Hyperechoic congenital lung lesions in a non-selected population: from prenatal detection till perinatal management

Thoracoscopic excision of asymptomatic antenatally diagnosed mediastinal bronchogenic cysts: A case report

Bronchogenic Cysts (BCs) are benign congenital malformations commonly located in the mediastinum. In recent years the development of antenatal diagnosis has changed the BCs management allowing an earlier minimally invasive approach. We report a case of an asymptomatic 8-months-old girl with antenatal diagnosis of subcarinal posterior mediastinal BC. Thoracoscopic excision of the cyst was successfully performed. The management of antenatally diagnosed BCs is discussed. Thoracoscopic treatment of BCs is safe and effective with the advantage of a reduced morbidity compared to thoracotomy.

Prenatal diagnosis and postnatal findings of bronchogenic cyst

Bronchogenic cysts arise from abnormal buds from the primitive esophagus and tracheobronchial tree, which do not extend to the site where alveolar differentiation occurs. Bronchogenic cysts are typically unilocular mucus field lesions arising from posterior membranous wall of the air way. The prenatal diagnosis usually is realized by two-dimensional ultrasound showing the large unilocular cystic image in the chest fetus. The prenatal percutaneous aspiration can reduce the risk of heart compression and permit better respiratory conditions to newborn. We present a case of a primiparous pregnant 23 year-old-woman prenatal ultrasound showed a large unilocular cyst in the left hemithorax with compression of the normal left lung tissue and contralateral mediastinal shift. This cyst was percutaneously aspirated without subsequent reaccumulation of fluid. The newborn did not have respiratory distress and the computed tomography scan confirmed the finding of a fluid-filled cyst in the left chest. The chest X-ray showed the displacement of the heart and the mediastinum from the left to the right. The prenatal diagnosis of bronchogenic cyst is very important to assess the degree of the compression of the normal lung and the mediastinum shift. Furthermore, the prenatal diagnosis permits planning delivery in the tertiary hospital with multidisciplinary team because of the risk of respiratory distress.

Congenital cystic adenomatoid malformation: is there a need for pregnancy termination?

Aim. Congenital cystic adenomatoid lung malformation is a rare unilateral dysplasia of the lung. Three pathologic types are described in the literature: type I with cysts >2 cm, type II with cysts <1 cm, and type III with microcysts. The aim of this paper is to present a case of a fetus with congenital cystic adenomatoid lung malformation and discuss the necessity for pregnancy termination according to its prognosis and future mortality. Case. A 36-year-old pregnant woman (para: 1, gravida: 1) presented in our department for anatomy ultrasound screening at 20 + 1 weeks of gestation. The ultrasound detected a cystic adenomatoid right lung malformation measuring 1.45 × 1.67 cm which caused mediastinal shift of the heart and the lung to the left side. Other findings were cysts of the choroid plexus and echogenic intracardiac foci. The parents after genetic counseling decided pregnancy termination. The pregnant received cabergoline for ablactation. Conclusion. Congenital cystic adenomatoid lung malformation has different prognosis according to the type (69% in type I, 0% in types II and III). Fetal hydrops, cardiac and skeletal anomalies, Potter's syndrome, and gastrointestinal atresia are common cofindings. Genetic counseling is necessary, and pregnancy termination is proposed to the cases with poor prognosis.

[Congenital lung malformations--when to operate?]

Advances in antenatal imaging over the past 10 years have completely changed diagnosis and management of congenital lung disease, especially for congenital cystic adenomatoid malformations and sequestrations that are the two lesions most commonly detected. If early surgical excision is required for symptomatic cases, management of asymptomatic malformations is still discussed. The natural evolution and consequences of later complications of congenital lung malformations need to be compared with the benefits of elective resection and surgical morbidity. Complete regression of sequestrations or clinical and morphological improvement in congenital lobar emphysema pleads for clinical watching. On the other hand, resection is advocated for cystic malformations, because of an increased risk of acute respiratory distress, later infections and the possibility of malignant transformation. Even though the proportion of asymptomatic patients that go on to develop symptoms is hard to evaluate, an argument for elective surgery is a better outcome than emergency surgery. Further studies and long term follow-up are still needed to understand the natural history of congenital lung malformations precisely and help to define the optimal way in which to manage them.

Neonatal outcome after prenatal interventions for congenital lung lesions

Congenital lung lesions, mostly congenital cystic adenomatoid malformations (CCAMs) and bronchopulmonary sequestrations (BPSs), are uncommon disorders. Prenatal intervention in severely affected (hydropic) fetuses has drastically improved perinatal survival. Not much is known, however, on the short-term and long-term respiratory and neurodevelopmental outcome. Several small case series have been reported and suggest an increased incidence of neonatal morbidity, mainly associated with prematurity and respiratory failure at birth. Overall, neonatal mortality and morbidity after prenatal interventions for CCAM seems to be worse than for BPS. This review focuses on the neonatal outcome after prenatal intervention for congenital lung lesions and summarizes the results reported in the literature.