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Sileo FG, Alameddine S, Iaccarino DA, Di Mascio D, Giuliani GA, Bertucci E, Khalil A, D'Antonio F. Outcome of fetal congenital pulmonary malformations: a systematic review and meta-analysis. J Perinat Med 2024; 52:457-466. [PMID: 38651628 DOI: 10.1515/jpm-2024-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 04/12/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVES To report the outcome of fetuses with a prenatal diagnosis of congenital lung malformation (CLM) diagnosed on ultrasound by performing a comprehensive assessment of these outcomes through a systematic review and meta-analysis. CONTENT CLMs are a heterogeneous group of anomalies that involve the lung parenchyma and its bronchovascular structures. Their presentation and evolution are variable, from entirely asymptomatic lesions with sonographic regression in utero to hydropic fetuses requiring fetal therapy, intrauterine death or neonatal morbidity. A systematic review was conducted in Medline, Embase and Cochrane databases including studies on fetuses with CLM diagnosed prenatally in order to report the in-utero natural history of these lesions. Thirty-nine studies (2,638 fetuses) were included in the final review. SUMMARY Regression/reduction in size of the lung lesion during pregnancy was reported in 31 % of cases, while its increase in 8.5 % of cases. Intra-uterine death complicated 1.5 % of pregnancies with fetal CLM, while neonatal and perinatal death were 2.2 and 3 %, respectively. Neonatal morbidity occurred in 20.6 % of newborns with CLM; 46 % had surgery, mainly elective. In fetuses with CLM and hydrops, fetal/perinatal loss occurred in 42 %. Assessment of the role of fetal therapy in improving the outcomes of pregnancies complicated by CLM was hampered by the small number of included cases and heterogeneity of type of interventions. OUTLOOK Fetuses with CLM prenatally diagnosed have a generally favorable outcome. Conversely, there is a low quality of evidence on the actual role of fetal therapy in improving the outcome of fetuses presenting with these anomalies.
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Affiliation(s)
- Filomena Giulia Sileo
- Prenatal Medicine Unit, Obstetrics and Gynaecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, International Doctorate School in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Sara Alameddine
- Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy
| | | | - Daniele Di Mascio
- Department of Maternal and Child Health and Urological Sciences, 9311 Sapienza University of Rome , Rome, Italy
| | - Giulia Andrea Giuliani
- Prenatal Medicine Unit, Obstetrics and Gynaecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
- Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy
| | - Emma Bertucci
- Prenatal Medicine Unit, Obstetrics and Gynaecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Asma Khalil
- Fetal Medicine Unit, Saint George's Hospital, London, UK
- Fetal Medicine Unit, Liverpool Women's Hospital, Liverpool, UK
| | - Francesco D'Antonio
- Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy
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Dhanju G, Goubran A, Kirkpatrick I, Wiebe S, Fogel J. Antenatal diagnosis of bronchopulmonary sequestration: A case report and review of the literature. Radiol Case Rep 2024; 19:604-613. [PMID: 38111561 PMCID: PMC10726340 DOI: 10.1016/j.radcr.2023.10.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 10/26/2023] [Indexed: 12/20/2023] Open
Abstract
Congenital lung malformations are a constellation of pathologies that can be diagnosed antenatally by ultrasound and fetal MRI. Ultrasound is considered the modality of choice for a routine assessment of second-trimester scans worldwide. Bronchopulmonary sequestration (BPS) and congenital pulmonary airway malformation (CPAM) are the 2 most common echogenic chest masses discovered incidentally during routine ultrasound scans in the second trimester. This paper describes BPS and differentiates it from CPAM sonographically in utero. An extensive literature search involving antenatal ultrasound is undertaken to review the most up-to-date understanding of the BPS. Furthermore, a case study at our institution and the literature review will help better describe the salient features of BPS. A 41-year-old female G3P1 visits our department for a routine second-trimester ultrasound. An echogenic lesion with a cystic component is visualized in this scan. Based on the grayscale and color imaging, this complex echogenic lesion was reported as CPAM and was referred to fetal assessment for confirmation. The fetal assessment diagnosed the lesion as BPS because of the pathognomonic feeding vessel from the thoracic aorta. Regardless of the congenital lung mass, any large mass compromising fetal well-being is an indication for intervention. The prognosis of BPS in the absence of fetal hydrops is excellent. A robust collaboration among radiologists, obstetricians, and pediatricians is required for the best outcome for the pregnancy and the neonate.
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Affiliation(s)
- Gurinder Dhanju
- University of Saskatchewan, SK, Canada
- St. Boniface Hospital, Winnipeg, MB, Canada
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Hamdar H, Nahle AA, Jawad A, Sikaria A, Alisame K, Abbas N. A unique case of intralobar pulmonary sequestration in an elderly patient: A case report. Respir Med Case Rep 2023; 46:101934. [PMID: 37920362 PMCID: PMC10618754 DOI: 10.1016/j.rmcr.2023.101934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/14/2023] [Indexed: 11/04/2023] Open
Abstract
Pulmonary sequestration (PS) is a rare congenital anomaly characterized by non-functional lung tissue receiving blood supply from an abnormal source. PS is typically diagnosed in young individuals but is uncommon in the elderly. This abstract describes a case of PS in a 62-year-old male patient presenting with recurrent fever, chronic cough, and difficulty breathing. Imaging revealed abnormal lung tissue disconnected from the bronchial tree, with blood supply from the descending thoracic aorta. Surgical intervention successfully treated the condition. The case emphasizes the need to consider PS as a possible diagnosis, even in older patients, and suggests further research into its possible etiologies.
