Bronchopulmonary dysplasia

Case contributed by Dr Benedikt Beilstein

Presentation

Preterm neonate (23rd gestational week; delivered via c-section due to maternal infection and PROM) with insufficent spontaneous breathing

Patient Data

Age: Newborn
Gender: Male
Modality: X-ray

Endotracheal tube with the tip just above the carina and hence, placed a little too deep.

Umbilic artery line malpositioned with folded line in a large aortic branch, either right renal artery/ SMA / coeliac trunk.

Moderate ground glass opacification with bilateral central dominance. The cardiac silhouette remains visible as does the diaphragm.

CONCLUSION: mild to moderate IRDS with centrally located ground glass airspace and interstitial opacities with mild air-bronchograms. Some semi-optimal placed lines and tubes.

One day later

Modality: X-ray

The x-ray taken the next day shows removal of the umbilic artery line and the endotracheal tube and newly inserted central venous line via the left brachial vein, the tip remaining in the subclavian vein, hence no central positioning.

Discrete progression of ground glass opacification with loss of visibility of the cardiac silhouette. Dilated small bowel loops in the upper abdomen , inserted NGT in correct position.

The child went on to have a prolonged CPAP therapy for 42 days and intermittent high flow oxygenation for another 5 days. Two months later, a control x-ray was taken because the child still suffered from abnormal respiratory function and shortness of breath which required permanent respiratory support.

Two months later

Modality: X-ray

X-RAY FINDINGS: Bilateral ill-defined reticulo-nodular markings predominantly on the right with obscuration of the right hemidiaphragm and heart border, positive air-bronchograms and hyperinflation of the left lower zone. No apparent atelectasis. The widened upper mediastinum on the right is most likely due to non-centric projection (see trachea and clavicles). Dilated small and large bowel loops.

CONCLUSION: Given the history of a preterm neonate with IRDS and consecutive prolonged oxygenation therapy and normal infection parameters (normal CRP and leucocyte count) the most likely diagnosis is bronchopulmonary dysplasia (BPD).

Case Discussion

The case illustrates a feared consequence of IRDS and consecutive high-pressure oxygenation in preterm neonates:  bronchopulmonary dysplasia, (BPD).

Clinically, this young fellow recovered quite well and was discharged from hospital some weeks later. The oxygen therapy could be reduced step by step from permanent to intermittent to zero and currently his medication is an inhaled corticosteroid. His lung, however will most most likely suffer from some irreversible parenchymal damage.

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Case Information

rID: 52167
Case created: 24th Mar 2017
Last edited: 26th Mar 2017
Systems: Paediatrics, Chest
Inclusion in quiz mode: Included

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