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Fusi G, Sartor A, Groussolles M, Joseph S, Vial J, Roditis L, Vayssière C, Abbo O. Successful Elective Thoracoscopic Resection of Complicate Extralobar Bronchopulmonary Sequestration after Intrafoetal Vascular Laser Ablation: The Paediatric Surgeon's Point of View. Case Rep Pediatr 2023; 2023:4959022. [PMID: 37664529 PMCID: PMC10473892 DOI: 10.1155/2023/4959022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/01/2023] [Accepted: 08/18/2023] [Indexed: 09/05/2023] Open
Abstract
Few reports of laser coagulation for foetal bronchopulmonary sequestration (BPS), a rare congenital malformation characterised by the absence of tracheobronchial connection and the presence of a systemic feeding artery, have been published. Additionally, very few of them focus also on the postnatal management, with results limited and controversial. Postnatal treatment of residual malformation remains debated, hence the need to share our experience of a combined pre- and postnatal approach to complicated extra-lobar BPS. We report the case of a female foetus with the diagnosis of a pulmonary lesion. Due to mediastinal shift, unilateral compressive hydrothorax, ascites, and hydrops, a foetal treatment with ultrasound-guided laser coagulation of the anomalous vessel was performed. At birth, due to the persistence of the malformation, an elective delayed thoracoscopical surgery was performed. Prenatal laser ablation for complicated BPS is a life-saving procedure not always resulting in lesion disappearance. Thoracoscopical surgical exploration in case of persistent lesions at birth offers the possibility of a minimally invasive sequestrectomy feasible and safe.
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Affiliation(s)
- Giulia Fusi
- Department of Pediatric Surgery, Toulouse University Hospital, Toulouse, France
| | - Agnès Sartor
- Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse, France
| | - Marion Groussolles
- Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse, France
| | - Solene Joseph
- Department of Pediatric Surgery, Toulouse University Hospital, Toulouse, France
| | - Julie Vial
- Department of Pediatric Radiology, Toulouse University Hospital, Toulouse, France
| | - Lea Roditis
- Department of Pediatric Pulmonology and Allergology, Toulouse University Hospital, Toulouse, France
| | - Christophe Vayssière
- Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse, France
| | - Olivier Abbo
- Department of Pediatric Surgery, Toulouse University Hospital, Toulouse, France
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Mencía S, Alonso C, Pallás-Alonso C, López-Herce J. Evaluation and Treatment of Pain in Fetuses, Neonates and Children. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1688. [PMID: 36360416 PMCID: PMC9689143 DOI: 10.3390/children9111688] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 10/25/2022] [Accepted: 10/28/2022] [Indexed: 08/03/2023]
Abstract
The perception of pain is individual and differs between children and adults. The structures required to feel pain are developed at 24 weeks of gestation. However, pain assessment is complicated, especially in neonates, infants and preschool-age children. Clinical scales adapted to age are the most used methods for assessing and monitoring the degree of pain in children. They evaluate several behavioral and/or physiological parameters related to pain. Some monitors detect the physiological changes that occur in association with painful stimuli, but they do not yet have a clear clinical use. Multimodal analgesia is recommended for pain treatment with non-pharmacological and pharmacological interventions. It is necessary to establish pharmacotherapeutic protocols for analgesia adjusted to the acute or chronic, type and intensity of pain, as well as age. The most used analgesics in children are paracetamol, ibuprofen, dipyrone, opioids (morphine and fentanyl) and local anesthetics. Patient-controlled analgesia is an adequate alternative for adolescent and older children in specific situations, such as after surgery. In patients with severe or persistent pain, it is very important to consult with specific pain services.
