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Kumbasar U, Uysal S, Doğan R. Congenital pulmonary malformations. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2024; 32:S60-S72. [PMID: 38584784 PMCID: PMC10995677 DOI: 10.5606/tgkdc.dergisi.2024.25713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/11/2023] [Indexed: 04/09/2024]
Abstract
There are many congenital anomalies of the lung, some of which have no clinical symptoms and are detected incidentally, while others, particularly in the neonatal and infant period, are recognized by their typical signs, symptoms, and radiological appearance. Some congenital lung anomalies are so important that they can cause the death of the patient if not diagnosed and treated early. Classification of congenital lung anomalies is difficult since these anomalies may be related to the airway, arterial and venous vascular system, pulmonary parenchyma, and primitive anterior intestinal anomalies from which the lung originates, and some anomalies may have several etiologic origins. In this review, all subgroups of congenital pulmonary malformations will be discussed.
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Affiliation(s)
- Ulaş Kumbasar
- Department of Thoracic Surgery, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Serkan Uysal
- Department of Thoracic Surgery, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Rıza Doğan
- Department of Thoracic Surgery, Hacettepe University Faculty of Medicine, Ankara, Türkiye
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2
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Luo D, Cheng K, Yuan M, Xu C, He T, Jia R, Dai S, Liu C. Previous pulmonary infection impacts thoracoscopic procedure outcomes in patients with congenital lung malformations: a retrospective cohort study. Respir Res 2023; 24:115. [PMID: 37072849 PMCID: PMC10114450 DOI: 10.1186/s12931-023-02412-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 03/30/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Patients with congenital lung malformations (CLMs) are at high risk for developing pulmonary infection. Nonetheless, prophylactic surgical excision of asymptomatic CLMs is controversial and often delayed to symptoms occurring out of concern for potential operative risks. This study aims to evaluate the impact of previous pulmonary infection on the outcome of thoracoscopic procedures in CLMs patients. METHODS This was a retrospective cohort study of CLMs patients who received an elective operation at a tertiary care center from 2015 to 2019. Patients were divided into pulmonary infection (PI) or non-infection of pulmonary (NPI) groups according to the history of pulmonary infection. Propensity score matching was used to minimize the bias between groups. The primary outcome was conversion to thoracotomy. Postoperative outcomes were compared between patients with and without PI. RESULTS We identified 464 patients, of whom 101 had a history of PI. Propensity score matching yielded a well-balanced cohort of 174 patients. PI was associated with higher conversion to thoracotomy (adjusted odds ratio = 8.7, 95% confidence interval, CI, 1.1-71.2, p = 0.039), blood loss (p = 0.044), and longer operative time (p < 0.001), chest tube placement time (p < 0.001), length of stay (p < 0.001), and postsurgical length of stay (p < 0.001). CONCLUSIONS Elective operation in CLMs patients with a history of PI was associated with an increased risk of conversion to thoracotomy, operative time, blood loss, chest tube placement time, length of stay, and postsurgical length of stay. Elective thoracoscopic procedures in asymptomatic CLMs patients are safe and effective, and earlier surgical intervention may be warranted.
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Affiliation(s)
- Dengke Luo
- Department of Pediatric Surgery, West China Hospital of Sichuan University, No 37, Guo Xue Xiang, Chengdu, 610041, China
| | - Kaisheng Cheng
- Department of Pediatric Surgery, West China Hospital of Sichuan University, No 37, Guo Xue Xiang, Chengdu, 610041, China
| | - Miao Yuan
- Department of Pediatric Surgery, West China Hospital of Sichuan University, No 37, Guo Xue Xiang, Chengdu, 610041, China
| | - Chang Xu
- Department of Pediatric Surgery, West China Hospital of Sichuan University, No 37, Guo Xue Xiang, Chengdu, 610041, China.
| | - Taozhen He
- Department of Pediatric Surgery, West China Hospital of Sichuan University, No 37, Guo Xue Xiang, Chengdu, 610041, China
| | - Ru Jia
- Department of Pediatric Surgery, West China Hospital of Sichuan University, No 37, Guo Xue Xiang, Chengdu, 610041, China
| | - Shiyi Dai
- Department of Pediatric Surgery, West China Hospital of Sichuan University, No 37, Guo Xue Xiang, Chengdu, 610041, China
| | - Chenyu Liu
- Department of Pediatric Surgery, West China Hospital of Sichuan University, No 37, Guo Xue Xiang, Chengdu, 610041, China
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Kersten CM, Hermelijn SM, Dossche LWJ, Muthialu N, Losty PD, Schurink M, Rietman AB, Poley MJ, van Rosmalen J, Zanen-van den Adel TPL, Ciet P, von der Thüsen J, Brosens E, Ijsselstijn H, Tiddens HAWM, Wijnen RMH, Schnater JM. COllaborative Neonatal Network for the first European CPAM Trial (CONNECT): a study protocol for a randomised controlled trial. BMJ Open 2023; 13:e071989. [PMID: 36931672 PMCID: PMC10030930 DOI: 10.1136/bmjopen-2023-071989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Abstract
INTRODUCTION Consensus is lacking on the optimal management of asymptomatic congenital pulmonary airway malformation (CPAM). For future studies, the CONNECT consortium (the COllaborative Neonatal Network for the first European CPAM Trial)-an international collaboration of specialised caregivers-has established consensus on a core outcome set of outcome parameters concerning respiratory insufficiency, surgical complications, mass effect and multifocal disease. These outcome parameters have been incorporated in the CONNECT trial, a randomised controlled trial which, in order to develop evidence-based practice, aims to compare conservative and surgical management of patients with an asymptomatic CPAM. METHODS AND ANALYSIS Children are eligible for inclusion after the CPAM diagnosis has been confirmed on postnatal chest CT scan and they remain asymptomatic. On inclusion, children are randomised to receive either conservative or surgical management. Subsequently, children in both groups are enrolled into a standardised, 5-year follow-up programme with three visits, including a repeat chest CT scan at 2.5 years and a standardised exercise tolerance test at 5 years.The primary outcome is exercise tolerance at age 5 years, measured according to the Bruce treadmill protocol. Secondary outcome measures are molecular genetic diagnostics, validated questionnaires-on parental anxiety, quality of life and healthcare consumption-, repeated imaging and pulmonary morbidity during follow-up, as well as surgical complications and histopathology. This trial aims to end the continuous debate surrounding the optimal management of asymptomatic CPAM. ETHICS AND DISSEMINATION This study is being conducted in accordance with the Declaration of Helsinki. The Medical Ethics Review Board of Erasmus University Medical Centre Rotterdam, The Netherlands, has approved this protocol (MEC-2022-0441). Results will be disseminated through peer-reviewed scientific journals and conference presentations. TRIAL REGISTRATION NUMBER NCT05701514.
