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Radiographic Outcomes in Pediatric Bronchiectasis and Factors Associated with Reversibility.

Dustin R Mills1,2,3, Ian B Masters1,4, Stephanie T Yerkovich4,5

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American Journal of Respiratory and Critical Care Medicine
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Pediatric bronchiectasis is often reversible, with 40% of children showing complete radiographic resolution. Younger age, less severe initial symptoms, and absence of Pseudomonas aeruginosa infection predict better outcomes.

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bronchial dilatationearly diagnosisresolutionreversible

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Area of Science:

  • Pediatric Pulmonology
  • Radiology
  • Infectious Diseases

Background:

  • Bronchiectasis in children was traditionally considered irreversible.
  • Recent small studies suggest potential reversibility.
  • Factors influencing radiographic resolution remain undefined.

Purpose of the Study:

  • To determine the extent of bronchiectasis reversibility in a large pediatric cohort.
  • To identify factors associated with radiographic resolution on chest high-resolution computed tomography (cHRCT).

Main Methods:

  • Retrospective analysis of 142 children with repeat cHRCT scans (2010-2021).
  • Exclusion criteria: cystic fibrosis, surgery, traction bronchiectasis, lobar opacification.
  • Scoring using modified Reiff score (MRS); resolution defined by normal bronchoarterial ratio on follow-up cHRCT.

Main Results:

  • Radiographic resolution observed in 40.1% (57/142), improvement in 39.4% (56/142).
  • Pseudomonas aeruginosa (PsA) infection was strongly associated with lack of resolution.
  • Younger age, lower MRS, and fewer exacerbations predicted resolution in PsA-negative patients.

Conclusions:

  • This large cohort confirms bronchiectasis is often reversible in children with proper management.
  • Younger children and those with less severe initial cHRCT findings are more likely to achieve resolution.
  • PsA infection significantly reduces the likelihood of radiographic reversibility.