Additional pediatric resources: GeneralPediatrics.com | PediatricEducation.org | SearchingPediatrics.com
Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed
Etiology/Pathophysiology:
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.
Pathology:
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.
Imaging Findings:
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.
DDX:
Not applicable
References:
Additional pediatric resources: GeneralPediatrics.com | PediatricEducation.org | SearchingPediatrics.com
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