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Bhende VV, Sharma TS, Krishnakumar M, Shah DM, Pankhaniya RN, Parmar ZN, Patel AM, Parmar DB, Kumar A, Dhami KB, Pathan SR, Sharma AS, Parikh VJ, Pathak HV, Barot RB, Shah DB, Kamani SM, Mehta NJ, Bhoraniya GD, Purswani RA. Surgical Management of Congenital Pulmonary Airway Malformations (CPAM) in an Infant and a Toddler: Case Report Depicting Two Distinct Surgical Techniques With Successful Outcomes. Cureus 2024; 16:e53526. [PMID: 38314387 PMCID: PMC10838388 DOI: 10.7759/cureus.53526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2024] [Indexed: 02/06/2024] Open
Abstract
Congenital pulmonary airway malformations (CPAM) compose the major part of congenital lung malformations (CLM) and have traditionally been treated by pulmonary lobectomy. In terms of surgical strategy, lobectomy has conventionally been the preferred treatment for CPAM localized to a single lobe. More recently, alternative approaches including lung-sparing resections (LSR), such as wedge or non-anatomic resections and segmentectomy, have been suggested. In asymptomatic CPAM early surgical resection is often shown to reduce infection and malignancy development. We describe two patients who were diagnosed with CPAM when being evaluated for respiratory tract infection. Patient 1 (P1) was a two-month-old infant weighing 4 kg with glucose-6-phosphate dehydrogenase (G6PD) deficiency and Patient 2 (P2) was a toddler aged one year, nine months weighing 9 kg. P1 underwent LSR for the CPAM diagnosed in the left upper lobe of the lung with conventional mechanical ventilation whilst right upper lobectomy was performed in P2 using one/single lung ventilation. In both cases, LSR and right upper lobectomy led to an uneventful postoperative recovery with no complications reported.
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Affiliation(s)
- Vishal V Bhende
- Pediatric Cardiac Surgery, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna Hospital, Bhaikaka University, Karamsad, IND
| | - Tanishq S Sharma
- Pediatric Cardiac Surgery, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna Hospital, Bhaikaka University, Karamsad, IND
| | | | - Deepali M Shah
- Pediatrics, Pramukh Swami Medical College, Shree Krishna Hospital, Bhaikaka University, Karamsad, IND
| | - Rajesh N Pankhaniya
- Pediatrics, Pramukh Swami Medical College, Shree Krishna Hospital, Bhaikaka University, Karamsad, IND
| | - Zalak N Parmar
- Pathology, Pramukh Swami Medical College, Shree Krishna Hospital, Bhaikaka University, Karamsad, IND
| | - Alpa M Patel
- Anesthesiology, Pramukh Swami Medical College, Shree Krishna Hospital, Bhaikaka University, Karamsad, IND
| | - Dharmendra B Parmar
- Radiodiagnosis, Pramukh Swami Medical College, Shree Krishna Hospital, Bhaikaka University, Karamsad, IND
| | - Amit Kumar
- Pediatric Cardiac Intensive Care, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna Hospital, Bhaikaka University, Karamsad, IND
| | - Kartik B Dhami
- Cardiac Anesthesiology, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna Hospital, Bhaikaka University, Karamsad, IND
| | - Sohilkhan R Pathan
- Clinical Research Services, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna Hospital, Bhaikaka University, Karamsad, IND
| | - Ashwin S Sharma
- Internal Medicine, Gujarat Cancer Society Medical College, Hospital and Research Centre, Ahmedabad, IND
| | - Vrajana J Parikh
- Pediatric Critical Care, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna Hospital, Bhaikaka University, Karamsad, IND
| | - Haryax V Pathak
- Surgery, Pramukh Swami Medical College, Shree Krishna Hospital, Bhaikaka University, Karamsad, IND
| | - Rushi B Barot
- Pediatrics, Pramukh Swami Medical College, Shree Krishna Hospital, Bhaikaka University, Karamsad, IND
| | - Dimple B Shah
- Pediatrics, Pramukh Swami Medical College, Shree Krishna Hospital, Bhaikaka University, Karamsad, IND
| | - Swati M Kamani
- Pediatrics, Pramukh Swami Medical College, Shree Krishna Hospital, Bhaikaka University, Karamsad, IND
| | - Nili J Mehta
- Pediatrics, Pramukh Swami Medical College, Shree Krishna Hospital, Bhaikaka University, Karamsad, IND
| | - Gaurav D Bhoraniya
- Pediatrics, Pramukh Swami Medical College, Shree Krishna Hospital, Bhaikaka University, Karamsad, IND
| | - Roshni A Purswani
- Anesthesiology, Pramukh Swami Medical College, Shree Krishna Hospital, Bhaikaka University, Karamsad, IND
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Engall N, Sethuraman C, Wilkinson DJ, Lansdale N, Peters RT. Does Timing of Resection Influence the Presence of Inflammation within Congenital Lung Malformations? Eur J Pediatr Surg 2023; 33:81-84. [PMID: 36209738 DOI: 10.1055/a-1957-6898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Opinion remains divided on whether to resect an asymptomatic congenital lung malformation (CLM) and on optimal timing of resection. This study aimed to determine if age at resection of CLM correlates with the presence of histological inflammation and/or incidence of prior antibiotic administration for lower respiratory tract infection (LRTI). MATERIALS AND METHODS A retrospective review of all CLMs resected between 2009 and 2021 was carried out. Data on antenatal detection, incidence of preoperative antibiotic use for LRTI, operative details, and histological reports were analyzed. Fisher's exact test and logistic regression were used to look for correlation between age at resection and (1) histological inflammation and/or (2) preoperative LRTI. RESULTS A total of 102 patients underwent resection at age 14 months (interquartile range: 6-23). Eighty percent of children were asymptomatic in the neonatal period and 22% of these went on to develop a respiratory symptom. In total, 59% of specimens had histological evidence of inflammation, with a significantly higher rate of inflammation after 10 months of age (71 vs. 35%; p = 0.0012). Logistic regression showed there was a positive correlation between age at resection and treatment for previous LRTI (p = 0.020). CONCLUSION Detection rates of inflammation in specimens resected after 10 months of age are double the rates of those resected prior to 10 months. Delaying resection of CLMs showed a higher frequency of treatment of LRTI. Earlier resection may therefore be advantageous for centers pursuing a resection strategy for asymptomatic lesions.