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Affiliation(s)
- Casper M Kersten
- Paediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
| | - Sergei M Hermelijn
- Paediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
| | - Louis W J Dossche
- Paediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
| | - Nagarajan Muthialu
- Tracheal Team, Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, London, UK
| | - Paul D Losty
- Paediatric Surgery, Institute Of Life Course And Medical Sciences, University of Liverpool, Liverpool, UK
- Paediatric Surgery, Ramathibodi Hospital Mahidol University, Bangkok, Thailand
| | - Maarten Schurink
- Paediatric Surgery, Radboud University Medical Centre Amalia Children's Hospital, Nijmegen, the Netherlands, Nijmegen, Netherlands
| | - André B Rietman
- Child and Adolescent Psychiatry, Erasmus MC Sophia Children Hospital, Rotterdam, Zuid-Holland, Netherlands
| | - Marten J Poley
- Paediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Joost van Rosmalen
- Biostatistics, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands
- Epidemiology, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands
| | | | - Pierluigi Ciet
- Radiology and Nuclear Medicine, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
- Paediatric Pulmonology, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
- Radiology and Medical Sciences, University of Cagliari, Cagliari, Italy
| | | | - Erwin Brosens
- Clinical Genetics, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
- Erasmus MC Cancer Centre, Rotterdam, Zuid-Holland, Netherlands
| | - Hanneke Ijsselstijn
- Paediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
| | - Harm A W M Tiddens
- Radiology and Nuclear Medicine, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
- Paediatric Pulmonology, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
| | - Rene M H Wijnen
- Paediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
| | - J Marco Schnater
- Paediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
- Tracheal Team, Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, London, UK
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Adams NC, Victoria T, Oliver ER, Moldenhauer JS, Adzick NS, Colleran GC. Fetal ultrasound and magnetic resonance imaging: a primer on how to interpret prenatal lung lesions. Pediatr Radiol 2020; 50:1839-1854. [PMID: 33252753 DOI: 10.1007/s00247-020-04806-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/01/2020] [Accepted: 08/10/2020] [Indexed: 12/22/2022]
Abstract
Fetal lung lesions include common lesions such as congenital pulmonary airway malformation (CPAM), bronchopulmonary sequestration (BPS) and combined CPAM-BPS hybrid lesions, as well as less common entities including congenital lobar emphysema/obstruction, bronchial atresia, bronchogenic cysts and rare malignant pulmonary lesions such as pleuropulmonary blastoma. Fetal lung lesions occur in approximately 1 in 15,000 live births and are thought to arise from a spectrum of abnormalities related to airway obstruction and malformation, with the lesion type depending on the timing of insult, level of bronchial tree involvement, and severity of obstruction. Lesions vary from small and asymptomatic to large and symptomatic with significant mass effect on surrounding structures. Accurate diagnosis and characterization of these anomalies is crucial for guiding patient counseling as well as perinatal and postnatal management. The goal of this review is to provide an overview of normal fetal lung appearance and imaging features of common and uncommon lesions on both ultrasound and MR imaging, and to discuss key aspects in reporting and evaluating the severity of these lesions.
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Affiliation(s)
- Niamh C Adams
- Department of Radiology, Children's Hospital of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
| | - Teresa Victoria
- Department of Radiology, Children's Hospital of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Edward R Oliver
- Department of Radiology, Children's Hospital of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Julie S Moldenhauer
- Department of Surgery, Children's Hospital of Pennsylvania, Philadelphia, PA, USA
| | - N Scott Adzick
- Department of Surgery, Children's Hospital of Pennsylvania, Philadelphia, PA, USA
| | - Gabrielle C Colleran
- Department of Radiology, National Maternity Hospital, Dublin, Ireland
- Department of Radiology, Children's Health Ireland at Temple Street, Dublin, Ireland
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Maneenil G, Ruangnapa K, Thatrimontrichai A, Janjindamai W, Dissaneevate S, Anantaseree W, Suntornlohanakul S. Clinical presentation and outcome in congenital pulmonary malformation: 25 year retrospective study in Thailand. Pediatr Int 2019; 61:812-816. [PMID: 31264305 DOI: 10.1111/ped.13934] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 06/19/2019] [Accepted: 06/25/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Congenital pulmonary malformations (CPM) are a group of rare abnormal lung development lesions that can have various presentations. The aim of this study was to define the differences in the clinical presentations of CPM in neonates, infants, and children, and to review the outcomes. METHODS A retrospective study was conducted at a tertiary care hospital in southern Thailand between 1992 and 2016. RESULTS Fifty-four patients were diagnosed with CPM, and the median age at onset was 1.7 months (IQR, 0.03-10 months). There were 33 cases (61.1%) of congenital pulmonary airway malformations, two (3.7%) of bronchogenic cyst, eight of (14.8%) congenital lobar emphysema, seven of (13.0%) pulmonary sequestrations, and four of (7.4%) congenital lung cysts. Twenty patients under 1 month old and 16 patients who were 1-12 months old had symptoms of respiratory distress. In contrast, 13 patients >1 year old had symptoms of pulmonary infection. There were significant differences in the numbers of patients who had cyanosis (P = 0.006), cough (P < 0.001), and fever (P < 0.001) between the three age groups. Thirty-eight patients (70%) required surgical treatment involving lobectomy (78.9%). Median follow-up duration was 28.1 months (IQR, 3.7-9.4 months). Nine of 10 patients had abnormal lung function tests, and 80.6% of patients had no subsequent limitations in physical activities. CONCLUSIONS Respiratory distress is the important clinical feature in neonates and infants, whereas the signs of pulmonary infection usually occur in children >1 year old. Good outcomes usually occur after surgery but need long-term follow up including lung function assessment.
