Advertisement

Radiology of Bronchopulmonary Dysplasia: From Preterm Birth to Adulthood

  • Outi TammelaEmail author
  • Päivi Korhonen
Chapter
Part of the Respiratory Medicine book series (RM)

Abstract

The radiographic course of bronchopulmonary dysplasia (BPD) was first categorized into four sequential stages in the pre-surfactant era: from the granular pattern and a positive air bronchogram of acute respiratory distress syndrome (RDS) to enlarged lucent areas, alternating with strands of density and cardiomegaly. Two radiographic stages of BPD have been suggested in the surfactant era. Leaky lung syndrome (LLS) is associated with hazy-to-opaque findings, caused by capillary leakage due to hyperoxia. Cystic findings, referred to as “bubbly lung,” represent more severe lung injury, with heterogeneous opaque strands, cystic lucencies of varying size, and regional air trapping. High-resolution computed tomography detects lung abnormalities typical of BPD with a greater sensitivity than chest radiographs. Typical findings in BPD patients include linear and subpleural triangular opacities, reduced lung attenuation, bullae or blebs, emphysema, collapse, consolidation, bronchial wall thickening, bronchiectasis, and inverse bronchopulmonary artery diameter ratios. In the imaging of BPD, magnetic resonance imaging (MRI) has the potential to give functional information, and it is sensitive in detection of early changes in cases of emphysema.

Keywords

Chest radiograph Cystic High-resolution computed tomography Leaky lung syndrome Magnetic resonance imaging Radiographic course Scoring 

Notes

Acknowledgments

We thank very much Päivi Savikurki, MD, pediatric radiologist, Tampere University Hospital, for valuable comments on the manuscript and help in choosing and editing the radiographs and Päivi Laarne, PhD, Medical Physicist, Tampere University Hospital, for help in the interpretation of radiation doses.