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Affiliation(s)
- Nick Engall
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Chitra Sethuraman
- Department of Pediatric Histopathology, Royal Manchester Children's Hospital, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - David John Wilkinson
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Nick Lansdale
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, United Kingdom of Great Britain and Northern Ireland.,Faculty of Biology Medicine and Health, The University of Manchester, Manchester, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Robert Thomas Peters
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, United Kingdom of Great Britain and Northern Ireland
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Duncan Phillips J, Hoover JD. Chest Wall Deformities and Congenital Lung Lesions. Surg Clin North Am 2022; 102:883-911. [DOI: 10.1016/j.suc.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Liu C, Yu X, Cheng K, Luo D, Yuan M, He T, Xu C. Hidden Infection in Asymptomatic Congenital Lung Malformations-A Decade Retrospective Study. Front Pediatr 2022; 10:859343. [PMID: 35498773 PMCID: PMC9047876 DOI: 10.3389/fped.2022.859343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/23/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Whether to operate on asymptomatic patients with congenital lung malformations (CLMs) remains controversial. Our study intended to find out the proportion of hidden infection in CLMs and its effect on surgery, to provide help for the management of asymptomatic CLMs patients. METHODS A retrospective review of the medical records of patients with asymptomatic CLMs from January 2011 to December 2020 was performed in our center. Selected asymptomatic patients were divided into a non-hidden infection group (NHI) and a hidden infection group (HI). RESULTS A total of 581 asymptomatic CLMs patients were included in this study. Thirty-two percent of asymptomatic CLMs patients had hidden infection in the lesion. Among various CLMs diseases, intralobular pulmonary sequestration had the highest percentage of hidden infection (48.8%). With age, the proportion of HI gradually increased. Patients in the HI and NHI groups were 223 and 121. The incidence of pleural adhesion and focal abscess in the HI group were 14.9 and 7.4%. Statistical significances were shown between the two groups in intraoperative blood loss (p = 0.002), operation time (p = 0.045), chest tube drainage time (p < 0.001), postoperative hospital stay (p < 0.001), and air leak (p = 0.012). CONCLUSION The proportion of HI detected by postoperative pathological results was high and they could increase the difficulty and risk of surgery. Therefore, early surgery may be a more appropriate choice for the management of asymptomatic CLMs patients.
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Affiliation(s)
- Chenyu Liu
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Xuejiao Yu
- Department of Clinical Pathology, West China Hospital of Sichuan University, Chengdu, China
| | - Kaisheng Cheng
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Dengke Luo
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Miao Yuan
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Taozhen He
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Chang Xu
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China
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Zeng J, Liang J, Li L, Liu W, Tang J, Yin X, Yin G. Surgical Treatment for Asymptomatic Congenital Pulmonary Airway Malformations in Children: Waiting or Not? Eur J Pediatr Surg 2021; 31:509-517. [PMID: 33641135 DOI: 10.1055/s-0040-1719057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Infection is undoubtedly the most important factor in influencing the timing and surgical strategy of congenital pulmonary airway malformation (CPAM) surgery. However, there have been no studies on the optimal timing of surgery for patients based on the probability of infection. The aim of this study was performed to explore the optimal timing of surgery of CPAM in children from the risk of infection. MATERIALS AND METHODS The correlation of age distribution and pulmonary infection of 237 children diagnosed by pathology from January 2012 to January 2020 in Guangzhou Women and Children's Medical Center were analyzed retrospectively. We defined the cases with preoperative computed tomographic findings of infection, pathological findings of large number of neutrophils, tissue cells, and abscess formation as the infection group. RESULTS The rate of infection in patients less than 2 years old was significantly lower than in patients over 2 years old (11.4% vs. 45.7%, p < 0.001). And the pulmonary lobectomy rate of patients with infection (29.0%) was significantly higher than in noninfected patients (17.2%) and whole patients (36.3%), p = 0.033. Patients with infection lose more blood during surgery (noninfected patients: 81.76 ± 13.14 mL, infected patients: 145.10 ± 25.39 mL, p = 0.027). The univariate analysis revealed that the infection rate of patients over 2 years old was 3.084 times that of patients ≤2 years old (odds ratio [OR]: 3.084, 95% confidence interval [CI]: 1.196-7.954; p = 0.020). The infection rate of CPAM types III and IV patients is lower than types I and II (OR: 0.531, 95% CI: 0.307-0.920; p = 0.024). CONCLUSION In consideration of the high risk of infection, lower minimally invasive surgery rate, an increased rate of pulmonary lobectomy, and more blood loss in patients over 2 years old, our study also supports early surgical treatment. Therefore, we suggest that for asymptomatic patients with CPAM I and CPAM II, surgical treatment should be performed when they are less than 2 years old, providing more options for surgical strategies and monitoring of CPAM patients.
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Affiliation(s)
- Jiahang Zeng
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Jianhua Liang
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Le Li
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Wei Liu
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Jue Tang
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Xiaoli Yin
- College of Life Science, South China Normal University, Guangzhou, China
| | - Guocai Yin
- College of Life Science, Jining Medical University, Jining, Shandong, China
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Tivnan P, Winant AJ, Epelman M, Lee EY. Pediatric Congenital Lung Malformations: Imaging Guidelines and Recommendations. Radiol Clin North Am 2021; 60:41-54. [PMID: 34836565 DOI: 10.1016/j.rcl.2021.08.002] [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: 10/19/2022]
Abstract
Congenital lung malformations are a spectrum of developmental anomalies comprised of malformations of the lung parenchyma, airways, and vasculature. Imaging assessment plays a pivotal role in the initial diagnosis, management, and follow-up evaluation of congenital lung malformations in the pediatric population. However, there is currently a lack of practical imaging guidelines and recommendations for the diagnostic imaging assessment of congenital lung malformations in infants and children. This article reviews the current evidence regarding the imaging evaluation of congenital lung malformations and provides up-to-date imaging recommendations for pediatric congenital lung malformations.