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Affiliation(s)
- Gunlawadee Maneenil
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Kanokpan Ruangnapa
- Pulmonary and Critical Care Medicine, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Anucha Thatrimontrichai
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Waricha Janjindamai
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Supaporn Dissaneevate
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Wanaporn Anantaseree
- Pulmonary and Critical Care Medicine, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Somchai Suntornlohanakul
- Pulmonary and Critical Care Medicine, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Pieper L, Zernikow B, Drake R, Frosch M, Printz M, Wager J. Dyspnea in Children with Life-Threatening and Life-Limiting Complex Chronic Conditions. J Palliat Med 2018; 21:552-564. [DOI: 10.1089/jpm.2017.0240] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lucas Pieper
- Paediatric Palliative Care Centre, Children's and Adolescents' Hospital, Datteln, and Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health–School of Medicine, Witten/Herdecke University, Datteln, Germany
| | - Boris Zernikow
- Paediatric Palliative Care Centre, Children's and Adolescents' Hospital, Datteln, and Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health–School of Medicine, Witten/Herdecke University, Datteln, Germany
| | - Ross Drake
- Clinical Lead Paediatric Palliative Care Service, Starship children's Health, Auckland, New Zealand
| | - Michael Frosch
- Paediatric Palliative Care Centre, Children's and Adolescents' Hospital, Datteln, and Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health–School of Medicine, Witten/Herdecke University, Datteln, Germany
| | - Michael Printz
- Paediatric Palliative Care Centre, Children's and Adolescents' Hospital, Datteln, and Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health–School of Medicine, Witten/Herdecke University, Datteln, Germany
| | - Julia Wager
- Paediatric Palliative Care Centre, Children's and Adolescents' Hospital, Datteln, and Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health–School of Medicine, Witten/Herdecke University, Datteln, Germany
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Makhijani AV, Wong FY. Conservative post-natal management of antenatally diagnosed congenital pulmonary airway malformations. J Paediatr Child Health 2018; 54:267-271. [PMID: 28960660 DOI: 10.1111/jpc.13727] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 07/20/2017] [Accepted: 08/13/2017] [Indexed: 12/01/2022]
Abstract
AIM Management of congenital pulmonary airway malformations (CPAM) is controversial, especially for asymptomatic patients. We aim to describe the clinical manifestations and management of CPAM at a tertiary paediatric hospital using a retrospective audit. METHODS Infants with CPAM were identified on the Fetal Diagnostic Unit database from 2007 to 2014. Information on antenatal and post-natal management was collected from medical record. RESULTS Thirty-five infants with antenatally diagnosed CPAM were included. Fetal CPAM volume ratio (CVR) was calculated from antenatal ultrasound measurement and used to categorise the infants into three groups of large (CVR ≥ 1.6, n = 8), medium (CVR of 0.5-1.6, n = 12) and small CPAM (CVR of ≤0.5, n = 15), respectively. Ten infants (10/35 = 29%) were symptomatic in the neonatal period. Overall, nine infants (26%) had surgical resection, among whom eight had large or medium-sized CPAM lesions as defined by the antenatal CVR. Three infants had neonatal emergency surgery and the remaining six had late elective surgery. Histology of eight cases showed CPAM, but one case showed congenital lobar emphysema. Criteria for surgery varied and included persistent symptoms after birth, complications during childhood and persistently abnormal chest X-ray. Most asymptomatic infants with CPAM were safely managed using a conservative approach, with no significant increase in late symptoms or complications. CONCLUSIONS Conservative management of CPAM may be considered for infants/children who remain asymptomatic, especially those with a small lesion. For large and medium-sized CPAM, delineation using computed tomography is required, and surgery may be beneficial to prevent late symptoms and the risk of emergency surgery.