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Affiliation(s)
| | | | - Ali Jawad
- Faculty of Medicine, Damascus University, Syria
| | | | - Komai Alisame
- MD in Thoracic Surgery, Alassad University Hospital, Damascus, Syria
| | - Nizar Abbas
- PhD in Thoracic Surgery, Head Department in Alassad University Hospital, Damascus, Syria
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4
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Gao Y, Xu W, Li W, Chen Z, Li Q, Liu Z, Liu H, Dai L. Epidemiology and prevalence of pulmonary sequestration in Chinese population, 2010-2019. BMC Pulm Med 2023; 23:8. [PMID: 36624419 PMCID: PMC9830928 DOI: 10.1186/s12890-023-02308-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Pulmonary sequestration (PS) is the second common congenital lung malformation and has been known for over 150 years. However, there is a scarcity of epidemiological studies on it. This study aimed to characterize the epidemiology of pulmonary sequestration in Chinese population in the recent decade by using a nationwide database. METHODS Using data from the Chinese Birth Defects Monitoring Network during 2010-2019, the prevalence rates for PS were calculated by birth year, maternal age, residence area, geographical region, and infant sex. Variations in prevalence and changes over time were further examined. Other variables of interest for analysis included the pregnancy outcomes of affected infants, the prenatal diagnosis, and the co-occurring anomalies of PS cases. RESULTS During the study period, we identified an average prevalence rate of 0.31, 0.11, and 0.42 per 10,000 live and still births for the isolated, non-isolated, and overall PS, respectively. An upward trend was observed for each category of PS. The prevalence rates varied significantly by maternal age (< 20 years, 0.34/10,000; 20-24 years, 0.33/10,000; 25-29 years, 0.45/10,000; 30-34 years, 0.46/10,000; ≥ 35 years, 0.36/10,000), residence area (urban vs. rural, 0.51/10,000 vs. 0.30/10,000), geographical region (western, 0.33/10,000; eastern, 0.49/10,000; central, 0.43/10,000), and by infant sex (male vs. female, 0.45/10,000 vs. 0.38/10,000). Non-isolated PS cases were more likely born prematurely than isolated cases (15.29% vs. 7.83%). 40.28% and 33.80% of non-isolated cases were accompanied by additional respiratory, and circulatory system malformations, respectively. CONCLUSIONS The study presents for the first time the prevalence of pulmonary sequestration in Chinese population. The rising prevalence and relatively poor perinatal outcome of affected fetuses or newborns indicate the necessity to improve perinatal management of PS.
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Affiliation(s)
- Yuyang Gao
- grid.13291.380000 0001 0807 1581National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, No.17 Section 3 Renminnanlu, Chengdu, 610041 Sichuan China ,grid.13291.380000 0001 0807 1581Pediatric Department, The Joint Laboratory for Pulmonary Development and Related Diseases, West China Institute of Women and Children’s Health, West China Second University Hospital, Sichuan University, No.17 Section 3 Renminnanlu, Chengdu, 610041 Sichuan China
| | - Wenli Xu
- grid.13291.380000 0001 0807 1581National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, No.17 Section 3 Renminnanlu, Chengdu, 610041 Sichuan China ,grid.13291.380000 0001 0807 1581Pediatric Department, The Joint Laboratory for Pulmonary Development and Related Diseases, West China Institute of Women and Children’s Health, West China Second University Hospital, Sichuan University, No.17 Section 3 Renminnanlu, Chengdu, 610041 Sichuan China
| | - Wenyan Li
- grid.13291.380000 0001 0807 1581National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, No.17 Section 3 Renminnanlu, Chengdu, 610041 Sichuan China
| | - Zhiyu Chen
- grid.13291.380000 0001 0807 1581National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, No.17 Section 3 Renminnanlu, Chengdu, 610041 Sichuan China
| | - Qi Li
- grid.13291.380000 0001 0807 1581National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, No.17 Section 3 Renminnanlu, Chengdu, 610041 Sichuan China
| | - Zhen Liu
- grid.13291.380000 0001 0807 1581National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, No.17 Section 3 Renminnanlu, Chengdu, 610041 Sichuan China
| | - Hanmin Liu
- Pediatric Department, The Joint Laboratory for Pulmonary Development and Related Diseases, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, No.17 Section 3 Renminnanlu, Chengdu, 610041, Sichuan, China. .,National Health Commission Key Laboratory of Chronobiology, Sichuan University, Chengdu, Sichuan, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China. .,NHC Key Laboratory of Chronobiology, Sichuan University, Chengdu, Sichuan, China.
| | - Li Dai
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, No.17 Section 3 Renminnanlu, Chengdu, 610041, Sichuan, China. .,Pediatric Department, The Joint Laboratory for Pulmonary Development and Related Diseases, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, No.17 Section 3 Renminnanlu, Chengdu, 610041, Sichuan, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China. .,Med-X Center for Informatics, Sichuan University, Chengdu, Sichuan, China. .,NHC Key Laboratory of Chronobiology, Sichuan University, Chengdu, Sichuan, China.
