1337 Non-Invasive Diagnosis of Tracheobronchomalacia in An Infant with Bpd Using 320-Slice Ct Bronchography

Abstract

Background: Abnormal airway development may occur in preterm infants with BPD, giving rise to symptomatic bronchomalacia in infants with severe disease. This condition may be under recognised in this population because diagnosis has required highly invasive procedures to be undertaken (bronchoscopy or bronchograms). We present a 6-month old infant (born at 24 weeks gestation) with severe BPD and pulmonary hypertension. Tracheobronchomalacia was suspected on clinical grounds because of repeated episodes of sudden and profound hypercapnia (pCO2 up to 150 mmHg) precipitated by periods of activity and coughing, despite support with mechanical ventilation. Because of worsening respiratory function Dynamic Volumetric CT bronchography was performed to assess airway patency non-invasively. Method: Parental consent was obtained to perform dynamic chest CT with contrast (320 slice Aquilon ONE CT scanner, Toshiba). Mechanical ventilation was temporarily interrupted and airway pressure reduced to 0 mmHg. Non-gated continuous imaging was acquired over 2 s while theinfant was breathing spontaneously through an endotracheal tube. Results: The scan was well tolerated by the infant. Dynamic changes in airway patency were demonstrated through the respiratory cycle, diagnostic of extensive bronchomalacia. The 3D dataset permitted demonstration of relationships with cardiac and vascular structures. Lung parenchymal architecture was defined. Radiation dose was comparable with conventional spiral chest CT or bronchography. Conclusions: We have demonstrated that tracheobronchomalacia can be diagnosed non-invasively in a sick infant, using a 320-slice Dynamic chest CT. This imaging modality offers exciting opportunities to enhance diagnostic evaluation in severe lung disease.