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Chou JTT, Kalantarova A, Borkowska-Kłos M, Kornacki J, Szczapa T, Wender-Ozegowska E. Multidisciplinary management of a large microcystic congenital pulmonary airway malformation: case report and literature review. J Matern Fetal Neonatal Med 2023; 36:2239424. [PMID: 37581300 DOI: 10.1080/14767058.2023.2239424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/03/2023] [Accepted: 07/17/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Congenital pulmonary airway malformations (CPAMs) are rare sporadic lesions frequently associated with poor fetal prognosis. Type 3 CPAMs are characterized by small hyperechogenic cysts (<5 mm). Hydrops often develops secondarily, and the fetal survival rate is approximately 5% in this setting. CASE PRESENTATION We present a case of a large type 3 CPAM complicated by fetal hydrops. The lesion was detected at 19 gestational weeks (GW) and confirmed by fetal MRI at 29 GW. At 22 GW, a course of maternal steroids was given as a possible treatment of type 3 CPAM. Peritoneal-amniotic shunt was placed twice to reduce fetal ascites, with unsatisfactory results. Similarly, polyhydramnios was relieved by two amnioreductions, but redeveloped soon after. A baby girl was delivered spontaneously at 33 GW and received a two-stage partial lobectomy in the first three months of life. Desaturations necessitated challenging invasive oscillatory ventilation between stages. Her outcome is unexpectedly positive and she may expect a good quality of life. She now approaches one year of age, with near-to-normal growth and developmental milestones. DISCUSSION Type 3 CPAMs complicated by fetal hydrops are associated with high perinatal mortality. While open fetal surgery remains a viable option in select specialist centers, antenatal interventions are typically ineffective. The survival of this infant can be attributed to prenatal management and early postnatal surgical intervention. The lack of guidelines for ventilation in this setting was a significant challenge for neonatal intensivists. Multidisciplinary vigilance and collaboration with frequent specialist follow ups were the key to success for both mother and child.
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Affiliation(s)
- Jadzia Tin-Tsen Chou
- Division of Reproduction, Department of Obstetrics, Gynecology, and Gynecologic Oncology, Poznan University of Medical Sciences, Poznań, Poland
| | - Anastasia Kalantarova
- Division of Reproduction, Department of Obstetrics, Gynecology, and Gynecologic Oncology, Poznan University of Medical Sciences, Poznań, Poland
| | - Monika Borkowska-Kłos
- Department of Neonatal Infectious Diseases, Poznan University of Medical Sciences, Poznań, Poland
| | - Jakub Kornacki
- Division of Reproduction, Department of Obstetrics, Gynecology, and Gynecologic Oncology, Poznan University of Medical Sciences, Poznań, Poland
| | - Tomasz Szczapa
- Department of Neonatal Infectious Diseases, Poznan University of Medical Sciences, Poznań, Poland
| | - Ewa Wender-Ozegowska
- Division of Reproduction, Department of Obstetrics, Gynecology, and Gynecologic Oncology, Poznan University of Medical Sciences, Poznań, Poland
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Cheng L, Duan J, Wang M, Lu D, Li H, Ma J, Liu J, Wang C, Zhang Y. Case Report: Prenatal and Postnatal Management for Fetal Bronchogenic Cysts During the COVID-19 Pandemic. Front Pediatr 2021; 9:675883. [PMID: 34307253 PMCID: PMC8292643 DOI: 10.3389/fped.2021.675883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/08/2021] [Indexed: 12/14/2022] Open
Abstract
Background: A fetal bronchogenic cyst (BC) is a rare congenital anomaly with an incidence of 0.147-0.238‰. The coronavirus disease 2019 (COVID-19) pandemic, as a particular situation, hindered pregnant women from receiving periodic prenatal checkups. Case Description: Until 34+6 weeks of gestation, a fetal case of the intrathoracic cyst was found by ultrasound examination. Further, MRI examination confirmed the diagnosis of the congenital mediastinal cystic lesion, probably a BC. Genetic testing was not conducted due to the COVID-19 pandemic. At 38+5 weeks of gestation with maternal COVID-19 testing negative, a live girl was delivered by cesarean section. Five months later, the child underwent bronchocystectomy, and the postoperative pathological lesions confirmed a (right upper mediastinum) BC. Conclusion: Herein, we reported the prenatal and postnatal management for a rare case of the congenital BC by multidisciplinary approaches during the COVID-19 pandemic. Fetal MRI and screening for fetal chromosomal abnormalities are especially recommended. This case contributes to the awareness that the COVID-19 pandemic interferes with regular follow-up schedules during pregnancy and may interfere with timely performed additional tests; which leads to more accurate genetic counseling. A combination of multidisciplinary approaches, including radiology, infection control, genetic counseling, obstetrics, and pediatric surgery, is pivotal for managing fetal BC during the COVID-19 pandemic.
