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Heriseanu C, Bizubac M, Draghia L, Marcu V, Gheorghe D, Cirstoveanu C. Congenital High Airway Obstructive Syndrome (CHAOS) Survival of a Newborn with Laryngeal Atresia. Diagnostics (Basel) 2023; 13:3658. [PMID: 38132244 PMCID: PMC10742956 DOI: 10.3390/diagnostics13243658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
Congenital high airway obstructive syndrome (CHAOS) is a rare congenital anomaly, frequently caused by laryngeal or tracheal atresia, tracheal stenosis, and obstructing laryngeal cysts. This is a congenital malformation, often fatal, with an unknown prevalence. Laryngeal atresia is the most frequent cause. We report a case of an intrauterine diagnosis of CHAOS and ascites in a 17-week fetus delivered at 38 weeks of gestation without other associated malformations. A fetoscopic procedure was performed at 22 weeks of gestation. An attempt was made to perforate the affected area to ensure pulmonary fluid circulation and the ascites' resolution. After birth, a tracheostomy was performed. The patient was mechanically ventilated until 11 months of age, when she was discharged with no cerebral or other complications of immediate postnatal anoxia or episodes of respiratory arrest. A laryngotracheoplasty was performed at 2 years old, but decannulation was not possible due to certain complications. At 5 years old, a new surgical intervention was performed, which allowed decannulation 6 months later.
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Affiliation(s)
- Carmen Heriseanu
- Neonatal Intensive Care Unit, “M.S. Curie” Children’s Hospital, Constantin Brâncoveanu Boulevard, No. 20, 4th District, 041451 Bucharest, Romania; (C.H.); (L.D.); (C.C.)
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Mihaela Bizubac
- Neonatal Intensive Care Unit, “M.S. Curie” Children’s Hospital, Constantin Brâncoveanu Boulevard, No. 20, 4th District, 041451 Bucharest, Romania; (C.H.); (L.D.); (C.C.)
- Department of Neonatal Intensive Care, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Loredana Draghia
- Neonatal Intensive Care Unit, “M.S. Curie” Children’s Hospital, Constantin Brâncoveanu Boulevard, No. 20, 4th District, 041451 Bucharest, Romania; (C.H.); (L.D.); (C.C.)
| | - Veronica Marcu
- Department of Radiology, “M.S. Curie” Children’s Hospital, Constantin Brâncoveanu Boulevard, No. 20, 4th District, 041451 Bucharest, Romania;
| | - Dan Gheorghe
- Department of ENT, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Catalin Cirstoveanu
- Neonatal Intensive Care Unit, “M.S. Curie” Children’s Hospital, Constantin Brâncoveanu Boulevard, No. 20, 4th District, 041451 Bucharest, Romania; (C.H.); (L.D.); (C.C.)
- Department of Neonatal Intensive Care, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Barrette LX, Morales CZ, Oliver ER, Gebb JS, Feygin T, Lioy J, Howell LJ, Hedrick HL, Jackson OA, Adzick NS, Javia LR. Risk factor analysis and outcomes of airway management in antenatally diagnosed cervical masses. Int J Pediatr Otorhinolaryngol 2021; 149:110851. [PMID: 34311168 DOI: 10.1016/j.ijporl.2021.110851] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/01/2021] [Accepted: 07/20/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE To investigate antenatally-determined imaging characteristics associated with invasive airway management at birth in patients with cervical masses, as well as to describe postnatal management and outcomes. STUDY DESIGN A retrospective analysis of 52 patients with antenatally diagnosed neck masses was performed using single-center data from January 2008 to January 2019. Antenatal imaging, method of delivery, management, and outcomes data were abstracted from the medical record and analyzed. RESULTS Antenatal diagnosis of neck masses in this cohort consisted of 41 lymphatic malformations (78.8%), 6 teratomas (11.5%), 3 hemangiomas (5.8%), 1 hemangioendothelioma (1.9%), and 1 giant foregut duplication cyst (1.9%). Mean gestational age at time of diagnostic imaging was 29 weeks 3 days (range: 19w4d - 37w). Overall, 22 patients (42.3%) required invasive airway management at birth, specifically 18 patients (34.6%) required endotracheal intubation and 4 (7.7%) required tracheostomy. 15 patients (28.8%) underwent ex-utero intrapartum treatment (EXIT) for the purposes of securing an airway. Polyhydramnios, tracheal deviation and compression, and anterior mass location on antenatal imaging were significantly associated with incidence of invasive airway intervention at birth, EXIT procedure, and tracheostomy during the neonatal hospitalization (p < 0.025; Fisher's exact test). Logistic regression analysis demonstrated statistically significant association between increasing antenatally-estimated mass volume and incidence of invasive airway management at birth (p = 0.02). Post-natal cervical mass management involved surgical excision (32.7%), sclerotherapy (50%), and adjuvant therapy with rapamycin (17.3%). Demise in the neonatal period occurred in 4 (7.7%) patients. CONCLUSION This series documents the largest single-center experience of airway management in antenatally diagnosed cervical masses. Fetal imaging characteristics may help inform the appropriate method of delivery, airway management strategy at birth, and prenatal counseling.