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Affiliation(s)
- Patrick Tivnan
- Department of Radiology, Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118, USA.
| | - Abbey J Winant
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Monica Epelman
- Department of Radiology, Nemours Children's Health System/Nemours Children's Hospital, 6535 Nemours Parkway, Orlando, FL 32827, USA
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
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Elhattab A, Elsaied A, Wafa T, Jugie M, Delacourt C, Sarnacki S, Aly K, Khen-Dunlop N. Thoracoscopic surgery for congenital lung malformations: Does previous infection really matter? J Pediatr Surg 2021; 56:1982-1987. [PMID: 33573805 DOI: 10.1016/j.jpedsurg.2021.01.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/13/2021] [Accepted: 01/19/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND/ PURPOSE Elective resection of congenital lung malformations (CLMs) is still debatable. The two main risks are malignant transformation and recurrent pulmonary infections. Our study aimed to assess the effect of previous pulmonary infection on the intraoperative and postoperative courses of thoracoscopic surgery for CLMs. METHODS This is a retrospective study including all thoracoscopic lung resections for CLMs between 2010 and 2019. Ninety patients were included. There was a history of previous pulmonary infection in 28 patients (group A) and no such history in 62 patients (group B). RESULTS The median age at operation for group A was 20.4 months (IQR:14.9-41.4) versus 15.1 months (IQR:9.7-20.8) in group B (p = 0.006). There were 10 conversions (35.7%) in group A and 8 (12.9%) in group B (p = 0.02). The operative time was significantly shorter in group B (p<0.002). In group A, 32.1% of patients experienced postoperative fever versus 11.3% of group B (p = 0.03), with higher antibiotics requirement (28.6% versus 6.5% respectively, p = 0.007). However, no significant differences were found in terms of postoperative complications (p = 0.99). CONCLUSION Earlier intervention for CLMs before the development of pulmonary infection carries higher chances for the success of the thoracoscopic approach with shorter operative time and more uneventful postoperative courses.
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Affiliation(s)
- Ahmad Elhattab
- Department of Pediatric Surgery, AP-HP, Necker-Enfants malades Hospital, Paris, France; Department of Pediatric Surgery, Mansoura University Children's Hospital, Mansoura, Egypt
| | - Adham Elsaied
- Department of Pediatric Surgery, Mansoura University Children's Hospital, Mansoura, Egypt
| | - Tamer Wafa
- Department of Pediatric Surgery, Mansoura University Children's Hospital, Mansoura, Egypt
| | - Myriam Jugie
- Intensive care Unit, AP-HP, Necker-Enfants malades Hospital, Paris, France
| | - Christophe Delacourt
- Department of Pediatric Pulmonology, AP-HP, Necker-Enfants malades Hospital, Paris, France; Université de Paris, Paris, France
| | - Sabine Sarnacki
- Department of Pediatric Surgery, AP-HP, Necker-Enfants malades Hospital, Paris, France; Université de Paris, Paris, France
| | - Kamal Aly
- Department of Pediatric Surgery, Mansoura University Children's Hospital, Mansoura, Egypt
| | - Naziha Khen-Dunlop
- Department of Pediatric Surgery, AP-HP, Necker-Enfants malades Hospital, Paris, France; Université de Paris, Paris, France
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Yang W, Shen C, Yu N, Guo Y, Pan W, Li P, Gao Y, Chen X, Cheng J. Computer-aided quantitative MSCT measurements may be useful for congenital lung malformations surgical approach selection. Pediatr Surg Int 2021; 37:1273-1280. [PMID: 34213588 DOI: 10.1007/s00383-021-04949-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To examine the association between the MSCT quantitative measurements of congenital lung malformations (CLM) and the selection of surgical approaches (lobectomy vs. lung-sparing surgery). METHODS This retrospective study evaluated CLM surgical cases at our institution from 2016 to 2018. MSCT quantitative measurements were generated by a semi-automated approach: the volume of the lesion (Vlesion), the volume of the lesion-involved lobe (Vlobe), the volume of the lesion-involved lung (Vlung) and the volume of the total lung (Vtotal lung). The proportions of Vlesion to Vlobe (Plesion/lobe), Vlesion to Vlung (Plesion/lung), and Vlesion to V total lung (Plesion/total lung) were calculated. We used Logistics regression to examine whether quantitative measurements were associated with the selection of surgical approaches. RESULTS 151 patients were included (median age at surgery 6 months). 82 patients underwent lung-sparing surgery, and 69 patients underwent lobectomy. Vlesion (OR 1.51, 95% CI 1.09-2.07), Plesion/lobe (OR 1.78, 95% CI 1.16-2.72), Plesion/lung (OR 1.63, 95% CI 1.13-2.35), and Plesion/total lung (OR 1.58, 95% CI 1.12-2.22) were positively associated with the selection of lobectomy. CONCLUSION The application of quantified MSCT analysis may provide insight into the quantitative characteristics of CLM, which could be potentially useful for surgical approach selection.
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Affiliation(s)
- Weili Yang
- Department of Pediatric Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Five Road, Xi'an, 710004, Shaanxi, China
| | - Cong Shen
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Nan Yu
- Department of Medical Imaging, The Affiliated Hospital of Shaanxi Chinese Medicine University, Xianyang, 712000, Shaanxi, China
| | - Youmin Guo
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Weikang Pan
- Department of Pediatric Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Five Road, Xi'an, 710004, Shaanxi, China
| | - Peng Li
- Department of Pediatric Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Five Road, Xi'an, 710004, Shaanxi, China
| | - Ya Gao
- Department of Pediatric Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Five Road, Xi'an, 710004, Shaanxi, China
| | - Xin Chen
- Department of Medical Imaging, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Five Road, Xi'an, 710004, Xi'an, China.
| | - Jiwen Cheng
- Department of Pediatric Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Five Road, Xi'an, 710004, Shaanxi, China.
