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Bronchopulmonary dysplasia: value of CT in identifying pulmonary sequelae
C Oppenheim1, T Mamou-Mani, N Sayegh
1Department of Pediatric Radiology, Hôpital des Enfants Malades, Paris, France.
Insights
Computed tomography (CT) scans are superior to chest radiographs for identifying lung damage in children with bronchopulmonary dysplasia (BPD). CT reveals characteristic abnormalities like hyperaeration and linear opacities, crucial for diagnosing BPD sequelae.
Area of Science:
- Pediatric Pulmonology
- Medical Imaging
- Neonatal Medicine
Background:
- Pulmonary dysfunction is a frequent complication in children surviving bronchopulmonary dysplasia (BPD).
- Chest radiographs are often inadequate for detecting BPD sequelae due to minor or absent abnormalities.
- Accurate identification of chronic lung changes in BPD survivors is essential for management.
Purpose of the Study:
- To evaluate the diagnostic value of computed tomography (CT) in identifying sequelae of bronchopulmonary dysplasia.
- To compare the sensitivity of CT scans versus chest radiographs in visualizing lung abnormalities in BPD survivors.
Main Methods:
- Twenty-three children with a history of neonatal BPD and chronic pulmonary dysfunction were included.
- Both chest radiographs and high-resolution CT scans of the chest were performed on all participants.
- Two reviewers qualitatively analyzed and compared radiographic and CT findings, noting lesion frequencies.
Main Results:
- Chest radiographs revealed abnormalities in 19 of 23 children, including hyperexpansion and linear opacities, with four showing normal findings.
- All 23 CT scans demonstrated abnormalities, with 20 children exhibiting multifocal hyperaeration, linear opacities, and subpleural opacities.
- No bronchiectasis was observed in any patient on either imaging modality.
Conclusions:
- CT scans provide superior visualization of lung lesions in BPD survivors compared to chest radiographs.
- Specific CT findings, including multifocal hyperaeration and characteristic opacities, are indicative of BPD sequelae.
- The absence of bronchiectasis on CT is noted in these cases of BPD sequelae.
Objective:
Pulmonary dysfunction is common in children who survive bronchopulmonary dysplasia. Chest radiographs are not satisfactory for the identification of the sequelae of bronchopulmonary dysplasia because, although they often show abnormalities, the abnormalities are usually minor and sometimes absent. We therefore assessed the value of CT for identifying the sequelae of bronchopulmonary dysplasia.
Materials And Methods:
Twenty-three children (mean age, 4 years) who had survived neonatal bronchopulmonary dysplasia and had signs of chronic pulmonary dysfunction (recurrent episodes of coughing, wheezing, dyspnea, pneumonia, respiratory insufficiency) were examined with chest radiographs and high-resolution CT scans of the chest. Two reviewers qualitatively analyzed the chest radiographic and CT findings by describing the most consistently found lesions and their frequencies.
Results:
The chest radiographs showed hyperexpansion in 17, hyperlucent areas in 11, and linear opacities in 10 of the 23 children. Pleural thickening was not observed, and four children had normal findings on chest radiographs. All 23 CT scans showed abnormalities, including multifocal areas of hyperaeration, well-defined linear opacities, and triangular subpleural opacities with an external base and an internal apex. In 20 of 23 children, all three abnormalities were present. For the three other children, two of these three abnormalities were found. No bronchiectasis was observed in any of the cases.
Conclusion:
Lesions in survivors of bronchopulmonary dysplasia with chronic pulmonary dysfunction are visualized better on CT scans than on chest radiographs. Importantly, CT findings of multifocal areas of hyperaeration, numerous linear opacities facing triangular subpleural opacities visible on several consecutive sections, and no bronchiectasis should suggest the presence of sequelae of bronchopulmonary dysplasia.