bronchopulmonary dysplasia

Former
premature newborn who is now 7 months old with respiratory distressCXR AP+lateral shows bilaterally increased interstitial lung markings and increased lung volumes along with emphysematous blebs in the left upper, left lower and right lower lobes. The diagnosis was bronchopulmonary dysplasia.
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Former
premature newborn who is now 6 years old with respiratory distressCoronal CT without contrast of the lungs shows bilaterally increased interstitial lung markings and increased lung volumes along with an emphysematous bleb in the left lower lobe. The diagnosis was bronchopulmonary dysplasia.
pediatricimaging.org • CC-by-nc-sa 4.0
Former
premature newborn now 1 year old with chronic respiratory distress. CXR (above) shows hyperexpansion and fine interstitial infiltrates. Axial CT without contrast of the chest (below) shows diffuse alveolar and interstitial lung disease bilaterally that is more prominent in the perihilar regions.The diagnosis was bronchopulmonary dysplasia.
pediatricimaging.org • CC-by-nc-sa 4.0
Premature
newborn with respiratory distress. Post-mortem gross pathological image of both lungs (above) shows the lungs to have an irregular surface due to the presence of multiple cysts in the lungs. Magnified image (below) better shows the heterogenous nature of the cysts in the lung.The diagnosis was Wilson Mikity syndrome / bronchopulmonary dysplasia.
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Bronchopulmonary dysplasia (BPD) refers to late pathological lung changes that develop in infants after several weeks on prolonged ventilation.

Terminology

BPD and chronic lung disease of prematurity (CLDP) have often been used interchangeably to describe the condition post-treatment of premature infants for respiratory distress syndrome. However, some suggest that there are different underlying pathogeneses and that CLDP encompasses other conditions besides BPD .

Pathology 

It is the result of a paradoxical combination of hypoxia and oxygen toxicity. There is initial capillary wall damage, interstitial fluid seepage and ensuing pulmonary edema, which is followed by loss of ciliated epithelium and bronchiolar mucosal necrosis. Areas of both hyperexpansion and atelectasis are seen. This is followed by eosinophilic exudate and squamous metaplasia and may ultimately lead to interstitial fibrosis/fibro-proliferative bronchiolitis.

Radiographic features

Plain radiograph
  • ill-defined reticular markings with interspersed rounded lucent areas diffusely involving hyperinflated lungs
  • the lungs may have relatively normal AP diameter on the lateral film
  • presence of cardiomegaly may indicate the development of pulmonary hypertension
  • in chronic cases, the lateral film may show a much narrower AP diameter compared with the chest width on the frontal film
CT

Bronchiectatic changes are usually not considered a feature .

Treatment and prognosis

Infants who survive neonatal bronchopulmonary dysplasia often show a slow but continuous improvement in respiratory status. Young adult survivors who have had moderate and severe bronchopulmonary dysplasia may have residual functional and characteristic structural pulmonary abnormalities; of these, the most notable is pulmonary emphysema .

Differential diagnosis

General imaging differential considerations include:

See also

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Bronchopulmonale Dysplasie:
interstitielles
Lungenemphysem
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