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Luo D, Fu X, Wang Q, Cheng K, Lv Y, Yuan M, Xu C, He T, Yang G, Wang Y, Jia R, Liu C. Thoracoscopic Clockwise Lobectomy May Be a Stylized Procedure for Treating Children with Congenital Lung Malformations. J Laparoendosc Adv Surg Tech A 2022; 32:1293-1298. [PMID: 36257641 DOI: 10.1089/lap.2022.0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Thoracoscopic lobectomy is a challenging procedure in children with congenital lung malformations (CLMs). This study aims to evaluate the safety and efficacy of thoracoscopic clockwise lobectomy (TCL) in CLMs in children and its potential to be a stylized procedure. Methods: All patients with CLMs who received TCL from 2015 to 2019 in our hospital were retrospectively reviewed. Clinical information was extracted from medical records, including patient demographics, operative details, and outcomes. Results: A total of 184 patients with a median age of 6.8 months (range, 3-156) and a median weight of 9 kg (range, 6-45) received TCL. Lesions were all located in the lower lobe and included congenital pulmonary airway malformation (n = 133), intralobar sequestration (n = 44), bronchiectasis (n = 4), and congenital lobar emphysema (n = 3). The mean (±standard deviation [SD]) operating time was 46 ± 7.5 minutes (range, 35-113). The mean (±SD) blood loss was 3.5 ± 0.8 mL (range, 1-60). Three patients converted to thoracotomy, and 162 patients did not have a chest tube placed. The postoperative course was uneventful in all patients except 2 patients who developed air leaks and 23 patients who developed a mild fever. The median length of postoperative hospital stay was 2 days. A total of 163 patients were followed up for more than 1 year without any complications. Conclusion: TCL is suitable for lower lobectomy and is safe and effective in standard and complicated thoracoscopic lobectomy. It could be recommended as a stylized procedure in treating children with CLMs.
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Affiliation(s)
- Dengke Luo
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoying Fu
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qinghai Wang
- Department of Pediatric Surgery, Guangyuan Central Hospital, Guangyuan, China
| | - Kaisheng Cheng
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Lv
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Miao Yuan
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chang Xu
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Taozhen He
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Gang Yang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yao Wang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ru Jia
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chenyu Liu
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
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6
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Gao R, Jiang L, Ren Z, Zhou L. Intralobular pulmonary sequestration in the middle lobe supplied by a right internal mammary artery: a case report. BMC Pulm Med 2022; 22:286. [PMID: 35883077 PMCID: PMC9327363 DOI: 10.1186/s12890-022-02083-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 07/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Pulmonary sequestration (PS) is a rare congenital malformation that is more common in the left lower lobe, and the thoracic aorta is the most common arterial supply. Case presentation We describe a case of a 67-year-old man with a chief complaint of intermittent cough and hemoptysis who had been diagnosed by multidetector computed tomography angiography with right middle lobe intralobular pulmonary sequestration supplied by a right internal mammary artery. Finally, he underwent middle pulmonary lobectomy with normal postoperative recovery. Discussion This is a rare intralobular pulmonary sequestration case for a feeding artery from the right internal mammary. Multidetector computed tomography angiography should be performed for diagnosis and preoperative evaluation once pulmonary sequestration is suspected.
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Affiliation(s)
- Rundi Gao
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China.,The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Libin Jiang
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhe Ren
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Linshui Zhou
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
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7
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Zhu P, Cheng K, He M, Wang Y, Shen P, He K, Xu C, Zhang B, Liu Z. Diagnostic value of congenital pulmonary airway malformation volume ratio for fetal hydrops due to congenital lung malformations: a systematic review and meta-analysis. Orphanet J Rare Dis 2022; 17:213. [PMID: 35658911 PMCID: PMC9164472 DOI: 10.1186/s13023-022-02347-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/26/2022] [Indexed: 12/04/2022] Open
Abstract
Objective Meta-analysis was used to evaluate the diagnostic value of a CVR cut-off value of 1.6 for fetal hydrops due to congenital lung malformation (CLM). Methods A systematic search of PubMed, Embase, Web of Science, CNKI, VIP, and Wanfang published before 7/30/2021 for the value of a congenital pulmonary airway malformation volume ratio (CVR) cut-off value of 1.6 for the diagnosis of fetal hydrops. According to the inclusion and exclusion criteria, the literature that met the requirements were obtained. A total of 75 articles were retrieved, and 12 articles were included for further analysis. The quality of these studies was evaluated according to the Quality Assessment for Studies of Diagnostic Accuracy tool (QUADAS-2) criteria. The Q test and heterogeneity I2 were used to evaluate the heterogeneity due to non-threshold effects, and Stata 15.0 was used for statistical analysis to evaluate the diagnostic value of the CVR cutoff value of 1.6 for fetal hydrops due to CLM. Results A total of 12 studies were included. The QUADAS-2 indicated that the risk of bias was relatively low, and the clinical applicability was relatively high. Statistical analysis was performed on included studies using a random effect model. Meta-analysis showed that the pooled sensitivity, specificity, diagnostic ratio and summary receiver operating characteristic (SROC) for the diagnosis of fetal hydrops by CVR were 0.86 (95% CI, 0.72–0.93; I2 = 59.84), 0.90 (95% CI, 0.88–0.93; I2 = 31.94), 58 (95% CI, 22–149; I2 = 100%), 0.93 (95% CI, 0.91–0.95). Conclusions The sensitivity and specificity of CVR cut-off value 1.6 for the diagnosis of CLM-induced fetal hydrops were high, no publication bias was observed, and the CVR cut-off value 1.6 is meaningful for the early diagnosis prediction of CLM-induced fetal hydrops.
