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


METHODS
Paediatric intensive care unit in a tertiary teaching hospital.


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.
Mok
Q
Q
Paediatric Intensive Care Unit, Great Ormond Street Hospital for Children, London WCIN 3JH, UK. mokq@gosh.nhs.uk
Negus
S
S
McLaren
C A
CA
Rajka
T
T
Elliott
M J
MJ
Roebuck
D J
DJ
McHugh
K
K
D001982:Bronchial Diseases / Q000000981:diagnostic imaging* / Q000628:therapy; D001995:Bronchography / Q000379:methods*; D045422:Continuous Positive Airway Pressure; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000000981:diagnostic imaging / Q000628:therapy; D011175:Positive-Pressure Respiration; D011829:Radiation Dosage; D016037:Single-Blind Method; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014133:Tracheal Diseases / Q000000981:diagnostic imaging* / Q000628:therapy; D015300:Ventilator Weaning