# Radiological Patterns of Pediatric Non-cystic Fibrosis Bronchiectasis: A Retrospective Study From Oman

## TL;DR

This study from Oman describes the HRCT features of pediatric non-cystic fibrosis bronchiectasis and links them to underlying conditions like immunodeficiency and ciliary dyskinesia.

## Contribution

The study provides a detailed characterization of HRCT patterns in pediatric NCFB in a Middle Eastern population.

## Key findings

- Diffuse bronchiectasis was the most common pattern, affecting over two-thirds of patients.
- Cylindrical bronchiectasis was universal, while cystic and varicose types were more common in patients with systemic disorders.
- Left lower lobe was the most frequently affected lobe, and older age at diagnosis correlated with more diffuse disease.

## Abstract

Background: Non-cystic fibrosis bronchiectasis (NCFB) remains underdiagnosed in pediatric populations, particularly in the Middle East.

Objective: To characterize the high-resolution computed tomography (HRCT) features of NCFB in pediatric patients, including extent, morphological subtype, and lobar distribution, and to evaluate their associations with underlying clinical diagnoses at a tertiary care center in Oman.

Methods: We conducted a retrospective cross-sectional study at Sultan Qaboos University Hospital (SQUH), a tertiary center in Oman, reviewing pediatric patients ≤18 years diagnosed with NCFB between January 2000 and December 2022. High-resolution computed tomography (HRCT) reports prepared by pediatric radiologists were reviewed. Data on clinical features, radiological patterns, lobar involvement, and etiologies were analyzed descriptively using IBM SPSS Statistics for Macintosh, Version 19.0 (IBM Corp., Armonk, NY).

Results: Of the 150 patients reviewed, 61 met the inclusion criteria. The mean age at diagnosis was 7.3 years, with 35 (57.4%) being male. Diffuse bronchiectasis was predominant, observed in 48 patients (78.7%), and involved more than two lobes in 40 cases (65.6%). The left lower lobe was the most frequently affected, seen in 13 patients (21.6%). Cylindrical bronchiectasis was present in all patients, while cystic in 25 patients (41.0%) and varicose in 19 patients (31.1%) forms were more common in those with systemic disorders, such as primary immunodeficiency (PID, 18 patients; 37.5%) and primary ciliary dyskinesia (PCD, 8 patients; 16.7%). Patients diagnosed at age ≥5 years had a significantly higher prevalence of diffuse disease.

Conclusion: HRCT is a crucial diagnostic tool for pediatric NCFB, particularly in children with recurrent infections or systemic comorbidities, such as PID or PCD. Early imaging may prevent irreversible damage and guide targeted treatment. Establishing national guidelines for pediatric chest CT utilization and incorporating multidisciplinary assessments may improve diagnostic timeliness and outcomes.