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Affiliation(s)
- Allya V Makhijani
- Monash Newborn, Monash Medical Centre Clayton, Melbourne, Victoria, Australia
| | - Flora Y Wong
- Monash Newborn, Monash Medical Centre Clayton, Melbourne, Victoria, Australia
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8
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Traumatic pulmonary pseudocysts mimicking a congenital malformation of the lung. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2017.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Shamas AG, Bohara K. Congenital cystic adenomatoid malformation of the lung (CCAM), a retrospective clinical audit and literature review in a tertiary centre in Scotland over a period of 14 years. J OBSTET GYNAECOL 2016; 37:19-24. [DOI: 10.1080/01443615.2016.1196480] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Ambrin Gull Shamas
- Department of Obstetrics & Gynaecology, Queens Mother’s Hospital, Glasgow, UK (Now Merged with Southern General Hospital, Glasgow)
| | - Karishma Bohara
- Department of Obstetrics & Gynaecology, Queens Mother’s Hospital, Glasgow, UK (Now Merged with Southern General Hospital, Glasgow)
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10
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Yeker R, Segura B, Saltzman D, Hess D. Case report: Giant congenital pulmonary airway malformation initially managed and resected on ECMO. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2016. [DOI: 10.1016/j.epsc.2016.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Gorospe L, Muñoz-Molina GM, Ayala-Carbonero AM, Fernández-Méndez MÁ, Arribas-Marcos Á, Castro-Acosta P, Arrieta P, García-Gómez-Muriel I, Gómez-Barbosa CF, Barrios-Barreto D. Cystic adenomatoid malformation of the lung in adult patients: clinicoradiological features and management. Clin Imaging 2016; 40:517-22. [DOI: 10.1016/j.clinimag.2015.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 11/05/2015] [Indexed: 01/13/2023]
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12
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Coskun Y, Akman I, Demir MK, Yapicier O, Somuncu S. A case of split notochord syndrome: Presenting with respiratory failure in the neonatal period. Intractable Rare Dis Res 2016; 5:121-3. [PMID: 27195197 PMCID: PMC4869579 DOI: 10.5582/irdr.2016.01010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Split notochord syndrome (SNS) is a very rare congenital anomaly. This report describes a male newborn with a neuroenteric cyst in the posterior mediastinum and multiple vertebrae anomalies presenting with respiratory failure and pulmonary hypertension. This report also discusses the embryological development and the etiologic theories of SNS.
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Affiliation(s)
- Yesim Coskun
- Department of Pediatrics, Goztepe Medical Park Hospital, School of Medicine, Bahcesehir University, Istanbul, Turkey
- Address correspondence to: Dr. Yesim Coskun, Neonatal Intensive Care Unit, Department of Pediatrics, Göztepe Medical Park Hospital, School of Medicine, Bahcesehir University, E5 uzeri 23 Nisan sokak No.17, Merdivenköy/Göztepe, Istanbul, Turkey. E-mail:
| | - Ipek Akman
- Department of Pediatrics, Goztepe Medical Park Hospital, School of Medicine, Bahcesehir University, Istanbul, Turkey
| | - Mustafa Kemal Demir
- Department of Radiology, Goztepe Medical Park Hospital, School of Medicine, Bahcesehir University, Istanbul, Turkey
| | - Ozlem Yapicier
- Department of Pathology, Goztepe Medical Park Hospital, School of Medicine, Bahcesehir University, Istanbul, Turkey
| | - Salih Somuncu
- Department of Pediatric Surgery, Goztepe Medical Park Hospital, School of Medicine, Bahcesehir University, Istanbul, Turkey
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David M, Lamas-Pinheiro R, Henriques-Coelho T. Prenatal and Postnatal Management of Congenital Pulmonary Airway Malformation. Neonatology 2016; 110:101-15. [PMID: 27070354 DOI: 10.1159/000440894] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 09/06/2015] [Indexed: 11/19/2022]
Abstract
Congenital pulmonary airway malformation (CPAM) is one of the most common lung lesions detected prenatally. Despite the research efforts made in the past few years, controversy and lack of clarity in the literature still exist regarding nomenclature, classification, pathogenesis and the management of CPAM. Therefore, it is of greatest importance to delineate the natural history of CPAMs and to create a consensus to guide the management and follow-up of these lesions. This review will focus on classification systems, highlighting the most recent advancements in pathogenesis, and current practice in the prenatal diagnosis of CPAM. Strategies of prenatal management and postnatal management will be reviewed. Long-term follow-up, including lung cancer risk, is discussed and an outcome perspective is presented.
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Affiliation(s)
- Mafalda David
- Pediatric Surgery Department, Centro Hospitalar Sx00E3;o Jox00E3;o, Porto, Portugal
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14
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Abstract
Antenatal diagnosis of lung lesion has become more accurate resulting in dilemma and controversies of its antenatal and postnatal management. Majority of antenatally diagnosed congenital lung lesions are asymptomatic in the neonatal age group. Large lung lesions cause respiratory compromise and inevitably require urgent investigations and surgery. The congenital lung lesion presenting with hydrops requires careful postnatal management of lung hypoplasia and persistent pulmonary hypertension. Preoperative stabilization with gentle ventilation with permissive hypercapnia and delayed surgery similar to congenital diaphragmatic hernia management has been shown to result in good outcome. The diagnostic investigations and surgical management of the asymptomatic lung lesions remain controversial. Postnatal management and outcome of congenital cystic lung lesions are discussed.
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Affiliation(s)
- Dakshesh H Parikh
- Department of Paediatric Surgery, Birmingham Children׳s Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham B4 6NH, UK.
| | - Shree Vishna Rasiah
- Southern West Midlands Newborn Network and Birmingham Women's Health Care NHS Trust, Mindelsohn Way, Edgbaston Birmingham, B15 2TG UK
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15
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Choudhry M, Drake D. Antenatally diagnosed lung malformations: a plea for long-term outcome studies. Pediatr Surg Int 2015; 31:439-44. [PMID: 25556419 DOI: 10.1007/s00383-014-3654-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2014] [Indexed: 10/24/2022]
Abstract
There is a wide variation in the management of infants with antenatally diagnosed lung malformations, with many paediatric surgeons and respiratory paediatricians recommending early investigations for all infants and a surgical excision for the majority of lesions, while others favour a conservative management for all asymptomatic infants. The benefits and risks of a surgical intervention have to be compared with the natural history of the untreated malformation and cohort studies from foetal diagnosis to adult life are required to provide the relevant evidence. Careful and repeated surveillance of identified foetuses is essential as recent advances in foetal medicine and surgery have improved the outcomes for the small minority, who are at risk of developing hydrops.