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Griggs C, Schmaedick M, Gerall C, Fan W, Orlas C, Price J, Simpson L, Miller R, DeFazio J, Stylianos S, Rothenberg S, Duron V. Vanishing congenital lung malformations: What is the incidence of true regression? J Neonatal Perinatal Med 2021; 15:105-111. [PMID: 34459416 DOI: 10.3233/npm-210740] [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: 11/15/2022]
Abstract
BACKGROUND A congenital lung malformation (CLM) that is diagnosed on prenatal ultrasound exam may subsequently become undetectable on later scans, a "vanishing" CLM. OBJECTIVE The purpose of our study is to characterize the prenatal natural history and postnatal outcomes of "vanishing" lesions treated at our institution. METHODS We performed a retrospective chart review of 107 patients diagnosed prenatally with CLM at our institution. Comparisons were made using Kruskal-Wallis or t-test for continuous variables and Fisher's exact test or Chi-Square test for categorical variables. Multivariable analysis using logistic regression was performed. RESULTS Of the 104 patients, 59 (56.7%) had lesions that became sonographically undetectable on serial ultrasound scans. Patients with lesions that vanished prenatally tended to need less Neonatal Intensive Care Unit (NICU) admission at birth (persistent CLM: 54.8%vs vanished CLM: 28.8%), decreased need for supplemental O2 at birth (persistent CLM: 31.0%vs vanished CLM: 11.9%), and decreased delay in feeds (persistent CLM: 26.2%vs vanished CLM: 8.5%) compared to those with persistent CLM. After multivariate analysis controlling for maternal steroid administration and sex, admission to NICU maintained a slight statistical significance, with patients in the vanishing CLM group 2.5 times less likely to be admitted to the NICU. None of our patients whose lesions vanished prenatally required mechanical ventilation. Eighty-six patients underwent postnatal computed tomography (CT) chest. Only 2 patients had lesions that regressed on postnatal CT. CONCLUSION Lesions that vanish on prenatal imaging may be associated with improved clinical outcomes. The rate of true regression at our institution was as low as 2.3%.
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Affiliation(s)
- C Griggs
- Department of Pediatric Surgery, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
| | - M Schmaedick
- Columbia University Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - C Gerall
- Department of Pediatric Surgery, Columbia University Medical Center, New York, New York. USA
| | - W Fan
- Department of Biostatistics, Irving Institute for Clinical and Translational Research, New York, New York, USA
| | - C Orlas
- Department of Pediatric Surgery, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
| | - J Price
- Department of Pediatric Surgery, Columbia University Medical Center, New York, New York. USA
| | - L Simpson
- Department of Obstetrics and Gynecology, New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - R Miller
- Department of Obstetrics and Gynecology, New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - J DeFazio
- Department of Pediatric Surgery, Columbia University Medical Center, New York, New York. USA
| | - S Stylianos
- Department of Pediatric Surgery, Columbia University Medical Center, New York, New York. USA
| | - S Rothenberg
- Department of Pediatric Surgery, Columbia University Medical Center, New York, New York. USA.,Department of Pediatric Surgery, Rocky Mountain Hospital for Children, Denver, Colorado, USA
| | - V Duron
- Department of Pediatric Surgery, Columbia University Medical Center, New York, New York. USA
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Zarfati A, Voglino V, Tomà P, Cutrera R, Frediani S, Inserra A. Conservative management of congenital bronchial atresia: The Bambino Gesù children's hospital experience. Pediatr Pulmonol 2021; 56:2164-2168. [PMID: 33760393 DOI: 10.1002/ppul.25385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 03/01/2021] [Accepted: 03/10/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Congenital bronchial atresia (CBA) is a rare airway malformation. No management guidelines exist because of limited evidence: treatment, surgical or conservative, is based on consensus and opinion. OBJECTIVE To review the experience of a pediatric tertiary center and provide additional data about nonsurgical management of CBA and its outcomes after a structured follow-up, and to help formulate appropriate evidence-based guidelines. METHODS A retrospective analysis of clinical, radiological, surgical, and pathological data of all pediatric patients with suspicion of CBA referred to the surgical department of the Bambino Gesù children's hospital of Rome between December 2013 and 2019, along with a review of the literature. RESULTS Among the 18 children initially included in the study, 2 were lost to follow-up after radiological diagnosis, 4 underwent surgery for radiological suspicion of other pulmonary malformations. The final population is composed of 12 conservatively managed patients. At the end of the follow-up (median: 29 months, range 3-61), 1 patient (8%) was symptomatic. CONCLUSION Conservative management for CBA appears to be safe. Surgery should be reserved for patients with symptomatic or complicated cases.
