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Reversible bronchial dilatation in children: comparison of serial high-resolution computer tomography scans of the
E A Gaillard1, H Carty, D Heaf
1Neonatal Unit, Liverpool Women's Hospital, Crown Street, Liverpool L8 7SS, UK. erol.gaillard@lwh-tr.nwest.nhs.uk
Insights
Pediatric bronchiectasis may not be irreversible, as many children show improvement or complete resolution of bronchial dilatation on sequential high-resolution computed tomography (HRCT) scans. This suggests caution in diagnosing this condition in children.
Area of Science:
- Pediatric Pulmonology
- Radiology
- Medical Imaging
Background:
- Bronchiectasis is typically considered irreversible in adults, with diagnostic criteria often extrapolated to children.
- Limited research exists on the natural history of pediatric bronchiectasis.
- Current diagnostic criteria for pediatric bronchiectasis are primarily based on adult studies and may mislabel reversible conditions.
Purpose of the Study:
- To evaluate changes in bronchial dilatation in children diagnosed with bronchiectasis (excluding cystic fibrosis) using sequential high-resolution computed tomography (HRCT).
Main Methods:
- Retrospective review of HRCT scans from 22 children diagnosed with bronchiectasis.
- Children had at least two lung CT scans between 1994 and 2000.
- A single radiologist, blinded to original reports, assessed scan changes.
Main Results:
- After a median interval of 21 months, complete resolution of bronchial dilatation was observed in 6 children.
- Eight additional children showed improvement in bronchial dilatation with medical treatment alone.
- These findings challenge the assumption of irreversibility in pediatric bronchiectasis.
Conclusions:
- Radiological diagnosis of bronchiectasis in children warrants caution due to unvalidated adult criteria.
- The reversibility observed in some pediatric cases suggests bronchiectasis may not always be a permanent condition in children.
- Further research is needed to establish specific diagnostic criteria for pediatric bronchiectasis.
Introduction:
Bronchiectasis is generally considered irreversible in the adult population, largely based on studies employing bronchography in cases with a significant clinical history. It is assumed, that the same is true for children. Few studies have examined the natural history of bronchiectasis in children and diagnostic criteria on high-resolution computer tomography of the lungs are derived from studies on adults. Frequently, bronchiectasis is reported in children in cases where localised bronchial dilatation is present, incorrectly labelling these children with an irreversible life-long condition.
Objective:
to evaluate changes in appearance of bronchial dilatation, unrelated to cystic fibrosis in children, as assessed by sequential high-resolution computer tomography (HRCT) of the lungs.
Methods:
The scans of 22 children with a radiological diagnosis of bronchiectasis, seen at Alder Hey Children's Hospital between 1994 and 2000, who had at least two CT scans of the lungs were reviewed by a single radiologist, who was blinded to the original report.
Results:
Following a median scan interval of 21 months (range 2-43), bronchial dilatation resolved completely in six children and there was improvement in appearances in a further eight, with medical treatment alone.
Discussion:
A radiological diagnosis of bronchiectasis should be considered with caution in children as diagnostic criteria derived from studies in adults have not been validated in children and the condition is generally considered irreversible.