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Affiliation(s)
- Muhammad Choudhry
- Department of Paediatric Surgery, Mater Dei Hospital, L-Imsida, Malta,
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Hama I, Takahashi S, Nakamura T, Ito Y, Kawasaki K, Sago H. Risk of respiratory syncytial virus infection in infants with congenital cystic lung disease. Pediatr Int 2015; 57:253-7. [PMID: 25441859 DOI: 10.1111/ped.12544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 06/07/2014] [Accepted: 07/31/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Congenital cystic lung disease (CCLD), which includes congenital cystic adenomatoid malformation, bronchopulmonary sequestration, and congenital lobar emphysema, has been reported to increase the risk of recurrent respiratory infection. In particular, respiratory syncytial virus (RSV) causes severe lower respiratory tract disease in high-risk infants. The objective of this study was to investigate the risk of severe RSV infection in infants with CCLD. METHODS Infants antenatally diagnosed as having CCLD and admitted to a neonatal intensive care unit at the National Center for Child Health and Development in Tokyo between September 2002 and October 2011 were included in this study. We investigated retrospectively whether the infants were hospitalized with RSV infection by 24 months of age using their medical records. RESULTS Forty-eight infants were antenatally diagnosed as having CCLD. Of the 48 infants, four (8.3%) were hospitalized with RSV infection by 24 months of age. CONCLUSIONS Infants with CCLD have increased risk of severe RSV infection.
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Affiliation(s)
- Ikuko Hama
- Division of Neonatology, National Center for Child Health and Development, Tokyo, Japan
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17
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Yazici MU, Ekinci S, Turkmen OK, Yalcin EG, Ciftci AO, Gucer S, Orhan D, Tezcan I. Recurrent hemoptysis and a mass in the thorax in an infant: the split notochord syndrome. European J Pediatr Surg Rep 2015; 2:38-42. [PMID: 25755968 PMCID: PMC4335950 DOI: 10.1055/s-0033-1354745] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 07/25/2013] [Indexed: 10/26/2022] Open
Abstract
Split notochord syndrome is a rare group of developmental abnormalities caused by abnormal splitting or deviation of the notochord clinically resulting in the duplicated bowel associated with vertebral anomalies. We report on a case of 11-month-old female infant with mediastinal hyperechogenic cyst and intestinal duplication cyst associated with T5-T6 hemivertebrae, scoliosis, and nonfusion of posterior part of T6 vertebrae, presenting with severe hemoptysis and hematemesis. The cysts were surgically removed, and histopathologic analysis revealed that the mediastinal cyst was lined by gastric mucosa and intestinal one was lined with gastric mucosa including ectopic pancreatic tissue. After removal of the lesion the patient made an uneventful recovery and shows no signs of long-term pulmonary sequelae.
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Affiliation(s)
- Mutlu Uysal Yazici
- Department of Pediatrics, Hacettepe University Children's Hospital, Ankara, Turkey
| | - Saniye Ekinci
- Department of Pediatric Surgery, Hacettepe University Children's Hospital, Ankara, Turkey
| | - Ozlem Keskin Turkmen
- Department of Pediatric Allergy and Immunology, Gaziantep University, Ankara, Turkey
| | - Ebru Gunes Yalcin
- Department of Pediatric Pulmonology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Arbay O Ciftci
- Department of Pediatric Surgery, Hacettepe University Children's Hospital, Ankara, Turkey
| | - Safak Gucer
- Department of Pediatric Pathology, Hacettepe University, Ankara, Turkey
| | - Diclehan Orhan
- Department of Pediatric Pathology, Hacettepe University, Ankara, Turkey
| | - Ilhan Tezcan
- Department of Pediatric Immunology, Hacettepe University School of Medicine, Ankara, Turkey
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18
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Prenatal diagnosis and postnatal findings of bronchogenic cyst. Case Rep Pulmonol 2013; 2013:483864. [PMID: 23762726 PMCID: PMC3677003 DOI: 10.1155/2013/483864] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 05/12/2013] [Indexed: 11/17/2022] Open
Abstract
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.
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Abstract
AIM Pediatric lung resection is a relatively uncommon procedure that is usually performed for congenital lesions. In recent years, thoracoscopic resection has become increasingly popular, particularly for small peripheral lesions. The aim of this study was to review our experience with traditional open lung resection in order to evaluate the existing "gold standard." MATERIALS AND METHODS We carried out a retrospective analysis of all children having lung resection for congenital lesions at our institution between 1997 and 2004. Data were collected from analysis of case notes, operative records and clinical consultation. The mean follow-up was 37.95 months. The data were analyzed using SPSS. RESULTS Forty-one children (13 F/28 M) underwent major lung resections during the study period. Their median age was 4.66 months (1 day-9 years). The resected lesions included 21 congenital cystic adenomatoid malformations, 14 congenital lobar emphysema, four sequestrations and one bronchogenic cyst. Fifty percent of the lesions were diagnosed antenatally. Twenty-six patients had a complete lobectomy while 15 patients had parenchymal sparing resection of the lesion alone. Mean postoperative stay was 5.7 days. There have been no complications in any of the patients. All patients are currently alive, asymptomatic and well. None of the patients have any significant chest deformity. CONCLUSIONS We conclude that open lung resection enables parenchymal sparing surgery, is versatile, has few complications and produces very good long-term results. It remains the "gold standard" against which minimally invasive techniques may be judged.