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Affiliation(s)
- Angelo Zarfati
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù' Children Hospital, Rome, Italy
| | - Valerio Voglino
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù' Children Hospital, Rome, Italy
| | - Paolo Tomà
- Pediatric Radiology Unit, Bambino Gesù' Children Hospital, Rome, Italy
| | - Renato Cutrera
- Pediatric Broncopneumology, Bambino Gesù' Children Hospital, Rome, Italy
| | - Simone Frediani
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù' Children Hospital, Rome, Italy
| | - Alessandro Inserra
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù' Children Hospital, Rome, Italy
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Prayer F, Mehollin-Ray AR, Cassady CC, Gruber GM, Brugger PC, Scharrer A, Metzelder M, Binder J, Hojreh A, Weber M, Prosch H, Prayer D, Kasprian G. Characterization of the Hyperintense Bronchus Sign as a Fetal MRI Marker of Airway Obstruction. Radiology 2021; 300:423-430. [PMID: 34032511 DOI: 10.1148/radiol.2021204565] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Fetal MRI-based differential diagnosis of congenital lung malformations is difficult because of the paucity of well-described imaging markers. Purpose To characterize the hyperintense bronchus sign (HBS) in in vivo fetal MRI of congenital lung malformation cases. Materials and Methods In this retrospective two-center study, fetal MRI scans obtained in fetuses with congenital lung malformations at US (January 2002 to September 2018) were reviewed for the HBS, a tubular or branching hyperintense structure within a lung lesion on T2-weighted images. The frequency of the HBS and respective gestational ages in weeks and days were analyzed. Areas under the curve (AUCs), 95% CIs, and P values of the HBS regarding airway obstruction, as found in histopathologic and postnatal CT findings as the reference standards, were calculated for different gestational ages. Results A total of 177 fetuses with congenital lung malformations (95 male fetuses) and 248 fetal MRI scans obtained at a median gestational age of 25.6 weeks (interquartile range, 8.9 weeks) were included. The HBS was found in 79% (53 of 67) of fetuses with bronchial atresia, 71% (39 of 55) with bronchopulmonary sequestration (BPS), 43% (three of seven) with hybrid lesion, 15% (six of 40) with congenital cystic adenomatoid malformation, and 13% (one of eight) with bronchogenic cyst at a median gestational age of 24.9 weeks (interquartile range, 9.7 weeks). HBS on MRI scans at any gestational age had an AUC of 0.76 (95% CI: 0.70, 0.83; P = .04) for the presence of isolated or BPS-associated airway obstruction at histopathologic analysis and postnatal CT. The AUC of HBS on fetal MRI scans obtained until gestational age of 26 weeks (AUC, 0.83; 95% CI: 0.75, 0.91; P < .001) was significantly higher (P = .045) than that for fetal MRI scans obtained after gestational age 26 weeks (AUC, 0.69; 95% CI: 0.57, 0.80; P = .004). Conclusion The hyperintense bronchus sign is a frequently detectable feature at fetal MRI and is associated with airway obstruction particularly before gestational age 26 weeks. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Dubinsky in this issue.
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Affiliation(s)
- Florian Prayer
- From the Department of Biomedical Imaging and Image-guided Therapy (F.P., A.H., M.W., H.P., D.P., G.K.), Center for Anatomy and Cell Biology (P.C.B.), Department of Pathology (A.S.), Division of Paediatric Surgery, Department of Surgery (M.M.), and Department of Obstetrics and Gynaecology (J.B.), Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; E. B. Singleton Department of Radiology, Texas Children's Hospital, Houston, Tex (A.R.M.R., C.C.C.); and Division of Anatomy and Developmental Biology, Karl Landsteiner University of Health Sciences, Krems, Austria (G.M.G.)
| | - Amy R Mehollin-Ray
- From the Department of Biomedical Imaging and Image-guided Therapy (F.P., A.H., M.W., H.P., D.P., G.K.), Center for Anatomy and Cell Biology (P.C.B.), Department of Pathology (A.S.), Division of Paediatric Surgery, Department of Surgery (M.M.), and Department of Obstetrics and Gynaecology (J.B.), Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; E. B. Singleton Department of Radiology, Texas Children's Hospital, Houston, Tex (A.R.M.R., C.C.C.); and Division of Anatomy and Developmental Biology, Karl Landsteiner University of Health Sciences, Krems, Austria (G.M.G.)
| | - Christopher C Cassady
- From the Department of Biomedical Imaging and Image-guided Therapy (F.P., A.H., M.W., H.P., D.P., G.K.), Center for Anatomy and Cell Biology (P.C.B.), Department of Pathology (A.S.), Division of Paediatric Surgery, Department of Surgery (M.M.), and Department of Obstetrics and Gynaecology (J.B.), Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; E. B. Singleton Department of Radiology, Texas Children's Hospital, Houston, Tex (A.R.M.R., C.C.C.); and Division of Anatomy and Developmental Biology, Karl Landsteiner University of Health Sciences, Krems, Austria (G.M.G.)
| | - Gerlinde M Gruber
- From the Department of Biomedical Imaging and Image-guided Therapy (F.P., A.H., M.W., H.P., D.P., G.K.), Center for Anatomy and Cell Biology (P.C.B.), Department of Pathology (A.S.), Division of Paediatric Surgery, Department of Surgery (M.M.), and Department of Obstetrics and Gynaecology (J.B.), Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; E. B. Singleton Department of Radiology, Texas Children's Hospital, Houston, Tex (A.R.M.R., C.C.C.); and Division of Anatomy and Developmental Biology, Karl Landsteiner University of Health Sciences, Krems, Austria (G.M.G.)
| | - Peter C Brugger
- From the Department of Biomedical Imaging and Image-guided Therapy (F.P., A.H., M.W., H.P., D.P., G.K.), Center for Anatomy and Cell Biology (P.C.B.), Department of Pathology (A.S.), Division of Paediatric Surgery, Department of Surgery (M.M.), and Department of Obstetrics and Gynaecology (J.B.), Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; E. B. Singleton Department of Radiology, Texas Children's Hospital, Houston, Tex (A.R.M.R., C.C.C.); and Division of Anatomy and Developmental Biology, Karl Landsteiner University of Health Sciences, Krems, Austria (G.M.G.)
| | - Anke Scharrer
- From the Department of Biomedical Imaging and Image-guided Therapy (F.P., A.H., M.W., H.P., D.P., G.K.), Center for Anatomy and Cell Biology (P.C.B.), Department of Pathology (A.S.), Division of Paediatric Surgery, Department of Surgery (M.M.), and Department of Obstetrics and Gynaecology (J.B.), Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; E. B. Singleton Department of Radiology, Texas Children's Hospital, Houston, Tex (A.R.M.R., C.C.C.); and Division of Anatomy and Developmental Biology, Karl Landsteiner University of Health Sciences, Krems, Austria (G.M.G.)
