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Monfregola A, De Angelis L, Comune R, Arienzo F, Barbato G, Di Stasio M, Pourmolkara D, Rosano N, Picchi SG, Galluzzo M, Granata V, Tamburrini S. Interlobar pulmonary sequestration with celiac aberrant artery in an elderly patient treated with combined endovascular and video-assisted thoracoscopic approach. Radiol Case Rep 2024; 19:3418-3424. [PMID: 38854910 PMCID: PMC11157120 DOI: 10.1016/j.radcr.2024.05.018] [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] [Received: 04/21/2024] [Revised: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 06/11/2024] Open
Abstract
Pulmonary sequestration is a rare congenital pulmonary anomaly where a portion of the lung parenchyma is supplied by an anomalous systemic artery, usually originating from the thoracic or abdominal aorta. Traditionally surgical resection and ligation of the aberrant feeding vessel are the gold standard treatments of this disease. Hybrid operations consisting in endovascular arterial embolization and surgical resection is a promising treatment option. We report a case of a 69-years-old man with symptomatic intralobular sequestration successfully treated by hybrid approach.
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Affiliation(s)
| | - Leda De Angelis
- Division of Radiology, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Rosita Comune
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Francesco Arienzo
- Department of Interventional Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Giovanni Barbato
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Mario Di Stasio
- Department of Thoracic Surgery, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Domenico Pourmolkara
- Department of Thoracic Surgery, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Nicola Rosano
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | | | - Michele Galluzzo
- Department of Emergency Radiology, San Camillo Forlanini Hospital, Rome, Italy
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, Naples, Italy
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Cancemi G, Distefano G, Vitaliti G, Milazzo D, Terzo G, Belfiore G, Di Benedetto V, Scuderi MG, Coronella M, Musumeci AG, Grippaldi D, Mauro LA, Foti PV, Basile A, Palmucci S. Congenital Lung Malformations: A Pictorial Review of Imaging Findings and a Practical Guide for Diagnosis. CHILDREN (BASEL, SWITZERLAND) 2024; 11:638. [PMID: 38929218 PMCID: PMC11201397 DOI: 10.3390/children11060638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/01/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024]
Abstract
The term congenital lung malformation (CLM) is used to describe a wide range of pathological conditions with different imaging and clinical manifestations. These anomalies stem from abnormal embryological lung development, potentially occurring across various stages of prenatal life. Their natural history can be variable, presenting in a wide range of severity levels and encompassing asymptomatic individuals who remain so until adulthood, as well as those who experience respiratory distress in the neonatal period. Through the PubMed database, we performed an extensive review of the literature in the fields of congenital lung abnormalities, including their diagnostic approach and findings. From our RIS-PACS database, we have selected cases with a final diagnosis of congenital lung malformation. Different diagnostic approaches have been selected, including clinical cases studied using plain radiograph, CT scan, prenatal ultrasound, and MR images. The most encountered anomalies can be classified into three categories: bronchopulmonary anomalies (congenital pulmonary airway malformations (CPAMs), congenital lobar hyperinflation, bronchial atresia, and bronchogenic cysts), vascular anomalies (arteriovenous malformation), and combined lung and vascular anomalies (scimitar syndrome and bronchopulmonary sequestration). CLM causes significant morbidity and mortality; therefore, the recognition of these abnormalities is necessary for optimal prenatal counseling and early peri- and postnatal management. This pictorial review aims to report relevant imaging findings in order to offer some clues for differential diagnosis both for radiologists and pediatric consultants.