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Affiliation(s)
- Lin Cheng
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China.,Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, China.,Wuhan Clinical Research Center for Reproductive Science and Birth Health, Wuhan, China
| | - Jie Duan
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China.,Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, China.,Wuhan Clinical Research Center for Reproductive Science and Birth Health, Wuhan, China
| | - Mei Wang
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China.,Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, China.,Wuhan Clinical Research Center for Reproductive Science and Birth Health, Wuhan, China
| | - Dan Lu
- Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, China.,Wuhan Clinical Research Center for Reproductive Science and Birth Health, Wuhan, China.,Department of Ultrasound Imaging, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Huan Li
- Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, China.,Wuhan Clinical Research Center for Reproductive Science and Birth Health, Wuhan, China.,Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jianhong Ma
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China.,Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, China.,Wuhan Clinical Research Center for Reproductive Science and Birth Health, Wuhan, China
| | - Juan Liu
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China.,Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, China.,Wuhan Clinical Research Center for Reproductive Science and Birth Health, Wuhan, China
| | - Cheng Wang
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China.,Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, China.,Wuhan Clinical Research Center for Reproductive Science and Birth Health, Wuhan, China
| | - Yuanzhen Zhang
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China.,Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, China.,Wuhan Clinical Research Center for Reproductive Science and Birth Health, Wuhan, China
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Hermelijn SM, Zwartjes RR, Tiddens HAWM, Cochius-den Otter SCM, Reiss IKM, Wijnen RMH, Schnater JM. Associated Anomalies in Congenital Lung Abnormalities: A 20-Year Experience. Neonatology 2020; 117:697-703. [PMID: 32841951 DOI: 10.1159/000509426] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/09/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION A congenital lung abnormality (CLA) is often found in conjunction with other abnormalities but screening guidelines for newborns with CLA have not yet been reported. We aimed to assess the incidence of associated anomalies in CLA patients born or followed up at our centre and the need for additional screening of newborns with a CLA. METHODS From a retrospective chart review of all patients born with a CLA between January 1999 and January 2019, we identified patients diagnosed with a congenital pulmonary airway malformation, bronchopulmonary sequestration, congenital lobar overinflation, bronchogenic cyst, or lung agenesis. Associated anomalies were noted and categorized according to the affected organ system. RESULTS Twenty-eight (14%) of 196 CLA patients had a major associated anomaly. This was most frequent in conjunction with a lung agenesis (100%) or bronchogenic cyst (29%). Congenital heart defects (32%) and gastrointestinal defects (18%) were the most frequently associated anomalies. Examination of newborns with a CLA should focus on the cardiovascular and gastrointestinal tract, and a chest and abdominal radiograph may be useful to assess signs of major associated anomalies, regardless of the clinical course.
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Affiliation(s)
- Sergei M Hermelijn
- Department of Paediatric Surgery and Intensive Care, Erasmus University Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Rutger R Zwartjes
- Department of Paediatric Pulmonology, Erasmus University Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Harm A W M Tiddens
- Department of Paediatric Pulmonology, Erasmus University Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Suzan C M Cochius-den Otter
- Department of Paediatric Surgery and Intensive Care, Erasmus University Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Irwin K M Reiss
- Department of Neonatology, Erasmus University Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - René M H Wijnen
- Department of Paediatric Surgery and Intensive Care, Erasmus University Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - J Marco Schnater
- Department of Paediatric Surgery and Intensive Care, Erasmus University Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands,
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