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Affiliation(s)
- Santiago Mencía
- Pediatric Intensive Care Service, Gregorio Marañón General University Hospital, Health Research Institute of Gregorio Marañón Madrid, 28029 Madrid, Spain
- Departamento de Salud Pública y Maternoinfantil, Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Carlos III Institute, 28029 Madrid, Spain
| | - Clara Alonso
- Carlos III Institute, 28029 Madrid, Spain
- Department of Neonatology, 12 de Octubre University Hospital, 28041 Madrid, Spain
| | - Carmen Pallás-Alonso
- Departamento de Salud Pública y Maternoinfantil, Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Carlos III Institute, 28029 Madrid, Spain
- Department of Neonatology, 12 de Octubre University Hospital, 28041 Madrid, Spain
| | - Jesús López-Herce
- Pediatric Intensive Care Service, Gregorio Marañón General University Hospital, Health Research Institute of Gregorio Marañón Madrid, 28029 Madrid, Spain
- Departamento de Salud Pública y Maternoinfantil, Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Carlos III Institute, 28029 Madrid, Spain
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Tse WT, Poon LC, Wah YM, Hui ASY, Ting YH, Leung TY. Bronchopulmonary sequestration successfully treated with prenatal radiofrequency ablation of feeding artery. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:325-327. [PMID: 32898279 DOI: 10.1002/uog.23110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/17/2020] [Accepted: 08/31/2020] [Indexed: 06/11/2023]
Affiliation(s)
- W T Tse
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR
| | - L C Poon
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR
| | - Y M Wah
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR
| | - A S Y Hui
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR
| | - Y H Ting
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR
| | - T Y Leung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR
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Victoria T, Johnson AM, Moldenhauer JS, Hedrick HL, Flake AW, Adzick NS. Imaging of fetal tumors and other dysplastic lesions: A review with emphasis on MR imaging. Prenat Diagn 2021; 40:84-99. [PMID: 31925807 DOI: 10.1002/pd.5630] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/22/2019] [Accepted: 10/26/2019] [Indexed: 12/23/2022]
Abstract
Fetal tumors and other dysplastic masses are relatively rare. They are usually the result of failure of differentiation and maturation during embryonic or fetal life; dysplastic lesions may be the consequence of an obstruction sequence. In this review, we present the most commonly encountered tumors and masses seen during fetal life. Imaging characteristics, tumoral organ of origin, and its effect on the surrounding organs and overall fetal hemodynamics are descriptors that must be relayed to the fetal surgeon and maternal fetal medicine expert, in order to institute most accurate parental counseling and appropriate perinatal treatment plan.
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Affiliation(s)
- Teresa Victoria
- Radiology Department Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ann M Johnson
- Radiology Department Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Julie S Moldenhauer
- Surgery Department Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Holly L Hedrick
- Surgery Department Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Alan W Flake
- Surgery Department Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - N Scott Adzick
- Surgery Department Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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5
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Grozdeva L, Senat MV, Vandewynckele N, Fouquet V, Castaigne V, Le Bouar G, Benachi A, Bouchghoul H. Antenatal Management of Bronchopulmonary Sequestration by Intrafetal Vascular Laser Ablation under Ultrasound Control: Narrative Review of the Literature and Report of Three Cases. Fetal Diagn Ther 2021; 48:34-42. [PMID: 33401273 DOI: 10.1159/000510823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 08/11/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of this study is to assess the effectiveness and safety of intrafetal vascular laser ablation (VLA) for fetuses with bronchopulmonary sequestration (BPS) with hydrops. METHODS First, we present 3 cases of fetuses with BPS and hydrops treated by VLA. Second, we aimed to conduct a narrative review to identify all reported cases of fetuses with BPS treated by intrafetal VLA. RESULTS The review of the literature identified 41 fetuses treated by VLA for BPS with hydrops. The median gestational age of the VLA was 27+0 weeks' gestation [25+0-31+0] with an associated procedure at the same time in 43% of the cases (pleuroamniotic shunt, thoracentesis, and amniodrainage). A second procedure was required in 25% of cases for residual flow in the feeding vessel. No stillbirth or neonatal death was reported. The complications reported were a fetal thoracic hematoma complicated by fetal anemia and 4 preterm deliveries with a rate of 9%. CONCLUSION VLA of the feeding vessel can be an effective treatment but is not without complications. In cases demonstrating cardiac output failure, intrafetal VLA should be considered as a treatment for BPS.