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Affiliation(s)
- Dhanya Mullassery
- Department of Pediatric Surgery, Royal Liverpool Children's Hospital, Alder Hey, Liverpool, UK L12 2AP
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20
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Makhija Z, Moir CR, Allen MS, Cassivi SD, Deschamps C, Nichols FC, Wigle DA, Shen KR. Surgical Management of Congenital Cystic Lung Malformations in Older Patients. Ann Thorac Surg 2011; 91:1568-73; discussion 1573. [DOI: 10.1016/j.athoracsur.2011.01.080] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 01/26/2011] [Accepted: 01/28/2011] [Indexed: 11/29/2022]
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21
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Management of fetal bronchogenic lung cysts: a case report and short review of literature. Case Rep Med 2010; 2010:751423. [PMID: 20339525 PMCID: PMC2842976 DOI: 10.1155/2010/751423] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2009] [Accepted: 01/05/2010] [Indexed: 11/17/2022] Open
Abstract
Congenital malformations of the lung (CML) are rare with similar embryological and clinical spectra and could result in mortality if left untreated. Bronchogenic cysts are formed during the budding of the tracheal diverticula and ventral foregut in the embryological period. In this paper we want to present a case of bronchogenic cyst with continuous intrauterine cyst aspiration follow-up. After the baby birth was operated and the postoperative period was uneventful. The pathological examination revealed a bronchogenic cyst.
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22
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Komori K, Kamagata S, Hirobe S, Toma M, Okumura K, Muto M, Kasai S, Hayashi A, Suenaga M, Miyakawa T. Radionuclide imaging study of long-term pulmonary function after lobectomy in children with congenital cystic lung disease. J Pediatr Surg 2009; 44:2096-100. [PMID: 19944215 DOI: 10.1016/j.jpedsurg.2009.04.033] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Revised: 04/27/2009] [Accepted: 04/28/2009] [Indexed: 12/17/2022]
Abstract
PURPOSE We evaluated the long-term pulmonary function after lobectomy for congenital cystic lung disease, in both infants and children, using radionuclide imaging (RI). METHODS We performed a retrospective review of 93 patients who underwent resection of cystic lung lesions between 1974 and 2001. The results of postoperative lung volume/perfusion scintigraphy at 1 (n = 64), 5 (n = 32), and 10 years (n = 18) after surgery (V1, 5, 10/Q1, 5, 10) and mean transit time (MTT-a marker for air-trapping) at 1, 5, and 10 years after surgery (MTT1, 5, 10) were compared with respect to age at operation, preoperative infection, underlying disease, and type of surgery. RESULTS Patients who were younger than 1 year at the time of surgery showed a significantly lower MTT5 (1.09 +/- 0.08) and MTT10 (1.15 +/- 0.11) than patients who were older than 1 year at the time of surgery (MTT5, 1.49 +/- 0.67; MTT10, 1.54 +/- 0.33). The noninfected group had significantly higher Q10 and lower MTT10 values (P < .05) compared to the infected group. No significant differences were observed between patients with single lobe vs multiple lobe resection. CONCLUSIONS The optimal age for surgery in patients with congenital cystic lung disease appears to be less than 1 year.
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Affiliation(s)
- Koji Komori
- Department of Surgery, Tokyo Metropolitan Kiyose Children's Hospital, Kiyose, Tokyo 204-8567, Japan
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23
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Stanton M, Njere I, Ade-Ajayi N, Patel S, Davenport M. Systematic review and meta-analysis of the postnatal management of congenital cystic lung lesions. J Pediatr Surg 2009; 44:1027-33. [PMID: 19433193 DOI: 10.1016/j.jpedsurg.2008.10.118] [Citation(s) in RCA: 143] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2008] [Revised: 10/21/2008] [Accepted: 10/30/2008] [Indexed: 11/17/2022]
Abstract
BACKGROUND Antenatally detected asymptomatic congenital cystic lung lesions may be managed conservatively or by surgical resection. We undertook a systematic review and meta-analysis to quantify the risks of elective surgery, emergency surgery, and observation. METHODS All series published between 1996 and 2008, where the postnatal management of congenital cystic lung lesions was described, were reviewed. A meta-analysis was performed to determine whether elective or emergency surgery was associated with a higher risk of adverse outcomes. RESULTS There were 41 reports describing 1070 patients (of whom 79% were antenatally detected). Five hundred five neonates survived without surgery into infancy, of whom only 16 (3.2%) became symptomatic. For all ages, elective surgery was associated with significantly less complications than emergency surgery. The risk ratio was 2.8 (95% confidence interval, 1.4-5.5; P < .005) when comparing complications after elective surgery with emergency surgery. CONCLUSIONS The risk of asymptomatic cases developing symptoms is small. However, elective surgery is associated with a better outcome than emergency surgery. If elective surgery is undertaken, it should be performed before 10 months. Although no prognostic indicators have so far been identified in the literature, a conservative approach may be appropriate for small lesions.
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Affiliation(s)
- Michael Stanton
- King's College Hospital, Paediatric Surgery, Denmark Hill, London, United Kingdom
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24
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Priest JR, Williams GM, Hill DA, Dehner LP, Jaffé A. Pulmonary cysts in early childhood and the risk of malignancy. Pediatr Pulmonol 2009; 44:14-30. [PMID: 19061226 DOI: 10.1002/ppul.20917] [Citation(s) in RCA: 217] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Surgery for congenital and early childhood lung cysts is often dictated by symptoms such as respiratory distress, infection or pneumothorax. Asymptomatic cysts present a therapeutic dilemma: surgical intervention and "conservative" observation have advocates. The risk of malignancy in such cysts is considered by some an indication for surgical intervention and is reviewed in this paper. Pleuropulmonary blastoma (PPB) is the most frequent malignancy associated with childhood lung cysts. Although rare, PPB occurs predictably in certain clinical and familial situations. This unique biology of PPB can inform the cyst management decision. The earliest manifestation of PPB is a malignant lung cyst in young children, clinically and radiographically indistinguishable from benign congenital lung cysts. Histopathologic examination differentiates cystic PPB from the benign cystic variants. Surgical excision of cystic PPB (with or without chemotherapy) cures approximately 85-90% of children. If not excised, cystic PPB evolves to cystic/solid or solid high-grade sarcoma (cure rate 45-60%) by age 2-6 years. Numerous reports of "malignancy in a congenital lung cyst" are now understood as the characteristic progression of cystic PPB. PPB is genetically determined in many cases. Detailed family history may reveal the hallmarks of PPB in the patient or young relatives: a unique constellation of diseases including lung cysts, cystic nephroma, childhood cancers, stromal sex-chord ovarian tumors, seminomas or dysgerminomas, intestinal polyps, thyroid hyperplasias, and hamartomas. Pneumothorax and multifocal/bilateral lung cysts also characterize PPB. These diagnoses predict that a lung cyst is more likely PPB than a benign congenital cyst. Patients fitting this pattern deserve histologic diagnosis. The genetic basis for this heritable syndrome is unknown but is being actively investigated.