References

  1. 1.
    Northway Jr WH, Rosan RC, Porter DY. Pulmonary disease following respirator therapy of hyaline membrane disease. Bronchopulmonary dysplasia. N Engl J Med. 1967;276(7):357–68.CrossRefPubMedGoogle Scholar
  2. 2.
    Swischuk LE, Shetty BP, John SD. The lungs in immature infants: how important is surfactant therapy in preventing chronic lung problems? Pediatr Radiol. 1996;26(8):508–11.CrossRefPubMedGoogle Scholar
  3. 3.
    Jobe AJ. The new BPD: an arrest of lung development. Pediatr Res. 1999;46:641–3.CrossRefPubMedGoogle Scholar
  4. 4.
    Wilson AC. What does imaging of the chest tell us about bronchopulmonary dysplasia. Pediatr Respir Rev. 2010;11:158–61.CrossRefGoogle Scholar
  5. 5.
    Bhandari A, Panitch HB. Pulmonary outcomes in bronchopulmonary dysplasia. Semin Perinatol. 2006;30:219–26.CrossRefPubMedGoogle Scholar
  6. 6.
    Edwards DK. Radiology of hyaline membrane disease, transient tachypnea of the newborn, and bronchopulmonary dysplasia. In: Farrell PM, editor. Lung development: biological and clinical perspectives, vol. 2. New York: Academic; 1982. p. 47–89.Google Scholar
  7. 7.
    Oppermann HC, Wille L, Bleyl U, Obladen M. Bronchopulmonary dysplasia in premature infants. A radiological and pathological correlation. Pediatr Radiol. 1977;5(3):137–41.Google Scholar
  8. 8.
    Heneghan MA, Sosulski R, Baquero JM. Persistent pulmonary abnormalities in newborns: the changing picture of bronchopulmonary dysplasia. Pediatr Radiol. 1986;16(3):180–4.Google Scholar
  9. 9.
    Fitzgerald P, Donoghue V, Gorman W. Bronchopulmonary dysplasia: a radiographic and clinical review of 20 patients. Br J Radiol. 1990;63(750):444–7.Google Scholar
  10. 10.
    Fitzgerald DA, Van Asperen PP, Lam AH, De Silva M, Henderson-Smart DJ. Chest radiograph abnormalities in very low birth weight survivors of chronic neonatal lung disease. J Paediatr Child Health. 1996;32:491–4.Google Scholar
  11. 11.
    Moya MP, Bisset GS, Auten Jr RL, Miller C, Hollingworth C, Frush DP. Reliability of CXR for the diagnosis of bronchopulmonary dysplasia. Pediatr Radiol. 2001;31:339–42.Google Scholar
  12. 12.
    Hyde I, English RE, Williams JD. The changing pattern of chronic lung disease of prematurity. Arch Dis Child. 1989;64:448–51.Google Scholar
  13. 13.
    Toce SS, Farrell PM, Leavitt LA, Samuels DP, Edwards DK. Clinical and roentgenographic scoring systems for assessing bronchopulmonary dysplasia. Am J Dis Child. 1984;138:581–5.Google Scholar
  14. 14.
    Yuksel B, Greenough A, Karani J, Page A. Chest radiograph scoring system for use in pre-term infants. Br J Radiol. 1991;64:1015–8.Google Scholar
  15. 15.
    Greenough A, Dimitriou G, Johnson AH, Calvert S, Peacock J, Karani J. The chest radiograph appearances of very premature infants at 36 weeks post-conceptional age. Br J Radiol. 2000;73:366–9.Google Scholar
  16. 16.
    Greenough A, Kavvadia V, Johnson AH, Calvert S, Peacock J, Karani J. A simple radiograph score to predict chronic lung disease in prematurely born infants. Br J Radiol. 1999;72:530–3.Google Scholar
  17. 17.
    Weinstein MR, Peters ME, Sadek M, Palta M. A new radiographic scoring system for bronchopulmonary dysplasia. Pediatr Pulmonol. 1994;18:284–9.Google Scholar
  18. 18.
    Maconochie I, Greenough A, Yuksel B, Page A, Karani J. A chest radiograph scoring system to predict chronic oxygen dependency in low birth weight infants. Early Hum Dev. 1991;26(1):37-43.Google Scholar
  19. 19.
    Noack G, Mortensson W, Robertson B, Nilsson R. Correlations between radiological and cytological findings in early development of bronchopulmonary dysplasia. Eur J Pediatr. 1993;152(12):1024-9.Google Scholar
  20. 20.
    Edwards DK. Radiographic aspects of bronchopulmonary dysplasia. J Pediatr. 1979;95(5):823-9.Google Scholar
  21. 21.
    Agrons GA, Courtney SE, Stocker JT, Markowitz RI. From the archives of AFIP. Lung disease in premature neonates: radiologic-pathologic correlation. Radiographics. 2005;25:1047–73.Google Scholar
  22. 22.
    May C, Prendergast M, Salman S, Rafferty GF, Greenough A. Chest radiograph thoracic areas and lung volumes in infants developing bronchopulmonary dysplasia. Pediatr Pulmonol. 2009;44:80–5.Google Scholar
  23. 23.
    Eber E, Zach MS. Long term pulmonary sequelae of bronchopulmonary dysplasia (chronic lung disease of infancy). Thorax. 2001;56:317–23.Google Scholar
  24. 24.
    Husain AN, Siddiqui NH, Stocker JT. Pathology of arrested acinar development in postsurfactant bronchopulmonary dysplasia. Hum Pathol. 1998;29(7):710–7.Google Scholar
  25. 25.
    Hyödynmaa E, Korhonen P, Ahonen S, Luukkaala T, Tammela O. Frequency and clinical correlates of radiographic patterns of bronchopulmonary dysplasia in very low birth weight infants by term age. Eur J Pediatr. 2012;171:95–102.Google Scholar