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Affiliation(s)
- Lora Grozdeva
- Department of Obstetrics and Gynecology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Saclay, Le Kremlin-Bicêtre, France
| | - Marie-Victoire Senat
- Department of Obstetrics and Gynecology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Saclay, Le Kremlin-Bicêtre, France
| | - Nada Vandewynckele
- Department of Neonatal Intensive Care, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, University Paris Saclay, Le Kremlin-Bicêtre, France
| | - Virginie Fouquet
- Department of Pediatric Surgery, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, University Paris Saclay, Le Kremlin-Bicêtre, France
| | - Vanina Castaigne
- Department of Obstetrics and Gynecology, Intercommunal Créteil Hospital, Créteil, France
| | | | - Alexandra Benachi
- Department of Obstetrics and Gynecology, Antoine Béclère Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Saclay, Clamart, France
| | - Hanane Bouchghoul
- Department of Obstetrics and Gynecology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Saclay, Le Kremlin-Bicêtre, France,
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6
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Ichino M, Macchini F, Morandi A, Persico N, Fabietti I, Zanini A, Leva E. Combined Pre- and Postnatal Minimally Invasive Approach to Complicated Pulmonary Sequestrations. European J Pediatr Surg Rep 2020; 8:e62-e67. [PMID: 32963928 PMCID: PMC7500973 DOI: 10.1055/s-0040-1713901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 05/16/2020] [Indexed: 11/28/2022] Open
Abstract
Pulmonary sequestration (PS) is mostly asymptomatic but there is a proportion of fetuses that develop hydrops, leading to fetal or neonatal death. Fetal treatments are available, but postnatal management of the residual lesions is not uniformly defined. We present two cases of combined pre- and postnatal minimally invasive approach to complicated extra-lobar PS. Patient 1 presented with complicated PS at 31 weeks of gestation. Ultrasound-guided laser coagulation of the anomalous artery was successful. The patient was born asymptomatic at 38 weeks. Neonatal magnetic resonance imaging (MRI) showed a residual mass, confirmed by computed tomography (CT) at 6 months. No systemic artery was described, but perfusion was present. We decided for thoracoscopic resection. A residual artery was identified and sealed. Patient 2 presented with complicated PS at 25 weeks of gestation, underwent laser coagulation of the anomalous artery and was born asymptomatic at 38 weeks. Neonatal MRI showed persistence of the lesion, confirmed by CT scan at 4 months. We proceeded with thoracoscopic resection. A residual vessel was ligated. The patients 1 and 2 are now 24 and 21 months old, respectively, and healthy. Prenatal treatment of complicated PS is a life-saving procedure. Postnatal thoracoscopic resection of the residual lesion is feasible and safe; we believe it is the best course of treatment to grant the complete excision of the malformation.
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Affiliation(s)
- Martina Ichino
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano, Lombardia, Italy
| | - Francesco Macchini
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano, Lombardia, Italy
| | - Anna Morandi
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano, Lombardia, Italy
| | - Nicola Persico
- Department of Obstetrics and Gynecology "L. Mangiagalli", Fetal Medicine and Surgery Service, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano, Lombardia, Italy.,Department of Clinical Science and Community Health, Università degli Studi di Milano, Milano, Lombardia, Italy
| | - Isabella Fabietti
- Department of Obstetrics and Gynecology "L. Mangiagalli", Fetal Medicine and Surgery Service, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano, Lombardia, Italy
| | - Andrea Zanini
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano, Lombardia, Italy
| | - Ernesto Leva
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano, Lombardia, Italy
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Millischer AE, Brasseur-Daudruy M, Mahallati H, Salomon LJ. The use of image fusion in prenatal medicine. Prenat Diagn 2019; 40:18-27. [PMID: 31508835 DOI: 10.1002/pd.5558] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/21/2019] [Accepted: 07/28/2019] [Indexed: 12/27/2022]
Abstract
Fusion imaging (FI), the simultaneous display of the same anatomical region using two imaging modalities, has been used in other areas of medicine for both diagnosis and guiding interventions. Examples include positron emission tomography-computed tomography (PET-CT) imaging in oncology and ultrasound-magnetic resonance imaging (US-MRI) fusion in biopsies of the prostate gland. The underlying principle is to take advantage of the complementary information in each modality to improve accuracy, be it diagnostic accuracy or targeting accuracy in biopsies. For example, PET-CT overlays the metabolic activity of lesions on the superb spatial and anatomical detail of CT. While the historical mainstay of fetal imaging has been ultrasound, advances in ultrafast MR imaging together with advances in fetal MRI over the past two decades, have resulted in the opportunity to explore fusion imaging in fetal medicine. We present an overview of the principles of US-MRI fusion imaging in prenatal medicine, report our local experience, and review the literature in this emerging area. We share our perspective on how FI can improve diagnostic confidence, be used as an educational tool, and potentially enhance guidance in certain fetal procedures.