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Affiliation(s)
- Pei Zhu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
| | - Kaisheng Cheng
- Department of Pediatric Surgery, West China Hospitial, Sichuan University, Sichuan, China
| | - Mingsheng He
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
| | - Yutong Wang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
| | - Pengyue Shen
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
| | - Kanglin He
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
| | - Chang Xu
- Department of Pediatric Surgery, West China Hospitial, Sichuan University, Sichuan, China.
| | - Ben Zhang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China.
| | - Zhenmi Liu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China.
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8
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El-Ali AM, Strubel NA, Lala SV. Congenital lung lesions: a radiographic pattern approach. Pediatr Radiol 2022; 52:622-636. [PMID: 34716454 DOI: 10.1007/s00247-021-05210-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/29/2021] [Accepted: 09/13/2021] [Indexed: 11/28/2022]
Abstract
Congenital lung malformations represent a spectrum of abnormalities that can overlap in imaging appearance and frequently coexist in the same child. Imaging diagnosis in the neonatal period can be challenging; however, the recognition of several archetypal radiographic patterns can aid in narrowing the differential diagnosis. Major radiographic archetypes include (1) hyperlucent lung, (2) pulmonary cysts, (3) focal opacity and (4) normal radiograph. Here we review the multimodality imaging appearances of the most commonly seen congenital lung malformations, categorized by their primary imaging archetypes. Along with the congenital lung malformations, we present several important imaging mimickers.
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Affiliation(s)
- Alexander Maad El-Ali
- Division of Pediatric Radiology, Department of Radiology, NYU Grossman School of Medicine, 550 First Ave., New York, NY, 10016, USA.
| | - Naomi A Strubel
- Division of Pediatric Radiology, Department of Radiology, NYU Grossman School of Medicine, 550 First Ave., New York, NY, 10016, USA
| | - Shailee V Lala
- Division of Pediatric Radiology, Department of Radiology, NYU Grossman School of Medicine, 550 First Ave., New York, NY, 10016, USA
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A 10-Year Retrospective Review of Prenatal Applications, Current Challenges and Future Prospects of Three-Dimensional Sonoangiography. Diagnostics (Basel) 2021; 11:diagnostics11081511. [PMID: 34441444 PMCID: PMC8394388 DOI: 10.3390/diagnostics11081511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/14/2021] [Accepted: 08/18/2021] [Indexed: 12/12/2022] Open
Abstract
Realistic reconstruction of angioarchitecture within the morphological landmark with three-dimensional sonoangiography (three-dimensional power Doppler; 3D PD) may augment standard prenatal ultrasound and Doppler assessments. This study aimed to (a) present a technical overview, (b) determine additional advantages, (c) identify current challenges, and (d) predict trajectories of 3D PD for prenatal assessments. PubMed and Scopus databases for the last decade were searched. Although 307 publications addressed our objectives, their heterogeneity was too broad for statistical analyses. Important findings are therefore presented in descriptive format and supplemented with the authors’ 3D PD images. Acquisition, analysis, and display techniques need to be personalized to improve the quality of flow-volume data. While 3D PD indices of the first-trimester placenta may improve the prediction of preeclampsia, research is needed to standardize the measurement protocol. In highly experienced hands, the unique 3D PD findings improve the diagnostic accuracy of placenta accreta spectrum. A lack of quality assurance is the central challenge to incorporating 3D PD in prenatal care. Machine learning may broaden clinical translations of prenatal 3D PD. Due to its operator dependency, 3D PD has low reproducibility. Until standardization and quality assurance protocols are established, its use as a stand-alone clinical or research tool cannot be recommended.
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10
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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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11
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Goley SM, Sakula-Barry S, Adofo-Ansong N, Isaaya Ntawunga L, Tekyiwa Botchway M, Kelly AH, Wright N. Investigating the use of ultrasonography for the antenatal diagnosis of structural congenital anomalies in low-income and middle-income countries: a systematic review. BMJ Paediatr Open 2020; 4:e000684. [PMID: 32864479 PMCID: PMC7443309 DOI: 10.1136/bmjpo-2020-000684] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/17/2020] [Accepted: 06/22/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Congenital anomalies are the fifth leading cause of under-5 mortality globally. The greatest burden is faced by those in low/middle-income countries (LMICs), where over 95% of deaths occur. Many of these deaths may be preventable through antenatal diagnosis and early intervention. This systematic literature review investigates the use of antenatal ultrasound to diagnose congenital anomalies and improve the health outcomes of infants in LMICs. METHODS A systematic literature review was conducted using three search strings: (1) structural congenital anomalies; (2) LMICs; and (3) antenatal diagnosis. The search was conducted on the following databases: Medline, Embase, PubMed and the Cochrane Library. Title, abstract and full-text screening was undertaken in duplicate by two reviewers independently. Consensus among the wider authorship was sought for discrepancies. The primary analysis focused on the availability and effectiveness of antenatal ultrasound for diagnosing structural congenital anomalies. Secondary outcomes included neonatal morbidity and mortality, termination rates, referral rates for further antenatal care and training level of the ultrasonographer. Relevant policy data were sought. RESULTS The search produced 4062 articles; 97 were included in the review. The median percentage of women receiving an antenatal ultrasound examination was 50.0% in African studies and 90.7% in Asian studies (range 6.8%-98.8%). Median detection rates were: 16.7% Africa, 34.3% South America, 34.7% Asia and 47.3% Europe (range 0%-100%). The training level of the ultrasound provider may affect detection rates. Four articles compared morbidity and mortality outcomes, with inconclusive results. Significant variations in termination rates were found (0%-98.3%). No articles addressed referral rates. CONCLUSION Antenatal detection of congenital anomalies remains highly variable across LMICs and is particularly low in sub-Saharan Africa. Further research is required to investigate the role of antenatal diagnosis for improving survival from congenital anomalies in LMICs. PROSPERO REGISTRATION NUMBER CRD42019105620.