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Affiliation(s)
- Louis-Xavier Barrette
- Division of Otolaryngology, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Carrie Z Morales
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Leonard and Madlyn Abramson Pediatric Research Center, 3615 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Edward R Oliver
- Department of Radiology, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Juliana S Gebb
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA; Division of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Tamara Feygin
- Department of Radiology, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Janet Lioy
- Division of Neonatology, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Lori J Howell
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA; Division of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Holly L Hedrick
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA; Division of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Oksana A Jackson
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Leonard and Madlyn Abramson Pediatric Research Center, 3615 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - N Scott Adzick
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA; Division of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Luv R Javia
- Division of Otolaryngology, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
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Alshafei A, Kassouma J, Khan A, Hassan M. Preterm Infant with Severe Respiratory Distress and Intubation Difficulty. Pediatr Rev 2021; 42:S60-S62. [PMID: 33386364 DOI: 10.1542/pir.2019-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Atef Alshafei
- NICU, Pediatric Department, Dubai Hospital, Dubai, United Arab Emirates;
| | - Jamal Kassouma
- ENT Department, Dubai Hospital, Dubai, United Arab Emirates
| | - Anwar Khan
- NICU, Pediatric Department, Dubai Hospital, Dubai, United Arab Emirates
| | - Moustafa Hassan
- NICU, Pediatric Department, Dubai Hospital, Dubai, United Arab Emirates
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Novoa RH, Quintana W, Castillo-Urquiaga W, Ventura W. EXIT (ex utero intrapartum treatment) surgery for the management of fetal airway obstruction: A systematic review of the literature. J Pediatr Surg 2020; 55:1188-1195. [PMID: 32151401 DOI: 10.1016/j.jpedsurg.2020.02.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 11/24/2019] [Accepted: 02/11/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE To provide a comprehensive overview of the perinatal and maternal outcomes of fetuses undergoing EXIT surgery for the management of fetal airway obstruction secondary to cervical or oral tumors. METHODS A comprehensive search from inception to September 2018 was conducted on databases including MEDLINE, EMBASE, Cochrane Library and LILACS. All studies that reported an EXIT surgery in singleton were considered eligible. A descriptive analysis was performed. RESULTS Out of the 250 full-text study reports, 120 articles reporting 235 cases of EXIT surgery were included. EXIT surgery was performed at 35.1 weeks of gestation on average. The most frequent diagnosis was teratoma (46.4%, n = 109/235). There were 13 adverse maternal events, and the most frequent one was postpartum hemorrhage (4.7%, n = 11/235). No maternal death was reported. Fetal and neonatal death occurred in 17% (40/235) of the cases. There were 29 adverse fetal events (12.2%), and the most frequent one was the failure of intubation or tracheostomy (3.4%, n = 8/235). CONCLUSION EXIT surgery could be considered for the management of an oral or cervical tumor that's highly suspicious of blocking the fetal airway. This systematic review reports that EXIT surgery poses substantial risks of maternal and fetal adverse events, including neonatal death. LEVEL OF EVIDENCE IV case series with no comparison group.
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Affiliation(s)
- Rommy H Novoa
- Resident trainee in Ob/Gyn Department of Obstetrics and Gynecology, InstitutoNacional Materno Perinatal, Lima, Peru; Faculty of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Willy Quintana
- Resident trainee in Ob/Gyn Department of Obstetrics and Gynecology, InstitutoNacional Materno Perinatal, Lima, Peru; Faculty of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | | | - Walter Ventura
- Fetal Medicine Unit, Instituto Nacional Materno Perinatal, Lima, Peru; Fetal Medicine Unit, Clinica Delgado, Grupo AUNA, Lima, Peru.