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Affiliation(s)
- Anne-Elodie Millischer
- Hôpital Necker-Enfants Malades, AP-HP, Université Paris Descartes and Fetus and LUMIERE team, Imagine Institute, Paris, France
| | | | - Houman Mahallati
- Hôpital Necker-Enfants Malades, AP-HP, Université Paris Descartes and Fetus and LUMIERE team, Imagine Institute, Paris, France
| | - Laurent J Salomon
- Hôpital Necker-Enfants Malades, AP-HP, Université Paris Descartes and Fetus and LUMIERE team, Imagine Institute, Paris, France
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8
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Abbasi N, Morency AM, Langer JC, Chiu PPL, Chami R, Windrim R, Keunen J, Seaward G, Ryan G. Fetal Sclerotherapy for Hydropic Congenital Cystic Adenomatoid Malformations of the Lung Refractory to Steroids: A Case Report and Review of the Literature. Fetal Diagn Ther 2019; 47:24-33. [PMID: 31112955 DOI: 10.1159/000497143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 01/21/2019] [Indexed: 11/19/2022]
Abstract
Microcystic congenital cystic adenomatoid malformations (CCAM), when associated with hydrops, carry a dismal prognosis. Options for treatment are limited and experimental, including antenatal corticosteroids, open fetal surgery, laser ablation and, more recently, sclerotherapy. We describe a case of a large, predominantly microcystic CCAM in a hydropic fetus treated successfully with direct interstitial injection of a sclerosant agent (3% sodium tetradecyl sulfate) at 23+3 weeks gestation, after multiple failed courses of steroids. Elective thoracoscopic right lower lobectomy was performed at 1 year of life and there have been no respiratory or other medical morbidities since. A literature review of fetal lung masses treated with sclerosants antenatally reveals that sclerotherapy may represent a novel treatment option for large hydropic microcystic CCAMs, which are unresponsive to corticosteroids. Further studies are required to evaluate the utility and safety of fetal sclerotherapy, as this may represent an alternative minimally invasive treatment option to fetal lobectomy.
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Affiliation(s)
- Nimrah Abbasi
- Fetal Medicine Unit, Ontario Fetal Centre, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada, .,University of Toronto, Toronto, Ontario, Canada,
| | - Anne-Maude Morency
- Fetal Medicine Unit, Ontario Fetal Centre, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Jacob C Langer
- Division of General and Thoracic Surgery, Department of Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Priscilla P L Chiu
- Division of General and Thoracic Surgery, Department of Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Rose Chami
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Rory Windrim
- Fetal Medicine Unit, Ontario Fetal Centre, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Johannes Keunen
- Fetal Medicine Unit, Ontario Fetal Centre, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Gareth Seaward
- Fetal Medicine Unit, Ontario Fetal Centre, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Greg Ryan
- Fetal Medicine Unit, Ontario Fetal Centre, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
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9
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Pock R, Straňák Z, Vojtěch J, Hašlík L, Feyereisl J, Krofta L. Bronchopulmonary Sequestration with Fetal Hydrops in a Monochorionic Twin Successfully Treated with Multiple Courses of Betamethasone. AJP Rep 2018; 8:e359-e361. [PMID: 30574430 PMCID: PMC6277237 DOI: 10.1055/s-0038-1676339] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 09/30/2018] [Indexed: 11/09/2022] Open
Abstract
Aim We present a case of severe bronchopulmonary sequestration (BPS) and fetal hydrops in one of the monochorionic twin successfully treated with multiple courses of betamethasone. Case Report A 21-year-old gravida 2 para 1 was referred to our hospital for suspected twin-to-twin transfusion syndrome (TTTS) at 28 0/7 weeks of gestational age. However, prenatal ultrasound of the larger twin revealed a chest lesion that was associated with significant ascites, massive hydrothorax, scant hepatomegaly, subcutaneous edema, and severe polyhydramnios. Magnetic resonance imaging confirmed the diagnosis of BPS and fetal hydrops. The estimated fetal weight discrepancy between the fetuses was 39% but the criteria for TTTS were not met. Repeated courses of betamethasone (3 courses, each with 2 × 14 mg of betamethasone intramuscularly/week) were administered with subsequent recovery from hydrops and reduction in BPS parameters. Amniodrainage was performed twice to reduce the amniotic fluid amount in affected twin. Postnatally, surgery of BPS was not required and follow-up at 6 months of corrected age revealed no side effects of antenatal steroids in either twin. Conclusion Antenatal steroids might be considered for noninvasive therapy in high-risk fetal patients with BPS especially when fetal intervention is unsuitable or not available.