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Affiliation(s)
| | | | - Nana Adofo-Ansong
- Department of Paediatrics, Mafikeng Provincial Hospital, Mafikeng, South Africa
| | | | - Maame Tekyiwa Botchway
- Department of Paediatric Surgery, University of the Witwatersrand, Johannesburg-Braamfontein, Gauteng, South Africa
| | - Ann Horton Kelly
- Department of Global Health & Social Medicine, King’s College London, London, UK
| | - Naomi Wright
- King’s Centre for Global Health and Health Partnerships, King’s College London, London, UK
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12
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Cho MK, Lee MY, Kang J, Kim J, Won HS, Lee PR, Jeong E, Lee BS, Kim EAR, Yoon H, Lee JS, Han M. Prenatal sonographic markers of the outcome in fetuses with bronchopulmonary sequestration. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:89-96. [PMID: 31609460 DOI: 10.1002/jcu.22780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 08/27/2019] [Accepted: 09/11/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE To evaluate the prenatal sonographic predictive markers of the outcome in fetuses with bronchopulmonary sequestration (BPS). METHODS BPS size and diameter of the feeding artery (FA) were measured prenatally and postnatally. Velocity of the FA and the left ventricular-modified myocardial performance index (LV mod-MPI) were also evaluated prenatally. RESULTS Forty-seven women were included in the study. Mean gestational age, mass size, diameter and velocity of the FA, and LV mod-MPI at prenatal diagnosis were 23.5 ± 2.2 weeks, 3.6 ± 8.3 cm, 2.3 ± 0.6 mm, 46.6 ± 15.4 cm/s, and 0.46 ± 0.06, respectively. Mean mass diameter and FA diameter measured on postnatal CT examinations were 3.8 ± 1.0 cm and 2.3 ± 0.7 mm, respectively. Five patients had respiratory symptoms after birth. Twenty children (43%) underwent or were scheduled to undergo mass excision, and the remaining 27 (57%) were doing well without any intervention. There was no neonatal death. LV mod-MPI at diagnosis, the FA diameter after birth and the serial change in the FA size were significantly associated with postnatal mass excision. CONCLUSION The FA diameter and LV mod-MPI may be additional markers for predicting whether fetuses with BPS should undergo mass excision in early childhood or conservative care.
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Affiliation(s)
- Min Kyong Cho
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Mi-Young Lee
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jisik Kang
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Juhee Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Hye-Sung Won
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Pil-Ryang Lee
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Euiseok Jeong
- Division of Neonatology, Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Byong Sop Lee
- Division of Neonatology, Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Ellen Ai-Rhan Kim
- Division of Neonatology, Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Heemang Yoon
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jin Seoung Lee
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Minkyu Han
- Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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13
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Kane SC, Ancona E, Reidy KL, Palma-Dias R. The Utility of the Congenital Pulmonary Airway Malformation-Volume Ratio in the Assessment of Fetal Echogenic Lung Lesions: A Systematic Review. Fetal Diagn Ther 2019; 47:171-181. [PMID: 31593968 DOI: 10.1159/000502841] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/21/2019] [Indexed: 11/19/2022]
Abstract
Although relatively uncommon, the incidence of fetal echogenic lung lesions - a heterogeneous group of anomalies that includes congenital pulmonary airway malformations (CPAM) and bronchopulmonary sequestrations (BPS) - has increased recently. Two decades ago, the CPAM-volume ratio (CVR) was first described as a tool to predict the development of hydrops, with this outcome found to be unlikely in fetuses with CVRs of ≤1.6 cm2. Since then, no clear international consensus has evolved as to the optimal CVR thresholds for the prediction of fetal/neonatal outcomes. This systematic review aimed to assess all original research studies that reported on the predictive utility of the CVR. Potentially relevant papers were identified through searching for citations of the paper that originally described the CVR, in addition to keyword searches of electronic databases. Fifty-two original research papers were included in the final review. Of these, 34 used the CVR for descriptive purposes only, 5 assessed the validity of established thresholds in different populations, and 13 proposed new thresholds. The evidence identified in this review would suggest that a threshold much lower than 1.6 cm2 is likely to be of greater utility in most populations for many outcomes of perinatal relevance. For neonatal outcomes (mostly respiratory compromise at birth), a CVR on the initial ultrasound scan ranging from 0.5 to 1.0 cm2 appears to have the greatest predictive value. Although a number of studies concurred that 1.6 cm2 was a useful threshold for the prediction of hydrops, many others were unable to assess this due to the rarity of this complication. For this reason, thresholds as low as 0.4 cm2 may be more useful for the prediction of a broader range of fetal concerns, including mediastinal shift and fluid collections. Further large-scale studies are required to determine the true utility of this well-established index.