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Beckers K, Faes J, Deprest J, Delaere PR, Hens G, De Catte L, Naulaers G, Claus F, Hermans R, Vander Poorten VLM. Long-term outcome of pre- and perinatal management of congenital head and neck tumors and malformations. Int J Pediatr Otorhinolaryngol 2019; 121:164-172. [PMID: 30917301 DOI: 10.1016/j.ijporl.2019.03.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/13/2019] [Accepted: 03/14/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Congenital head and neck pathology may cause direct postnatal airway obstruction. Prenatal diagnosis facilitates safe delivery with pre- and perinatal airway assessment and management and Ex-Utero-Intrapartum-Treatment (EXIT) if necessary. Fetoscopic airway evaluation can optimize the selection of patients in need of an EXIT procedure. METHODS Description of 11 consecutive fetuses, born with a potential airway obstruction between 1999 and 2011 and treated at the University Hospitals Leuven, with a long-term follow-up until 2018. An algorithm including fetoscopic airway evaluation is presented. RESULTS In utero imaging revealed seven teratomas, one fourth branchial pouch cyst, one thymopharyngeal duct remnant, one lymphatic malformation and one laryngeal atresia. A multidisciplinary team could avoid EXIT in eight patients by ultrasonographic (n = 2) or fetoscopic (n = 6) documentation of accessible airways. Three patients needed an EXIT-to-airway-procedure. Neonatal surgery included tracheostomy during EXIT (n = 2) and resection of teratoma (n = 7) or branchiogenic pathology (n = 3). All patients do well at long-term (minimum 54 months) follow-up. CONCLUSIONS Combining prenatal imaging and perinatal fetoscopy, EXIT-procedure and neonatal surgery yields an optimal long-term outcome in these complex patients. Fetoscopy can dramatically reduce the number of EXIT-procedures.
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Affiliation(s)
- Karen Beckers
- Otorhinolaryngology, Head & Neck Surgery, University Hospitals Leuven, Belgium and Department of Oncology, Section Head & Neck Oncology, KU Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
| | - Julie Faes
- Department of Obstetrics & Gynaecology and Fetal Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Jan Deprest
- Department of Obstetrics & Gynaecology and Fetal Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Pierre R Delaere
- Otorhinolaryngology, Head & Neck Surgery, University Hospitals Leuven, Belgium and Department of Oncology, Section Head & Neck Oncology, KU Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
| | - Greet Hens
- Otorhinolaryngology, Head & Neck Surgery, University Hospitals Leuven, Belgium and Department of Oncology, Section Head & Neck Oncology, KU Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
| | - Luc De Catte
- Department of Obstetrics & Gynaecology and Fetal Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Gunnar Naulaers
- Department of Neonatal Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Filip Claus
- Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Robert Hermans
- Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Vincent L M Vander Poorten
- Otorhinolaryngology, Head & Neck Surgery, University Hospitals Leuven, Belgium and Department of Oncology, Section Head & Neck Oncology, KU Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium.
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6
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Mudaliyar US, Sreedhar S. Chaos syndrome. BJR Case Rep 2017; 3:20160046. [PMID: 30363271 PMCID: PMC6159205 DOI: 10.1259/bjrcr.20160046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 01/18/2017] [Accepted: 01/30/2017] [Indexed: 11/22/2022] Open
Abstract
Congenital high airway obstruction syndrome (CHAOS) is the obstruction of the foetal upper airways, which may be partial or complete. It is usually incompatible with life. Prenatal recognition of the disease is quite important. We report here a case of CHAOS diagnosed on antenatal ultrasonography.
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Affiliation(s)
| | - Sneha Sreedhar
- Pediatric Dentist, Department of Dentistry, Bhaktivedanta hospital and Research institute, Mumbai, India
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Maughan E, Lesage F, Butler CR, Hynds RE, Hewitt R, Janes SM, Deprest JA, Coppi PD. Airway tissue engineering for congenital laryngotracheal disease. Semin Pediatr Surg 2016; 25:186-90. [PMID: 27301606 DOI: 10.1053/j.sempedsurg.2016.02.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Regenerative medicine offers hope of a sustainable solution for severe airway disease by the creation of functional, immunocompatible organ replacements. When considering fetuses and newborns, there is a specific spectrum of airway pathologies that could benefit from cell therapy and tissue engineering applications. While hypoplastic lungs associated with congenital diaphragmatic hernia (CDH) could benefit from cellular based treatments aimed at ameliorating lung function, patients with upper airway obstruction could take advantage from a de novo tissue engineering approach. Moreover, the international acceptance of the EXIT procedure as a means of securing the precarious neonatal airway, together with the advent of fetal surgery as a method of heading off postnatal co-morbidities, offers the revolutionary possibility of extending the clinical indication for tissue-engineered airway transplantation to infants affected by diverse severe congenital laryngotracheal malformations. This article outlines the necessary basic components for regenerative medicine solutions in this potential clinical niche.