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Affiliation(s)
- John R Priest
- International Pleuropulmonary Blastoma Registry, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota 55404, USA.
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25
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Abstract
Esophageal atresia, congenital diaphragmatic hernia, bronchopulmonary malformations and cystic lung diseases are the common neonatal thoracic surgical lesions encountered in practice. The availability of antenatal ultrasonography has lead to these lesions being detected before birth. Antenatal diagnosis can be made with a fair degree of accuracy in tertiary fetal medicine centres. Antenatal intervention is limited in a very few centres in the western world and not being done in India at present. The outcome of these babies with antenatal diagnosis of thoracic lesions has changed in the last decade. Earlier intervention is now possible in cystic lung disease before infectious complication has set in. All these lesions are managed exclusively in well developed neonatal surgery units with excellent outcome in the western world. The present study reviews the antenatal detection, clinical presentation, interventional/surgical procedures [antenatally and postnatally] and outcome of these common neonatal thoracic surgical lesions.
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Affiliation(s)
- A Narendra Kumar
- Department of Pediatric Surgery, Niloufer Hospital for Women and Children, Hyderabad, India.
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26
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Lo AYS, Jones S. Lack of consensus among Canadian pediatric surgeons regarding the management of congenital cystic adenomatoid malformation of the lung. J Pediatr Surg 2008; 43:797-9. [PMID: 18485941 DOI: 10.1016/j.jpedsurg.2007.12.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Accepted: 12/03/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE Review of the literature suggests that there is lack of consensus regarding the management of antenatally diagnosed congenital cystic adenomatoid malformation of the lung (CCAM) that is asymptomatic at birth. This study aims to describe the variability among Canadian pediatric surgeons in how this pathologic finding is managed. METHODS Surveys were sent to all practicing Canadian members of Canadian Association of Pediatric Surgeons. Responders were asked to state whether they recommend resection or nonoperative management and to describe the follow-up imaging type and frequency used. RESULTS A 69% response rate was obtained. There was no consistency regarding the imaging modality used to detect asymptomatic CCAM. Sixty-seven percent of responders recommend resection of persistent but asymptomatic CCAM; there was neither consensus with regard to age at which resection is performed (2-18 months) nor technical considerations at resection (61% open, 83% lobectomy). Among the responders who do not recommend resection, the frequency of follow-up was variable (every 3 months to every year), as were the imaging modality used and the length of follow-up (3 years to indefinitely); 80% of neonates in whom nonoperative management was recommended initially ultimately underwent resection. CONCLUSIONS Lack of consensus among Canadian pediatric surgeons, and even within institutions, regarding the management of antenatally diagnosed CCAM in the asymptomatic neonate, is demonstrated. This clearly highlights the need for prospective studies.
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Affiliation(s)
- Andrea Yan-Sin Lo
- Division of General Surgery, Kingston General Hospital, Queen's University, Kingston, Canada K7L 2V7
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27
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Abecasis F, Ferreira MG, Oliveira A, Velho HV. Carcinoma bronquíolo-alveolar associado a malformação congénita das vias aéreas pulmonares em adolescente assintomático. REVISTA PORTUGUESA DE PNEUMOLOGIA 2008; 14:285-90. [DOI: 10.1016/s0873-2159(15)30236-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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28
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Rose SH, Elliott BA, Brown MJ, Long TR, Wass CT. Perioperative Risk Associated With an Unrecognized Bronchogenic Cyst: Clinical Significance and Anesthetic Management. J Cardiothorac Vasc Anesth 2007; 21:720-2. [PMID: 17905283 DOI: 10.1053/j.jvca.2006.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2006] [Indexed: 11/11/2022]
Affiliation(s)
- Steven H Rose
- Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
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Sundararajan L, Parikh DH. Evolving experience with video-assisted thoracic surgery in congenital cystic lung lesions in a British pediatric center. J Pediatr Surg 2007; 42:1243-50. [PMID: 17618888 DOI: 10.1016/j.jpedsurg.2007.02.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND/PURPOSE Video-assisted thoracic surgery (VATS) is increasingly used for the resection of congenital cystic lung lesions (CLLs). This study aimed to evaluate the efficacy of VATS and its outcome in both antenatally and postnatally detected CLLs. METHODS Forty-six patients managed during 2000-2005 were studied. Demographics, investigations, operative details, and outcome data were collected and evaluated. Patients were divided into 3 groups for analysis. RESULTS Antenatally diagnosed (groups I and II, n = 35): group I (20) had VATS at 20 months median (range, 16-35 months). Video-assisted thoracic surgery was successful in 14 of 20 (70%), notably in all cases of extralobar sequestrations and foregut duplication cysts. Inadequate vision/lung collapse and technical difficulties were the main reasons for conversion to open thoracotomy. Group II (n = 15) was considered unsuitable for VATS because of neonatal symptoms (6 congenital cystic adenomatoid malformations of the lung [CCAMs]) and/or large size/inexperience (5 CCAMs, 4 sequestrations) and had elective thoracotomy at 8 months median (range, 6 days-20 months). Postnatally diagnosed (group III, n = 11): 3 CCAMs, 6 duplications, and 2 sequestrations were diagnosed because of recurrent chest infection (8) or stridor (2), or incidentally (1) at 8 years median (range, 1.2-14 years). Video-assisted thoracic surgery was successful in 3 foregut duplications. A duplication and an intralobar sequestration were converted; open thoracotomy was performed in others because of previous recurrent pneumonic episodes. Postoperative pain and hospital stay were significantly less (P < .001) in successful VATS resection: median of 2 days (range, 1-7 days) compared with thoracotomy median of 6 days (range, 4-20 days). CONCLUSIONS Video-assisted thoracic surgery is a safe and effective option for asymptomatic congenital CLLs. It is anticipated that more successful CCAM resections using VATS will occur in the future as our technical ability improves.