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Affiliation(s)
- Stefan C Kane
- Pregnancy Research Centre, Department of Maternal Fetal Medicine, The Royal Women's Hospital, Parkville, Victoria, Australia, .,Ultrasound Services, Pauline Gandel Women's Imaging Centre, The Royal Women's Hospital, Parkville, Victoria, Australia, .,The University of Melbourne, Department of Obstetrics and Gynaecology, Parkville, Victoria, Australia,
| | - Emanuele Ancona
- Pregnancy Research Centre, Department of Maternal Fetal Medicine, The Royal Women's Hospital, Parkville, Victoria, Australia.,Ultrasound Services, Pauline Gandel Women's Imaging Centre, The Royal Women's Hospital, Parkville, Victoria, Australia.,Obstetrics and Gynaecology Unit, Department of Women's and Children's Health, The University of Padua, Padua, Italy
| | - Karen L Reidy
- Pregnancy Research Centre, Department of Maternal Fetal Medicine, The Royal Women's Hospital, Parkville, Victoria, Australia.,Ultrasound Services, Pauline Gandel Women's Imaging Centre, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Ricardo Palma-Dias
- Pregnancy Research Centre, Department of Maternal Fetal Medicine, The Royal Women's Hospital, Parkville, Victoria, Australia.,Ultrasound Services, Pauline Gandel Women's Imaging Centre, The Royal Women's Hospital, Parkville, Victoria, Australia.,The University of Melbourne, Department of Obstetrics and Gynaecology, Parkville, Victoria, Australia
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14
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Galganski LA, Anderson JE, Saadai P. Prenatal and Postnatal Intervention for a Congenital Lung Mass. JAMA Surg 2019; 153:961-962. [PMID: 29898208 DOI: 10.1001/jamasurg.2018.0889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Laura A Galganski
- Fetal Care and Treatment Center, Division of Pediatric General, Thoracic and Fetal Surgery, University of California, Davis
| | - Jamie E Anderson
- Fetal Care and Treatment Center, Division of Pediatric General, Thoracic and Fetal Surgery, University of California, Davis
| | - Payam Saadai
- Fetal Care and Treatment Center, Division of Pediatric General, Thoracic and Fetal Surgery, University of California, Davis
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15
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Congenital Cystic Adenomatoid Malformation Volume Ratio in Prenatal Assessment of Prognosis of Fetal Pulmonary Sequestrations. Curr Med Sci 2019; 39:658-662. [PMID: 31347005 DOI: 10.1007/s11596-019-2088-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 12/29/2018] [Indexed: 10/26/2022]
Abstract
This study aimed to evaluate the prognosis of pulmonary sequestration (PS) by measuring congenital cystic adenomatoid malformation volume ratio (CVR) value in fetal congenital PS. The fetal CVR in 49 cases of fetal PS diagnosed by prenatal ultrasound in Xiangyang No. 1 People's Hospital from March 2010 to June 2017 were measured, and the clinical outcomes were observed. According to the prenatal ultrasound CVR value, 49 fetuses diagnosed with PS were divided into 2 groups: group 1 with CVR≥1.26, and group 2 with CVR<1.26. The incidence rate of fetal edema, respiratory distress symptoms and survival rate were compared between the two groups. The risk factors of the fetal PS were evaluated by single and multiple Logistic regression analysis. The correlation between CVR and fetal prognosis was analyzed. Of the 49 fetuses, there were 34 cases of PS (ILS) type (69.39%, 34/49), 10 cases of PS (ELS) type I (20.41%, 10/49) and 5 cases of PS (ELS) type II (10.20%, 5/49). Forty-six cases (93.88%, 46/49) were born alive, there was 1 case (CVR ≥1.26) (2.04%, 1/49) of induced abortion, and 2 cases (CVR ≥1.26) (4.08%, 2/49) of stillbirths. In group 1 (n=24), 21 cases were born alive, and the incidence rate of newborn respiratory distress and fetal edema was 100% (21/21) and 79.17% (19/24) respectively. In group 2 (n=25), there were 3 cases (12%,3/25) of newborn respiratory distress, 3 cases (12%, 3/25) of fetal edema, and the rate of live birth was 100%. There were statistically significant differences between the two groups in the incidence of fetal edema, postpartum respiratory symptoms and survival rate. CVR was a risk factor for PS and was associated with fetal prognosis. CVR in the midtrimester of pregnancy is an effective index to evaluate the prognosis of fetal PS. CVR ≥1.26 is associated with an increased risk of fetal edema, infant respiratory distress and intrauterine or postnatal death.
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16
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Prenatal diagnosis of fetal intraabdominal extralobar pulmonary sequestration: a 12-year 3-center experience in China. Sci Rep 2019; 9:943. [PMID: 30700771 PMCID: PMC6353922 DOI: 10.1038/s41598-018-37268-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 12/04/2018] [Indexed: 01/23/2023] Open
Abstract
To provide useful information for diagnosing and predicting fetal intraabdominal extralobar pulmonary sequestration (IEPS), a retrospective review of diagnostic approaches was conducted. Ultrasonography was performed serially in 21 fetuses with IEPS from 2005 to 2017. Prenatal sonographic features, treatment, and outcomes of each case were evaluated and collected. These cases of IEPS were also compared to 43 cases previously reported by other researchers from 1986 to 2017. Of the 21 sonographic features, 14 (67%) were hyperechoic, 21 (100%) were well circumscribed, and 17 (81%) depicted a mass that shifted with fetal breaths/hiccups non-synchronized with adjacent organs (sliding sign). Feeding arteries were detected prenatally in 18 patients (86%). The lesion volume was 10.17 ± 4.66 cm3, the congenital cystic adenomatoid malformation volume ratio and cardiothoracic ratio were in normal range. The gestational age at diagnosis, location and echotexture of the lesion, and rate of surgical treatment were similar to previous studies, but with a significantly higher rate of detected feeding arteries (P < 0.01), and associated anomalies (P < 0.01). All infants who underwent surgery after birth had satisfactory outcomes. The sliding sign and feeding artery are essential features of IEPS in prenatal diagnosis.