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Affiliation(s)
- Elizabeth Maughan
- Stem Cells and Regenerative Medicine Section, DBC, UCL Institute of Child Health, 30 Guilford St, London, UK; Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Flore Lesage
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK; Department of Development and Regeneration, Biomedical Sciences Group, University of Leuven, Leuven, Belgium
| | - Colin R Butler
- Stem Cells and Regenerative Medicine Section, DBC, UCL Institute of Child Health, 30 Guilford St, London, UK; Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Robert E Hynds
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Richard Hewitt
- Ear, Nose and Throat Department, Great Ormond Street Hospital, London, UK
| | - Sam M Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Jan A Deprest
- Stem Cells and Regenerative Medicine Section, DBC, UCL Institute of Child Health, 30 Guilford St, London, UK; Department of Development and Regeneration, Biomedical Sciences Group, University of Leuven, Leuven, Belgium; Department of Paediatric Surgery, Great Ormond Street Hospital, London, UK; Department of Obstetrics and Gynaecology, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
| | - Paolo De Coppi
- Stem Cells and Regenerative Medicine Section, DBC, UCL Institute of Child Health, 30 Guilford St, London, UK; Department of Paediatric Surgery, Great Ormond Street Hospital, London, UK.
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D'Eufemia MD, Cianci S, Di Meglio F, Di Meglio L, Di Meglio L, Vitale SG, Laganà AS, Chiofato B, Rapisarda AMC, Padula F, La Rosa V, Coco C, Vascone C. Congenital high airway obstruction syndrome (CHAOS): discussing the role and limits of prenatal diagnosis starting from a single-center case series. J Prenat Med 2016; 10:4-7. [PMID: 28725339 DOI: 10.11138/jpm/2016.10.1.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES we aimed to report our experience about congenital high airway obstruction syndrome (CHAOS) that is a rare and fatal congenital anomaly; laryngeal atresia is the most frequent cause. Sonographic findings are enlarged echogenic lungs, dilated trachea, and ascites. METHODS we performed a single-center case series analysis collecting antenatally through ultrasound examination, and some of them confirmed by autopsy. RESULTS we report six cases of CHAOS diagnosed by antenatal ultrasonography between 2007 and 2013. CONCLUSION to date literature provides very few individual case reports. This work describes typical sonographic findings of this syndrome and it underlines the importance of early prenatal diagnosis to improve prognosis thought an ex utero intrapartum treatment, that seems to be the only chance of survival for the affected fetus.
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Affiliation(s)
- Maria Diletta D'Eufemia
- Department of Woman, Child and General and Specialistics Surgery, Second University of Naples, Italy
| | - Stefano Cianci
- Department of Medical Surgical Specialties, Gynecology and Obstetrics Section, University of Catania, Italy
| | - Filippo Di Meglio
- Department of Gynaecological-Obstetrical Sciences and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Letizia Di Meglio
- Clinical Department of Gynaecology and Obstetrics of Physiopathology Reproduction, "Federico II" University of Naples, Italy
| | - Lavinia Di Meglio
- Clinical Department of Gynaecology and Obstetrics of Physiopathology Reproduction, "Federico II" University of Naples, Italy
| | - Salvatore Giovanni Vitale
- Unit of Gynaecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina, Italy
| | - Antonio Simone Laganà
- Unit of Gynaecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina, Italy
| | - Benito Chiofato
- Unit of Gynaecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina, Italy
| | | | - Francesco Padula
- Department of Prenatal Diagnosis, Altamedica Fetal Maternal Medical Centre, Rome, Italy
| | - Valentina La Rosa
- Unit of Psychodiagnostics and Clinical Psychology, University of Catania, Italy
| | - Claudio Coco
- Department of Prenatal Diagnosis, Altamedica Fetal Maternal Medical Centre, Rome, Italy
| | - Carmine Vascone
- Department of Woman, Child and General and Specialistics Surgery, Second University of Naples, Italy
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Prenatal diagnosis of congenital high airway obstruction syndrome: report of two cases and brief review of the literature. Case Rep Obstet Gynecol 2013; 2013:728974. [PMID: 24251054 PMCID: PMC3819797 DOI: 10.1155/2013/728974] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 09/17/2013] [Indexed: 11/24/2022] Open
Abstract
Congenital high airway obstruction syndrome (CHAOS) is the obstruction of the fetal upper airways, which may be partial or complete. It is usually incompatible with life. Prenatal recognition of the disease is quite important due to the recently described management options. We report here two cases of CHAOS due to tracheal atresia diagnosed by antenatal ultrasonography and fetal MRI. We also briefly review the relevant literature with the associated management options.
