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Computed tomography versus bronchography in the diagnosis and management of tracheobronchomalacia in ventilator dependent infants

¹ Paediatric Intensive Care Unit, Great Ormond Street Hospital for Children, London WCIN 3JH, UK
² Department of Radiology, Great Ormond Street Hospital for Children
³ Cardiothoracic Unit, Great Ormond Street Hospital for Children

Correspondence to:
Correspondence to:
Dr Mok
Paediatric Intensive Care Unit, Great Ormond Street Hospital for Children, London WCIN 3JH, UK; mokq{at}gosh.nhs.uk

Aim: To assess the relative accuracy of dynamic spiral computed tomography (CT) compared with tracheobronchography, in a population of ventilator dependent infants with suspected tracheobroncho-malacia (TBM).

Setting: Paediatric intensive care unit in a tertiary teaching hospital.

Patients and methods: Infants referred for investigation and management of ventilator dependence and suspected of having TBM were recruited into the study. Tracheobronchography and CT were performed during the same admission by different investigators who were blinded to the results of the other investigation. The study was approved by the hospital research ethics committee, and signed parental consent was obtained.

Results: Sixteen infants were recruited into the study. Fifteen had been born prematurely, and five had cardiovascular malformations. In 10 patients there was good or partial correlation between the two investigations, but in six patients there was poor or no correlation. Bronchography consistently showed more dynamic abnormalities, although CT picked up an unsuspected double aortic arch. Radiation doses were 0.27–2.47 mSv with bronchography and 0.86–10.67 mSv with CT.

Conclusions: Bronchography was a better investigation for diagnosing TBM and in determining opening pressures. Spiral CT is unreliable in the assessment of TBM in ventilator dependent infants. In addition, radiation doses were considerably higher with CT.

Abbreviations: CPAP, continuous positive airway pressure; CT, computed tomography; PEEP, positive end expiratory pressure; TBM, tracheobronchomalacia

Keywords: tracheobronchomalacia; bronchography; computed tomography; radiation dose; premature

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