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Affiliation(s)
- Lakshmi Sundararajan
- Department of Paediatric Surgery, Birmingham Children's Hospital NHS Trust, B4 6NH Birmingham, UK
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30
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Harmath A, Csaba A, Hauzman E, Hajdú J, Pete B, Papp Z. Congenital lung malformations in the second trimester: prenatal ultrasound diagnosis and pathologic findings. JOURNAL OF CLINICAL ULTRASOUND : JCU 2007; 35:250-5. [PMID: 17373682 DOI: 10.1002/jcu.20341] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
PURPOSE To correlate prenatal sonographic diagnosis of cystic lung malformations with fetopathologic findings after termination of pregnancy. METHODS We retrospectively analyzed the data of 16 terminated cases in which a cystic lung lesion was diagnosed pre- or postnatally. RESULTS On average, prenatal diagnosis was established on the 21(st) gestational week (range, 19-26 weeks). The cause of termination was severe polyhydramnios in 4 cases, nonimmune fetal hydrops in 4 cases, other congenital malformation in 5 cases (renal malformation, 2 cases; congenital diaphragmatic hernia, 3 cases), and obstetrical conditions (intrauterine death, placental abruption, spontaneous abortion) in 3 cases. In 11 cases, congenital cystic adenomatoid malformation (CCAM) was the presumptive prenatal diagnosis. Autopsy confirmed the prenatal diagnosis in 6 of them, while in the other 5 cases, an enteric cyst, a laryngeal atresia, an unidentified tumor, a pulmonary hypoplasia, and an extralobar pulmonary sequestration were found on histologic examination. On the other hand, the autopsy revealed CCAM in those 5 cases in which other malformations were suggested prenatally. CONCLUSION The prenatal sonographic diagnosis of CCAM is difficult. Our cases emphasize the important role of fetopathology even today in the verification of prenatal diagnosis based on sonographic examinations.
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Affiliation(s)
- Agnes Harmath
- Department of Obstetrics and Gynecology, Semmelweis University Faculty of Medicine, H-1088 Budapest, Baross u. 27, Hungary
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Ramos SG, Barbosa GH, Tavora FR, Jeudy J, Torres LAGM, Tone LG, Trad CS. Bronchioloalveolar carcinoma arising in a congenital pulmonary airway malformation in a child: case report with an update of this association. J Pediatr Surg 2007; 42:E1-4. [PMID: 17502169 DOI: 10.1016/j.jpedsurg.2007.02.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
An 8-year-old girl was evaluated for a mass in the left pulmonary lobe. Her clinical history was remarkable for an intermittent dry cough since the age of 2, with recurrent episodes of purulent sputum and fever. She underwent left lower lobectomy, which was found to be a bronchioloalveolar carcinoma arising in a type 1 congenital pulmonary airway malformation at pathologic examination. No additional therapies were undertaken. Two years after resection, imaging studies showed 5 contralateral pulmonary nodules suggestive of disseminated disease with a poor outcome. A review of presentation, treatment, and outcome of this association was made.
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Affiliation(s)
- Simone G Ramos
- Department of Pathology, Faculty of Medicine of Ribeirão Preto, University of São Paulo, 14049-900 Ribeirão Preto, São Paulo, Brazil.
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32
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Cocker DM, Parikh D, Brown R. Multiple antenatally diagnosed foregut duplication cysts excised and the value of thoracoscopy in diagnosing small concurrent cysts. Ann R Coll Surg Engl 2007; 88:W8-10. [PMID: 17059707 PMCID: PMC1963762 DOI: 10.1308/147870806x129269] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A case report of a female neonate referred with antenatally diagnosed cystic lesions within the right hemithorax and under the left hemidiaphragm is presented to highlight the ease with which these lesions can be resected in an asymptomatic post-natal infant with minimally invasive surgery. The diagnostic and cosmetic benefits of minimally invasive surgery are also demonstrated. While excising the documented thoracic cyst, another small cyst was identified adherent to the right main bronchus. An elective laparoscopic excision of the abdominal cyst was also successful. A brief review of the complications and treatment of foregut duplication cysts is detailed.
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Affiliation(s)
- Daniel M Cocker
- Department of Paediatric Surgery, Birmingham Children's Hospital NHS TrustBirmingham, UK
| | - Dakshesh Parikh
- Department of Paediatric Surgery, Birmingham Children's Hospital NHS TrustBirmingham, UK
| | - Rachel Brown
- Department of Pathology, Birmingham Children's Hospital NHS TrustBirmingham, UK
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33
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Laser literature watch. Photomed Laser Surg 2006; 24:424-53. [PMID: 16875454 DOI: 10.1089/pho.2006.24.424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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