| | - Martin Metzelder
- From the Department of Biomedical Imaging and Image-guided Therapy (F.P., A.H., M.W., H.P., D.P., G.K.), Center for Anatomy and Cell Biology (P.C.B.), Department of Pathology (A.S.), Division of Paediatric Surgery, Department of Surgery (M.M.), and Department of Obstetrics and Gynaecology (J.B.), Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; E. B. Singleton Department of Radiology, Texas Children's Hospital, Houston, Tex (A.R.M.R., C.C.C.); and Division of Anatomy and Developmental Biology, Karl Landsteiner University of Health Sciences, Krems, Austria (G.M.G.)
| | - Julia Binder
- From the Department of Biomedical Imaging and Image-guided Therapy (F.P., A.H., M.W., H.P., D.P., G.K.), Center for Anatomy and Cell Biology (P.C.B.), Department of Pathology (A.S.), Division of Paediatric Surgery, Department of Surgery (M.M.), and Department of Obstetrics and Gynaecology (J.B.), Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; E. B. Singleton Department of Radiology, Texas Children's Hospital, Houston, Tex (A.R.M.R., C.C.C.); and Division of Anatomy and Developmental Biology, Karl Landsteiner University of Health Sciences, Krems, Austria (G.M.G.)
| | - Azadeh Hojreh
- From the Department of Biomedical Imaging and Image-guided Therapy (F.P., A.H., M.W., H.P., D.P., G.K.), Center for Anatomy and Cell Biology (P.C.B.), Department of Pathology (A.S.), Division of Paediatric Surgery, Department of Surgery (M.M.), and Department of Obstetrics and Gynaecology (J.B.), Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; E. B. Singleton Department of Radiology, Texas Children's Hospital, Houston, Tex (A.R.M.R., C.C.C.); and Division of Anatomy and Developmental Biology, Karl Landsteiner University of Health Sciences, Krems, Austria (G.M.G.)
| | - Michael Weber
- From the Department of Biomedical Imaging and Image-guided Therapy (F.P., A.H., M.W., H.P., D.P., G.K.), Center for Anatomy and Cell Biology (P.C.B.), Department of Pathology (A.S.), Division of Paediatric Surgery, Department of Surgery (M.M.), and Department of Obstetrics and Gynaecology (J.B.), Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; E. B. Singleton Department of Radiology, Texas Children's Hospital, Houston, Tex (A.R.M.R., C.C.C.); and Division of Anatomy and Developmental Biology, Karl Landsteiner University of Health Sciences, Krems, Austria (G.M.G.)
| | - Helmut Prosch
- From the Department of Biomedical Imaging and Image-guided Therapy (F.P., A.H., M.W., H.P., D.P., G.K.), Center for Anatomy and Cell Biology (P.C.B.), Department of Pathology (A.S.), Division of Paediatric Surgery, Department of Surgery (M.M.), and Department of Obstetrics and Gynaecology (J.B.), Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; E. B. Singleton Department of Radiology, Texas Children's Hospital, Houston, Tex (A.R.M.R., C.C.C.); and Division of Anatomy and Developmental Biology, Karl Landsteiner University of Health Sciences, Krems, Austria (G.M.G.)
| | - Daniela Prayer
- From the Department of Biomedical Imaging and Image-guided Therapy (F.P., A.H., M.W., H.P., D.P., G.K.), Center for Anatomy and Cell Biology (P.C.B.), Department of Pathology (A.S.), Division of Paediatric Surgery, Department of Surgery (M.M.), and Department of Obstetrics and Gynaecology (J.B.), Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; E. B. Singleton Department of Radiology, Texas Children's Hospital, Houston, Tex (A.R.M.R., C.C.C.); and Division of Anatomy and Developmental Biology, Karl Landsteiner University of Health Sciences, Krems, Austria (G.M.G.)
| | - Gregor Kasprian
- From the Department of Biomedical Imaging and Image-guided Therapy (F.P., A.H., M.W., H.P., D.P., G.K.), Center for Anatomy and Cell Biology (P.C.B.), Department of Pathology (A.S.), Division of Paediatric Surgery, Department of Surgery (M.M.), and Department of Obstetrics and Gynaecology (J.B.), Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; E. B. Singleton Department of Radiology, Texas Children's Hospital, Houston, Tex (A.R.M.R., C.C.C.); and Division of Anatomy and Developmental Biology, Karl Landsteiner University of Health Sciences, Krems, Austria (G.M.G.)
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12
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Fleming MA, Xu TO, Gander JW, Levin DE. Lung surgery in children and their post-operative risk of respiratory infection. Pediatr Surg Int 2021; 37:627-630. [PMID: 33423100 PMCID: PMC8035278 DOI: 10.1007/s00383-020-04851-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/29/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Pediatric surgeons at our institution are often asked by families about a theoretical increased risk of severe common upper respiratory infections in children status post lung resection. No data exist on this topic. We, therefore, aimed to examine the risk of severe respiratory infection in children after pulmonary resection. METHODS A chart review was conducted on all pediatric patients who underwent pulmonary resection between August 1st, 2009 and January 31st, 2019. Collected data included patient characteristics, operation, complications and any admission for respiratory infection. RESULTS Fifty-seven patients met inclusion criteria. Resections included lobectomy (45.6%), segmentectomy (14.0%), and wedge resection (40.4%). Twelve (21.1%) were immunocompromised and 6 (10.5%) had post-operative complications. Within 1 year of surgery, 2 (3.5%) patients were hospitalized for a viral upper respiratory illness (URI), 1 (1.8%) for bacterial pneumonia, and none due to influenza. CONCLUSION In the general pediatric population, the risk of admission for respiratory illness is 3-21%. At this institution, overall risk of respiratory infection after lung resection appears comparable to baseline community risk. Our findings could aid counseling pediatric patients and their families regarding the 1-year risk of infection after lung resection.
