peribronchial thickening was noted on chest radiographs of 14.5% of patients. Pleural effusion was observed only in one patient (age 17 years and 11.5 months), whereas interstitial disease was not observed in any patient.


CONCLUSIONS
In pediatric cases, SARS manifests with nonspecific radiographic features making radiological differentiation difficult, especially from other commonly encountered childhood respiratory viral illnesses causing airspace disease. The radiographic presentation of suspected SARS cases ranged from normal to mild perihilar peribronchial thickening. The radiographic presentations, as expected, were relatively more pronounced in the SARS probable cases.
Babyn
Paul S
PS
Department of Diagnostic Imaging, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada. paul.babyn@sickkids.ca
Chu
Winnie C W
WC
Tsou
Ian Y Y
IY
Wansaicheong
Gervais K L
GK
Allen
Upton
U
Bitnun
Ari
A
Chee
Thomas S G
TS
Cheng
Frankie W T
FW
Chiu
Man-Chun
MC
Fok
Tai-Fai
TF
Hon
Ellis K L
EK
Gahunia
Harpal K
HK
Kaw
Gregory J L
GJ
Khong
Pek L
PL
Leung
Chi-Wai
CW
Li
Albert M
AM
Manson
David
D
Metreweli
Constantine
C
Ng
Pak-Cheung
PC
Read
Stanley
S
Stringer
David A
DA
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D013902:Radiography, Thoracic; D045169:Severe Acute Respiratory Syndrome / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000635:transmission; D014057:Tomography, X-Ray Computed