Paediatric ImagingBronchopulmonary dysplasia
(BPD) (also called chronic lung disease of prematurity (CLD)), a chronic lung disease that develops in infants treated with positive pressure mechanical ventilation and oxygen. New treatments and technologies have improved the outcome for premature babies and as a result the number of babies affected by BPD has increased. Classically BPD has been defined clinically as a baby with an oxygen dependency at 28 days of age and an abnormal chest radiograph. However, typical histological changes of BPD may be present at autopsy in infants dying within the first week of life. This definition also fails to account for the gestational age.
Pathologically the condition is characterized by areas of hyperexpansion and atelectasis interspersed with patchy areas of fibrosis. Characteristic radiographic appearances are patchy or linear strands of increased density with localized areas of unequal aeration and generalized hyperaeration (Fig.1) . Cardiomegaly may occur in severe cases and signifies pulmonary hypertension. Radionuclide ventilation and perfusion scans show ventilation perfusion mismatches and air trapping with delayed washout of nuclide, particularly in bullous areas. The chest radiograph may return to normal in babies whose disease remains mild. Severe BPD may be fatal or lead to debilitating chronic pulmonary insufficiency. Follow-up in babies with BPD shows an increased number of later respiratory infections and an increased incidence of reactive airway disease.
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Typical moderately severe BPD with pulmonary hyperinflation, areas of alveolar consolidation and hyperinflation. The changes are evenly distributed.
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Bronchopulmonary dysplasia, Fig.1 | |