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Affiliation(s)
- Mark A Fleming
- Department of Surgery, Division of Pediatric Surgery, University of Virginia School of Medicine, 1215 Lee St., Charlottesville, VA, 22908, USA.
| | - Thomas O Xu
- Department of Surgery, Division of Pediatric Surgery, University of Virginia School of Medicine, 1215 Lee St., Charlottesville, VA, 22908, USA
| | - Jeffrey W Gander
- Department of Surgery, Division of Pediatric Surgery, University of Virginia School of Medicine, 1215 Lee St., Charlottesville, VA, 22908, USA
| | - Daniel E Levin
- Department of Surgery, Division of Pediatric Surgery, University of Virginia School of Medicine, 1215 Lee St., Charlottesville, VA, 22908, USA
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13
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Reyna JC, Zagory JA, Yallapragada S, Santiago-Munoz P, Schindel DT. Establishment of a multidisciplinary fetal center streamlines approach for congenital lung malformations. J Matern Fetal Neonatal Med 2020; 35:2883-2888. [PMID: 32847439 DOI: 10.1080/14767058.2020.1811667] [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: 10/23/2022]
Abstract
PURPOSE Fetuses with a diagnosis of congenital lung malformations (CLM) on prenatal imaging are commonly referred to a multi-disciplinary specialty team for prenatal assessment and postnatal management. The net effect of such services is broadly stated to improve the outcomes of affected newborns. However, these claims are relatively unsubstantiated. METHODS After IRB approval, a retrospective review of children diagnosed with CLM from 2008 to 2018 and referred to a large urban children's hospital was performed. A comparison was performed between prenatally diagnosed patients having a multi-disciplinary fetal center evaluation (FC) and prenatally diagnosed patients who did not receive a referral or were seen prior to the establishment of the center (NON-FC). RESULTS Eighty-eight live-born patients with a prenatal diagnosis of CLM were identified, with 49 in the FC group and 39 NON-FC. Thirty-four (63%) and 23 (59%) patients underwent operative resection of CLM, respectively. FC patients presented earlier at first postnatal follow-up (42 vs. 145 days, p = .03), had fewer preoperative office visits (2.1 vs. 3.4, p = .0003), received fewer preoperative chest radiographs (0.5 vs. 1.3; p = .002) and chest computed tomography (0.9 vs. 1.4; p = .001), and had fewer preoperative pneumonias (0 vs. 17.4%; p = .02) compared to their NON-FC counterparts. FC patients were also more likely to undergo resection at an earlier age (217 vs. 481 days, p = .003) and were more likely to undergo a minimally invasive resection (75% vs. 39.1%, p = .015). There were no differences in post-operative outcomes between the two groups. CONCLUSION Children with a prenatal diagnosis of CLM appear to benefit from an organized multi-specialty team approach in several impactful parameters. Hospital systems and providers that invest in similar strategies are likely to achieve improved outcomes in the care of newborns prenatally diagnosed with a CLM.
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Affiliation(s)
- Juan C Reyna
- University of Texas Southwestern School of Medicine, Dallas, TX, USA
| | - Jessica A Zagory
- Division of Pediatric Surgery, Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Sushmita Yallapragada
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern, Dallas, TX, USA
| | - Patricia Santiago-Munoz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Southwestern, Dallas, TX, USA
| | - David T Schindel
- Division of Pediatric Surgery, Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
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14
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King A, Lee TC, Steen E, Olutoye OO, Belfort MA, Cassady CI, Mehollin-Ray AR, Keswani SG. Prenatal Imaging to Predict Need for Urgent Perinatal Surgery in Congenital Lung Lesions. J Surg Res 2020; 255:463-468. [PMID: 32622160 DOI: 10.1016/j.jss.2020.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Congenital lung malformations (CLMs) have a variable natural history: some patients require urgent perinatal surgical intervention (UPSI) and others remain asymptomatic. These lesions have potential growth until 26-28 wk gestation. CLM volume ratio (CVR) has been shown to predict the risk of hydrops in CLMs. However, no criteria exist to delineate lesions requiring urgent surgical intervention in the perinatal period. Our goal was to determine prenatal diagnostic features that predict the need for UPSI in patients diagnosed with CLM. METHODS Records and imaging features of all fetuses evaluated by our fetal center between May 2015 and December 2018 were retrospectively reviewed. Data included demographics, fetal ultrasound and magnetic resonance imaging, CVR, surgical treatment, and outcome. Features were analyzed for their ability to predict the need for UPSI. RESULTS Sixty-four patients were referred for CLM, with 48 patients serially followed. Nine (18.8%) patients were followed nonoperatively, 35 (72.9%) underwent resection, and four (8.3%) were lost to follow-up. Of the patients who underwent resection, 24 (68.5%) were electively resected and 11 were urgently resected. Five (14.3%) patients underwent ex utero intrapartum treatment resection, and six (17.1%) were urgently resected for symptomatic CLM. There were no cases of UPSI with final CVR <1.1. Of the patients with final CVR 1.1-1.7, 43% required urgent resection. CVR ≥1.1 has 100% sensitivity and 87.8% specificity to predict patients requiring UPSI (area under the curve of 0.98). CONCLUSIONS A final CVR ≥1.1 is highly predictive for UPSI. Patients with a final CVR ≥1.1 should be referred for delivery at centers with pediatric surgeons equipped for potential UPSI for CLM.