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Affiliation(s)
- Radovan Pock
- Department of Gynaecology and Obstetrics, Third Faculty of Medicine, Charles University, Prague, Czech Republic.,Department of Gynaecology and Obstetrics, Fetal Medicine Center, Institute for the Care of Mother and Child, Prague, Czech Republic
| | - Zbyněk Straňák
- Department of Gynaecology and Obstetrics, Third Faculty of Medicine, Charles University, Prague, Czech Republic.,Department of Gynaecology and Obstetrics, Fetal Medicine Center, Institute for the Care of Mother and Child, Prague, Czech Republic
| | - Jiří Vojtěch
- Department of Gynaecology and Obstetrics, Third Faculty of Medicine, Charles University, Prague, Czech Republic.,Department of Gynaecology and Obstetrics, Fetal Medicine Center, Institute for the Care of Mother and Child, Prague, Czech Republic
| | - Lubomír Hašlík
- Department of Gynaecology and Obstetrics, Third Faculty of Medicine, Charles University, Prague, Czech Republic.,Department of Gynaecology and Obstetrics, Fetal Medicine Center, Institute for the Care of Mother and Child, Prague, Czech Republic
| | - Jaroslav Feyereisl
- Department of Gynaecology and Obstetrics, Third Faculty of Medicine, Charles University, Prague, Czech Republic.,Department of Gynaecology and Obstetrics, Fetal Medicine Center, Institute for the Care of Mother and Child, Prague, Czech Republic.,Department of Gynaecology and Obstetrics, Institute for Postgraduate Medical Education, Prague, Czech Republic
| | - Ladislav Krofta
- Department of Gynaecology and Obstetrics, Third Faculty of Medicine, Charles University, Prague, Czech Republic.,Department of Gynaecology and Obstetrics, Fetal Medicine Center, Institute for the Care of Mother and Child, Prague, Czech Republic
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Coleman AM, Merrow AC, Crombleholme TM, Jaekle R, Lim FY. Fetal MRI of Torsed Bronchopulmonary Sequestration with Tension Hydrothorax and Hydrops in a Twin Gestation. Fetal Diagn Ther 2015; 40:156-60. [PMID: 25659425 DOI: 10.1159/000371513] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 12/08/2014] [Indexed: 11/19/2022]
Abstract
While bronchopulmonary sequestration typically has a benign course, this congenital lung malformation has a high mortality rate when associated with untreated in utero tension hydrothorax and hydrops. Hydrops related to bronchopulmonary sequestration is believed to result from torsion of the mass with compromise of the associated blood supply. The impaired venous return of the mass then leads to tension hydrothorax with compression of the heart and mediastinal vessels, impairing global venous return. To our knowledge, this scenario has only been described prenatally by ultrasound. We present the imaging findings of a dichorionic, diamniotic twin gestation with one fetus developing tension hydrothorax and hydrops from presumed intermittent torsion of a bronchopulmonary sequestration. This diagnosis was only able to be confirmed by MRI prior to the use of ultrasound-guided interstitial laser photocoagulation for the treatment of this anomaly.
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Affiliation(s)
- Alan M Coleman
- Cincinnati Fetal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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