  26. 26.
    Lanning P, Tammela O, Koivisto M. Radiological incidence and course of bronchopulmonary dysplasia in 100 consecutive low birth weight neonates. Acta Radiol. 1995;36(4):353–7.Google Scholar
  27. 27.
    Hakulinen AL, Heinonen K, Lansimies E, Kiekara O. Pulmonary function and respiratory morbidity in school-age children born prematurely and ventilated for neonatal respiratory insufficiency. Pediatr Pulmonol. 1990;8:226–32.Google Scholar
  28. 28.
    Lindroth M, Mortensson W. Long term follow-up of ventilator treated low birthweight infants. I. Chest X-ray, pulmonary mechanics, clinical lung disease and growth. Acta Paediatr Scand. 1986;75:819–26.Google Scholar
  29. 29.
    Andreasson B, Lindroth M, Mortensson W, Svenningsen NW, Jonson B. Lung function eight years after neonatal ventilation. Arch Dis Child. 1989;64:108–13.Google Scholar
  30. 30.
    Northway Jr WH, Moss RB, Carlisle KB, Parker BR, Popp RL, Pitlick PT, Eichler I, Lamm RL, Brown BW. Late pulmonary sequelae of bronchopulmonary dysplasia. N Engl J Med. 1990;323:1793–9.Google Scholar
  31. 31.
    Wilson M, Mikity V. A new form of respiratory disease in premature infants. Am J Dis Child. 1960;99:489–99.Google Scholar
  32. 32.
    Hoepker A, Seear M, Petrocheilou A, Hayes Jr D, Nair A, Deodhar J, Kadam S, O’Toole J. Wilson-Mikity syndrome: updated diagnostic criteria based on nine cases and a review of the literature. Pediatr Pulmonol. 2008;43:1004–12.Google Scholar
  33. 33.
    Rossi UG, Owens CM. The radiology of chronic lung disease in children. Review Arch Dis Child. 2005;90:601–7.Google Scholar
  34. 34.
    Bankier AA, Tack D. Dose reduction strategies for thoracic multidetector computed tomography. Background, current issues, and recommendations. J Thorac Imaging. 2010;25:278–88.Google Scholar
  35. 35.
    Christner JA, Kofler JM, McCollough CH. Estimating effective dose for CT using dose-length product compared with using organ doses: consequences of adopting international commission on radiological protection publication 103 or dual-energy scanning. AJR Am J Roentgenol. 2010;194:881–9.Google Scholar
  36. 36.
    Ochiai M, Hikino S, Yabuuchi H, Nakayama H, Sato K, Ohga S, et al. A new scoring system for computed tomography of the chest for assessing the clinical status of bronchopulmonary dysplasia. J Pediatr. 2008;152:90–5.Google Scholar
  37. 37.
    Jobe AH, Bancalari E. NICHD/NHLRI workshop summary: bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2001;163:1723–9.Google Scholar
  38. 38.
    Oppenheim C, Mamou-Mani T, Sayegh N, de Blic J, Scheinmann P, Lallemand D. Bronchopulmonary dysplasia: value of identifying pulmonary sequelae. AJR Am J Roentgenol. 1994;193:169–72.Google Scholar
  39. 39.
    Aukland SM, Rosendahl K, Owens CM, Fosse KR, Eide GE, Halvorsen T. Neonatal bronchopulmonary dysplasia predicts abnormal pulmonary HRCT scans in long-term survivors of extreme preterm birth. Thorax. 2009;64:405–10.Google Scholar
  40. 40.
    Howling SJ, Northway Jr WH, Hansell DM, Moss RB, Ward S, Műller NL. Pulmonary sequelae of bronchopulmonary dysplasia survivors: high resolution CT findings. Am Respir J. 2000;174:1323–6.Google Scholar
  41. 41.
    La Tour AT, Spadola L, Sayegh Y, Comescure C, Pfister R, Argiroffo CB, et al. Chest CT in bronchopulmonary dysplasia: clinical and radiological correlations. Pediatr Pulmonol. 2013;48:693–8.CrossRefGoogle Scholar
  42. 42.
    Sarria EE, Mattiello R, Rao L, Tiller CJ, Pointdexter B, Applegate KE, et al. Quantitative assessment of chronic lung disease of infancy using computed tomography. Eur Respir J. 2012;39:992–9.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Wong P, Murray C, Louw J, French N, Chambers D. Adult bronchopulmonary dysplasia: computed tomography pulmonary findings. J Med Imaging Radiat Oncol. 2011;55:373–8.CrossRefPubMedGoogle Scholar
  44. 44.
    Aquino SL, Schechter MS, Chilers C, Ablin DS, Chills B, Webb WR. High-resolution inspiratory and expiratory CT in older children and adults with BPD. AJR Am J Roentgenol. 1999;173:963–7.CrossRefPubMedGoogle Scholar
  45. 45.
    Yablonsky DA, Suskianskii A, Woods JC, Gierada DS, Quick JD, Hogg JC, et al. Quantification of lung microstructure with hyperpolarized 3He diffusion MRI. J Appl Physiol. 2009;107:1258–65.CrossRefGoogle Scholar
  46. 46.
    Adams EW, Harrison MC, Counsell SJ, Allsop JM, Kenea NL, Hainal JV, et al. Increased lung water and tissue damage in bronchopulmonary dysplasia. J Pediatr. 2004;145:503–7.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of PediatricsTampere University HospitalTampereFinland

Personalised recommendations