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17
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Khen-Dunlop N, Farmakis K, Berteloot L, Gobbo F, Stirnemann J, De Blic J, Brunelle F, Delacourt C, Revillon Y. Bronchopulmonary sequestrations in a paediatric centre: ongoing practices and debated management. Eur J Cardiothorac Surg 2018; 54:246-251. [DOI: 10.1093/ejcts/ezy049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 01/14/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Naziha Khen-Dunlop
- Deparmtent of Pediatric Surgery, AP-HP, Hopital Necker-Enfants malades, Paris, France
- Université Paris Descartes, Sorbonne Paris Cite, Paris, France
- EA FETUS, Paris, France
| | - Konstantinos Farmakis
- Deparmtent of Pediatric Surgery, AP-HP, Hopital Necker-Enfants malades, Paris, France
| | - Laureline Berteloot
- Deparmtent of Pediatric Radilogy, AP-HP, Hopital Necker-Enfants malades, Paris, France
| | - Francesca Gobbo
- Deparmtent of Pediatric Surgery, AP-HP, Hopital Necker-Enfants malades, Paris, France
| | - Julien Stirnemann
- Université Paris Descartes, Sorbonne Paris Cite, Paris, France
- EA FETUS, Paris, France
- Department of Obstetrics, AP-HP, Hopital Necker-Enfants malades, Paris, France
| | - Jacques De Blic
- Université Paris Descartes, Sorbonne Paris Cite, Paris, France
- Department of Pediatric Pulmunology, AP-HP, Hopital Necker-Enfants malades, Paris, France
| | - Francis Brunelle
- Université Paris Descartes, Sorbonne Paris Cite, Paris, France
- Deparmtent of Pediatric Radilogy, AP-HP, Hopital Necker-Enfants malades, Paris, France
| | - Christophe Delacourt
- Université Paris Descartes, Sorbonne Paris Cite, Paris, France
- Department of Pediatric Pulmunology, AP-HP, Hopital Necker-Enfants malades, Paris, France
| | - Yann Revillon
- Deparmtent of Pediatric Surgery, AP-HP, Hopital Necker-Enfants malades, Paris, France
- Université Paris Descartes, Sorbonne Paris Cite, Paris, France
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18
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Oliver ER, DeBari SE, Giannone MM, Pogoriler JE, Johnson AM, Horii SC, Gebb JS, Howell LJ, Adzick NS, Coleman BG. Going With the Flow: An Aid in Detecting and Differentiating Bronchopulmonary Sequestrations and Hybrid Lesions. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:371-383. [PMID: 28795424 DOI: 10.1002/jum.14346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 04/30/2017] [Accepted: 05/05/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To assess the ability of prenatal ultrasound (US) in identifying systemic feeding arteries in bronchopulmonary sequestrations and hybrid lesions and report the ability of US in classifying bronchopulmonary sequestrations as intralobar or extralobar. METHODS Institutional Review Board-approved radiology and clinical database searches from 2008 to 2015 were performed for prenatal lung lesions with final diagnoses of bronchopulmonary sequestrations or hybrid lesions. All patients had detailed US examinations, and most patients had ultrafast magnetic resonance imaging (MRI). Lesion location, size, and identification of systemic feeding arteries and draining veins were assessed with US. RESULTS The study consisted of 102 bronchopulmonary sequestrations and 86 hybrid lesions. The median maternal age was 30 years. The median gestational age was 22 weeks 5 days. Of bronchopulmonary sequestrations, 66 had surgical pathologic confirmation, and 100 had postnatal imaging. Bronchopulmonary sequestration locations were intrathoracic (n = 77), intra-abdominal (n = 19), and transdiaphragmatic (n = 6). Of hybrid lesions, 84 had surgical pathologic confirmation, and 83 had postnatal imaging. Hybrid lesion locations were intrathoracic (n = 84) and transdiaphragmatic (n = 2). Ultrasound correctly identified systemic feeding arteries in 86 of 102 bronchopulmonary sequestrations and 79 of 86 hybrid lesions. Of patients who underwent MRI, systemic feeding arteries were reported in 62 of 92 bronchopulmonary sequestrations and 56 of 81 hybrid lesions. Ultrasound identified more systemic feeding arteries than MRI in both bronchopulmonary sequestrations and hybrid lesions (P < .01). Magnetic resonance imaging identified systemic feeding arteries that US did not in only 2 cases. In cases in which both systemic feeding arteries and draining veins were identified, US could correctly predict intrathoracic lesions as intralobar or extralobar in 44 of 49 bronchopulmonary sequestrations and 68 of 73 hybrid lesions. CONCLUSIONS Ultrasound is most accurate for systemic feeding artery detection in bronchopulmonary sequestrations and hybrid lesions and can also type the lesions as intralobar or extralobar when draining veins are evaluated.
