title: Multidetector-row computed tomography evaluation of bilateral bronchial narrowing associated with increased pulmonary blood flow in children with congenital heart disease.
abstract: BACKGROUND
  Quantitative assessment of bilateral bronchial narrowing in children with congenital heart disease (CHD) with a left-to-right shunt has not yet been reported.
  
  
  OBJECTIVE
  In the present study, main bronchial size was evaluated bilaterally in normal subjects using multidetector-row computed tomography (MDCT), and the feasibility for diagnosis of bronchial narrowing in children with CHD associated with increased pulmonary blood flow was investigated.
  
  
  METHODS
  The short-axis diameter, long-axis diameter, and the cross-sectional area of the bilateral bronchi were measured immediately proximal to the origin of the superior lobar branch in 86 children aged 1-52 months. Subjects were divided into three groups as follows: group 1 (normal subjects; n = 52), group 2 (asymptomatic left-to-right shunt group; n = 25), and group 3 (symptomatic left-to-right shunt group with respiratory insufficiency; n = 9).
  
  
  RESULTS
  Age, height, weight, and body surface area were significantly correlated with short- and long-axis bronchial diameters, and bronchial cross-sectional area in group 1. In group 2, the left bronchial cross-sectional area was significantly lower than group 1 (P < .001), whereas the right bronchial area was not significantly different. In group 3, the right bronchial area was significantly lower than that in groups 1 and 2 (P < .05). Although the left bronchial area in group 3 was significantly lower than in group 1 (P < .001), it was not significantly different from that in group 2.
  
  
  CONCLUSIONS
  Our study suggests that MDCT can be used to quantify bilateral bronchial narrowing. Left main bronchial obstruction develops during the early stage of heart failure, followed by the development of right bronchial narrowing.
authors.affiliation: Department of Pediatrics, University of Tokushima, Tokushima, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Watanabe
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Hayabuchi
authors.forename: Ryuji
authors.initials: R
authors.lastname: Nakagawa
authors.forename: Takahiko
authors.initials: T
authors.lastname: Saijo
authors.forename: Shoji
authors.initials: S
authors.lastname: Kagami
mesh_terms: D001980:Bronchi / Q000473:pathology*; D016084:Bronchoconstriction; D001995:Bronchography / Q000379:methods*; D016022:Case-Control Studies; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D011651:Pulmonary Artery / Q000503:physiopathology*; D011652:Pulmonary Circulation; D012039:Regional Blood Flow; D012131:Respiratory Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology