Bronchopulmonary Dysplasia
Ashley DAvidoffMD The CommonVein.com
Finding: Bronchopulmonary Dysplasia (BPD)
The Common Vein Ashley Davidoff MD
| Part A: Bronchopulmonary Dysplasia – Finding |
| Definition |
A chronic lung disease of premature infants (usually < 32 weeks) who required mechanical ventilation and oxygen therapy. It is characterized by arrested alveolar development, leading to simplified lung architecture (fewer, larger alveoli) and fibrosis. |
| Etymology |
- Dysplasia: Abnormal growth/development.
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| Also Known As (AKA) |
Chronic Lung Disease of Prematurity. |
| Imaging Signs |
- Coarse Reticulation: Strands of density (“messy lungs”) alternating with lucency.
- Hyperinflation: Flattened diaphragms.
- Cystic Changes: In severe cases, multiple small bubbly cysts.
- Adult Sequelae: Early onset emphysema, mosaic attenuation (air trapping), and architectural distortion in young adults with a history of prematurity.
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| Imaging Modalities |
- CXR: Diagnostic in neonates.
- CT: Used in older children/adults to assess permanent damage (emphysema-like changes).
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| Structural Changes |
“Alveolar Simplification.” The septation process (forming millions of tiny alveoli) stops. The result is a lung with fewer, larger air sacs, reducing the surface area for gas exchange. Fibrosis occurs in the interstitium. |
| Assessment |
- Clinical Context: Diagnosis is defined by the need for supplemental oxygen at 36 weeks post-menstrual age.
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| Differential Diagnosis |
- Wilson-Mikity Syndrome (Historical)
- Neonatal Pneumonia
- Pulmonary Interstitial Glycogenosis (PIG)
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| Causes |
- Barotrauma/Volutrauma: Mechanical ventilation injury.
- Oxygen Toxicity: Free radical damage.
- Prematurity: Immature lung is vulnerable.
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| Pathophysiology |
Inflammation interferes with the signaling pathways (VEGF) required for alveolarization and angiogenesis. |
| What Next? |
- Long-term: These patients are prone to asthma, viral infections (RSV), and pulmonary hypertension. Monitor with PFTs.
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| Key Points and Pearls |
- The “Old BPD” vs “New BPD”: “Old” BPD (pre-surfactant era) had intense fibrosis/scarring. “New” BPD (post-surfactant) is mostly alveolar simplification (stopped growth) with less scarring.
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| References |
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