Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed
BPD is an end stage lung disease due primarily to oxygen toxicity from chronic ventilatory support. Other contributing factors include the effects of intermittent positive pressure ventilation, patent ductus arteriosus, and problems with pulmonary toilet. It is most commonly seen as a sequelae to hyaline membrane disease, but can also be seen as a sequelae to meconium aspiration, persistent fetal circulation, and congenital heart disease.
Initially generalized capillary leak and mucosal necrosis is seen. At 1-2 weeks exudative alveolar and airway necrosis is seen along with hyaline membrane formation, mucosal squamous metaplasia and interstitial edema. At 2-3 weeks overdistended alveoli and scarred lung is seen. At several months large lung cysts and progressive interstitial and alveolar septal fibrosis is seen.
As ventilation techniques change, the classic radiographic stages of BPD are rarely seen. Classically, over time, the imaging findings progress. Initially the typical "ground glass" pattern of hyaline membrane disease is seen. At 1-2 weeks complete opacification of the lungs ("white out") is seen. At 2-3 weeks multiple small cystic lucencies of relatively uniform size and distribution are seen giving the lung a bubbly appearance. By several months of age, lung volume is increased, and the small cystic lucencies have coalesced into larger ones surrounded by fibrotic stranding. In most survivors, clinical and radiologic signs of BPD clear within 2-3 years.
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