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10
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Johnson N, Shah PS, Shannon P, Campisi P, Windrim R. A Challenging Delivery by EXIT Procedure of a Fetus With a Giant Cervical Teratoma. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2009; 31:267-271. [DOI: 10.1016/s1701-2163(16)34126-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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11
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Mong A, Johnson AM, Kramer SS, Coleman BG, Hedrick HL, Kreiger P, Flake A, Johnson M, Wilson RD, Adzick NS, Jaramillo D. Congenital high airway obstruction syndrome: MR/US findings, effect on management, and outcome. Pediatr Radiol 2008; 38:1171-9. [PMID: 18704392 DOI: 10.1007/s00247-008-0962-2] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Revised: 05/11/2008] [Accepted: 07/10/2008] [Indexed: 11/26/2022]
Abstract
BACKGROUND Congenital high airway obstruction syndrome (CHAOS) is a rare disorder defined as any fetal abnormality that obstructs the larynx or trachea. Prompt airway intervention at delivery after accurate prenatal diagnosis may allow survival of this otherwise fatal condition. OBJECTIVE To identify prenatal MRI findings in CHAOS, to compare these findings with those of fetal US, to determine if imaging alters diagnosis and management decisions, and to correlate prenatal with postnatal imaging findings. MATERIALS AND METHODS Records and MRI scans of ten fetuses with CHAOS were reviewed, and the findings correlated with outside and same-day fetal US and postnatal imaging findings. Fetal lung volumes were measured on MRI scans. RESULTS Large lung volumes were found in 90% of the fetuses. Increased lung signal intensity, inverted diaphragm, and a dilated, fluid-filled lower airway were identified in all. The obstruction level was identified in 90%. MRI changed screening US diagnosis in 70%, but was concordant with the tertiary care US imaging in 90%. Seven fetuses were terminated or died in utero, and three fetuses survived after ex utero intrapartum tracheostomy placement. Autopsy or bronchoscopy performed in 60% confirmed CHAOS. Postnatal chest radiographs and CT showed hyperinflation, while US and fluoroscopy showed diminished diaphragmatic motion. CONCLUSION MRI demonstrates large lung volumes, increased lung signal intensity, inverted diaphragm, and dilated fluid-filled lower airway, and usually identifies the obstruction level. The degree of correlation between MRI and tertiary prenatal US is high, but CHAOS is frequently misdiagnosed on screening US. Correct diagnosis may enable planned airway management. Voluminous lungs and diaphragmatic abnormalities persist on postnatal imaging.
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Affiliation(s)
- Andrew Mong
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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12
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Pereira KD, Smith SL. The Management of Severe Upper Airway Obstruction in the Newborn. EAR, NOSE & THROAT JOURNAL 2008. [DOI: 10.1177/014556130808701007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Kevin D. Pereira
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland, Baltimore
| | - Stacey L. Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Health Science Center at San Antonio
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13
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McDevitt H, Kubba H, Macara L, Reynolds B, Simpson J. Four cases of congenital airway obstruction: optimising perinatal management. Acta Paediatr 2007; 96:1542-5. [PMID: 17850403 DOI: 10.1111/j.1651-2227.2007.00177.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Congenital anomalies causing airway obstruction in the newborn are potentially fatal. However if an effective airway can be maintained the long-term prognosis is often excellent. We present four cases of airway obstruction, three of which were diagnosed antenatally. We discuss the role of antenatal imaging and review delivery options including the need for a multidisciplinary team approach. In conclusion, we recommend antenatal imaging with both ultrasound scan and magnetic resonance to inform perinatal management. Polyhydramnios, in association with suspected neonatal airway obstruction, should alert clinicians to a high-risk situation. We recognize that even in skilled hands, securing an airway can be very difficult and alternatives such as maintenance of the fetomaternal circulation or extra-corporeal life support should be considered.
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Affiliation(s)
- Helen McDevitt
- Queen Mother's Hospital, Yorkhill Division, Glasgow, Scotland
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