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Affiliation(s)
- Alice King
- Division of Pediatric Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas.
| | - Timothy C Lee
- Division of Pediatric Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Emily Steen
- Division of Pediatric Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Oluyinka O Olutoye
- General Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Michael A Belfort
- Division of Obstetrics and Gynecology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Christopher I Cassady
- Division of Obstetrics and Gynecology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas; Division of Radiology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Amy R Mehollin-Ray
- Division of Obstetrics and Gynecology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas; Division of Radiology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Sundeep G Keswani
- Division of Pediatric Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
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15
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Duron V, Zenilman A, Griggs C, DeFazio J, Price JC, Fan W, Vivero M, Castrillon J, Schmaedick M, Iqbal E, Rothenberg S. Asymptomatic Congenital Lung Malformations: Timing of Resection Does Not Affect Adverse Surgical Outcomes. Front Pediatr 2020; 8:35. [PMID: 32117840 PMCID: PMC7033465 DOI: 10.3389/fped.2020.00035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 01/24/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Optimal timing for resection of asymptomatic congenital lung malformations (CLMs) remains controversial. The aim of this study is to define optimal timing for surgical intervention of patients with CLMs and define clinical variables that affect surgical outcomes. Methods: An IRB-approved retrospective analysis was conducted for patients undergoing surgery for CLMs between 2012 and 2017. Subjects were divided into cohorts based on timing of operative intervention. "Early intervention" was defined as surgery within 4 months of birth; "intermediate intervention"-between 4 and 6 months; and "late intervention"-6-12 months. Surgical outcomes including intraoperative estimated blood loss (EBL), surgical time, post-operative pneumothorax, length of time chest tube stayed in, and hospital length of stay were compared among the three groups using Fisher's exact test or Chi-squared test for categorical variables and one-way analysis of variance test for continuous variables. Results: We analyzed 63 patients who underwent surgery for CLM. There were no significant differences in baseline characteristics. Timing of surgery did not significantly correlate with post-operative outcomes. Specifically, there was no difference in operative time, EBL, post-operative pneumothorax, or length of hospital stay among the early, intermediate, and late intervention groups. Even after controlling for cyst-volume ratio (CVR), timing of surgery still did not affect post-operative outcomes. Conclusions: Surgical outcomes for resection of CLMs are not significantly affected by timing of surgery. We advocate for early intervention to decrease the incidence of associated complications that can occur with later intervention.
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Affiliation(s)
- Vincent Duron
- Department of Pediatric Surgery, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, United States
| | - Ariela Zenilman
- Department of Pediatric Surgery, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, United States
| | - Cornelia Griggs
- Department of Pediatric Surgery, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, United States
| | - Jennifer DeFazio
- Department of Pediatric Surgery, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, United States
| | - Jessica C Price
- Department of Pediatric Surgery, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, United States
| | - Weijia Fan
- Columbia University Mailman School of Public Health, New York, NY, United States
| | - Matthew Vivero
- Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, United States
| | - Juliana Castrillon
- Department of Pediatric Surgery, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, United States
| | - Maggie Schmaedick
- Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, United States
| | - Emaad Iqbal
- Department of Pediatric Surgery, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, United States
| | - Steven Rothenberg
- Department of Pediatric Surgery, Rocky Mountain Hospital for Children at Presbyterian/St. Luke's Medical Center, Denver, CO, United States
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16
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Ito A, Takao M, Shimamoto A, Kaneda S, Matsushita K, Inoue M, Uchida K. Introduction of thoracoscopic surgery for congenital pulmonary airway malformation in infants: review of 13 consecutive surgical cases. J Thorac Dis 2019; 11:5079-5086. [PMID: 32030224 DOI: 10.21037/jtd.2019.12.14] [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] [Indexed: 12/20/2022]
Abstract
Background Although complete video-assisted thoracic surgery (C-VATS) has been demonstrated to have several advantages compared with conventional thoracotomy, there are few reports on the clinical feasibility of C-VATS for CPAM in infants. Methods We retrospectively evaluated 13 consecutive patients (neonates 4; infants 9) surgically treated for congenital pulmonary airway malformation (CPAM) from 1 January 2008 to 31 March 2017. Results In the group of neonates, all 4 cases were prenatally diagnosed and they underwent semi-emergent surgery after birth due to respiratory failure. In the group of 9 infants, 5 cases were prenatally diagnosed and 4 cases were diagnosed at age >2.5 years due to symptoms associated with pulmonary cystic infection. Pulmonary resection consisted of the following: 8 lobectomies, 1 segmentectomy, 2 wedge resection, 1 fractionated lung resection and 1 lobectomy with segmentectomy. Overall, there were 9 thoracotomy and 4 thoracoscopic surgeries. Mean operation time was 162 min (range, 67-290 min) and blood loss was 21 mL (range, 0-74 mL) on average. There were no complications such as thoracic deformity or respiratory failure, however in 2 of those who underwent segmentectomy the cystic remnant remained. No statistically significant differences were observed between the thoracotomy Group and C-VATS group in terms of age and height at intervention, operation time, blood loss, postoperative day of drain removal, and length of hospital stay after surgery. However, only the average body weight was heavier in C-VATS group (P=0.03). Conclusions Since early surgical resection of asymptomatic CPAM is often recommended for the prevention of infections and the development of lung malignancy, we recommend performing surgery after the age of 1 year if the patient's condition is stable. Furthermore, C-VATS lobectomy may be feasible if they are older than 18 months or weigh more than 10 kg.
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Affiliation(s)
- Atsushi Ito
- Department of Thoracic and Cardiovascular Surgery Mie University School of Medicine, Tsu, Japan
| | - Motoshi Takao
- Department of Thoracic and Cardiovascular Surgery Mie University School of Medicine, Tsu, Japan
| | - Akira Shimamoto
- Department of Thoracic and Cardiovascular Surgery Mie University School of Medicine, Tsu, Japan
| | - Shinji Kaneda
- Department of Thoracic and Cardiovascular Surgery Mie University School of Medicine, Tsu, Japan
| | - Kohei Matsushita
- Department of Gastrointestinal and Pediatric Surgery, Mie University School of Medicine, Tsu, Japan
| | - Mikihiro Inoue
- Department of Gastrointestinal and Pediatric Surgery, Mie University School of Medicine, Tsu, Japan
| | - Keiichi Uchida
- Department of Gastrointestinal and Pediatric Surgery, Mie University School of Medicine, Tsu, Japan
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17
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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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