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Affiliation(s)
- Edward R Oliver
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Suzanne E DeBari
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Mariann M Giannone
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jennifer E Pogoriler
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Pathology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ann M Johnson
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Steven C Horii
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Juliana S Gebb
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lori J Howell
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - N Scott Adzick
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Beverly G Coleman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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19
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Lin MF, Xie HN, Zhao XH, Peng R, Zheng J, Peng ZP. Systemic Venous Drainage Is Associated with an Unfavorable Prenatal Behavior in Fetal Bronchopulmonary Sequestration. Fetal Diagn Ther 2017; 44:291-298. [PMID: 29268259 DOI: 10.1159/000485035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 11/06/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This study aimed to determine the significance of the venous drainage pattern of bronchopulmonary sequestration (BPS) in the prenatal course. METHODS The venous drainage pattern of fetuses with BPS was determined with high-definition flow and confirmed by postnatal three-dimensional computed tomography angiography scan or autopsy. The volume of BPS lesions during gestation was recorded by the three-dimensional ultrasonographic Virtual Organ Computer-Aided Analysis software. The relationship between venous drainage pattern and prenatal characteristics was determined. RESULTS Seventy-one fetuses were enrolled: 35 with systemic venous drainage (SVD) and 36 with pulmonary venous drainage (PVD). The volumes of BPS lesions significantly increased from the middle second trimester to the later second trimester in the SVD group. A marked decrease from the later second trimester to the third trimester was observed in the PVD group. The incidences of associated anomalies, hydrops, and polyhydramnios in the SVD group were 14.2, 23.3, and 33.3%, respectively, significantly higher than those in the PVD group (0, 0, and 5.6%, respectively). CONCLUSIONS Our data indicate that SVD is correlated with a higher risk of associated anomalies and an unfavorable prenatal course in fetal BPS. Identification of the venous drainage pattern is of clinical significance in predicting the prenatal behavior of fetal BPS.
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Affiliation(s)
- Mei-Fang Lin
- Department of Ultrasonic Medicine and Fetal Medical Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hong-Ning Xie
- Department of Ultrasonic Medicine and Fetal Medical Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou,
| | - Xiu-Hua Zhao
- Department of Ultrasonic Medicine and Fetal Medical Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ruan Peng
- Department of Ultrasonic Medicine and Fetal Medical Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ju Zheng
- Department of Ultrasonic Medicine and Fetal Medical Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhen-Peng Peng
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Abstract
Recent improvements in fetal therapies and perinatal care and the multidisciplinary involvement in fetal medicine have increased the demand for more accurate prenatal diagnosis. Fetal Magnetic Resonance Imaging (MRI) is a complementary imaging technique for the assessment of thoraco-abdominal anomalies for which Ultrasonography (US) is not conclusive. It is indicated in selected situations to precise the prognosis in diaphragmatic hernia, to characterise the nature and extension of a pulmonary malformation, to locate a bowel atresia or to better depict an abdominal cystic lesion or tumoural extension. It has become a mandatory complementary diagnostic tool and improves the management of the fetuses and newborns.
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21
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Kane SC, Da Silva Costa F, Crameri JA, Reidy KL, Kaganov H, Palma-Dias R. Antenatal assessment and postnatal outcome of fetal echogenic lung lesions: a decade’s experience at a tertiary referral hospital. J Matern Fetal Neonatal Med 2017; 32:703-709. [DOI: 10.1080/14767058.2017.1388367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Stefan C. Kane
- Department of Maternal Fetal Medicine, Pregnancy Research Centre, The Royal Women’s Hospital, Parkville, Australia
- Department of Obstetrics and Gynecology, The University of Melbourne, The Royal Women’s Hospital, Parkville, Australia
- Pauline Gandel Women’s Imaging Centre, The Royal Women’s Hospital, Parkville, Australia
| | - Fabrício Da Silva Costa
- Department of Obstetrics and Gynecology, The University of Melbourne, The Royal Women’s Hospital, Parkville, Australia
- Monash Ultrasound for Women, Clayton, Victoria, Australia
- Perinatal Services, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia
| | - Joseph A. Crameri
- Department of Paediatric and Neonatal Surgery, The Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Karen L. Reidy
- Department of Maternal Fetal Medicine, Pregnancy Research Centre, The Royal Women’s Hospital, Parkville, Australia
- Pauline Gandel Women’s Imaging Centre, The Royal Women’s Hospital, Parkville, Australia
| | - Helen Kaganov
- Maternity Services, Werribee Mercy Hospital, Werribee, Victoria, Australia
| | - Ricardo Palma-Dias
- Department of Obstetrics and Gynecology, The University of Melbourne, The Royal Women’s Hospital, Parkville, Australia
- Pauline Gandel Women’s Imaging Centre, The Royal Women’s Hospital, Parkville, Australia
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22
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Lyons K, Cassady C, Mehollin-Ray A, Krishnamurthy R. Current Role of Fetal Magnetic Resonance Imaging in Body Anomalies. Semin Ultrasound CT MR 2015; 36:310-23. [PMID: 26296482 DOI: 10.1053/j.sult.2015.05.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Fetal MR body applications have become more common in recent years as both in utero therapies, including fetoscopic surgery, and improvements in perinatal care have increased the demand for precise antenatal anatomic detail. This article discusses the variety of fast imaging sequences available to the fetal imager and describes their applications to both common and unusual congenital pathologies, including of the neck, chest, abdomen/pelvis and musculoskeletal systems.
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Affiliation(s)
- Karen Lyons
- EB Singleton Department of Diagnostic Radiology, Texas Children׳s Hospital, Baylor College of Medicine, Houston, TX
| | - Christopher Cassady
- EB Singleton Department of Diagnostic Radiology, Texas Children׳s Hospital, Baylor College of Medicine, Houston, TX.
| | - Amy Mehollin-Ray
- EB Singleton Department of Diagnostic Radiology, Texas Children׳s Hospital, Baylor College of Medicine, Houston, TX
| | - Rajesh Krishnamurthy
- EB Singleton Department of Diagnostic Radiology, Texas Children׳s Hospital, Baylor College of Medicine, Houston, TX
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