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Affiliation(s)
- Giovanna Cancemi
- U.O.C. Radiodiagnostica Lentini, ASP Siracusa, 96016 Siracusa, Italy;
| | - Giulio Distefano
- Institute of Nephrology and Dialysis—Nephrological, Vascular and Internal Medicine Diagnostic Ultrasound Service, Maggiore Hospital of Modica, ASP Ragusa, 97015 Modica, Italy;
| | - Gioele Vitaliti
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico G. Rodolico-San Marco, University of Catania, 95123 Catania, Italy; (G.V.); (D.M.); (G.T.); (G.B.); (M.C.); (P.V.F.); (A.B.)
| | - Dario Milazzo
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico G. Rodolico-San Marco, University of Catania, 95123 Catania, Italy; (G.V.); (D.M.); (G.T.); (G.B.); (M.C.); (P.V.F.); (A.B.)
| | - Giuseppe Terzo
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico G. Rodolico-San Marco, University of Catania, 95123 Catania, Italy; (G.V.); (D.M.); (G.T.); (G.B.); (M.C.); (P.V.F.); (A.B.)
| | - Giuseppe Belfiore
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico G. Rodolico-San Marco, University of Catania, 95123 Catania, Italy; (G.V.); (D.M.); (G.T.); (G.B.); (M.C.); (P.V.F.); (A.B.)
| | - Vincenzo Di Benedetto
- Division of Pediatric Surgery, University Hospital Policlinico G. Rodolico-San Marco, University of Catania, 95123 Catania, Italy; (V.D.B.); (M.G.S.)
| | - Maria Grazia Scuderi
- Division of Pediatric Surgery, University Hospital Policlinico G. Rodolico-San Marco, University of Catania, 95123 Catania, Italy; (V.D.B.); (M.G.S.)
| | - Maria Coronella
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico G. Rodolico-San Marco, University of Catania, 95123 Catania, Italy; (G.V.); (D.M.); (G.T.); (G.B.); (M.C.); (P.V.F.); (A.B.)
| | | | - Daniele Grippaldi
- UOSD I.P.T.R.A.-Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico G. Rodolico-San Marco, University of Catania, 95123 Catania, Italy; (D.G.); (L.A.M.)
| | - Letizia Antonella Mauro
- UOSD I.P.T.R.A.-Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico G. Rodolico-San Marco, University of Catania, 95123 Catania, Italy; (D.G.); (L.A.M.)
| | - Pietro Valerio Foti
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico G. Rodolico-San Marco, University of Catania, 95123 Catania, Italy; (G.V.); (D.M.); (G.T.); (G.B.); (M.C.); (P.V.F.); (A.B.)
| | - Antonio Basile
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico G. Rodolico-San Marco, University of Catania, 95123 Catania, Italy; (G.V.); (D.M.); (G.T.); (G.B.); (M.C.); (P.V.F.); (A.B.)
| | - Stefano Palmucci
- UOSD I.P.T.R.A.-Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico G. Rodolico-San Marco, University of Catania, 95123 Catania, Italy; (D.G.); (L.A.M.)
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Dougherty D, Diaconescu A, Shah NR, VanHulle R, Ladino-Torres M, Treadwell MC, Mychaliska GB, Perrone EE. Prenatal Measurements of Congenital Lung Malformations: Can They Predict Postnatal Size? J Surg Res 2024; 293:259-265. [PMID: 37804795 DOI: 10.1016/j.jss.2023.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 08/21/2023] [Accepted: 09/07/2023] [Indexed: 10/09/2023]
Abstract
INTRODUCTION Prenatally diagnosed congenital lung malformations (CLMs) are monitored via ultrasound and measured by congenital pulmonary airway malformation volume ratios (CVRs) which can predict postnatal respiratory symptoms. This study compared CVR to postnatal lesion size to help guide prenatal counseling. METHODS A retrospective chart review evaluated the prenatal imaging and postnatal outcomes for patients who were prenatally diagnosed with CLMs and had a postnatal computed tomography (CT) scan at one institution. RESULTS Fifty-seven patients were included. Four had symptoms requiring urgent resection. The remaining were discharged and had clinic follow-up with CT scan to determine next steps: five had no identified lesions, eight had lesions whose diagnosis did not warrant an operation, and 40 had lesions whose diagnosis rendered size a factor in operative decision-making. Of these 40, 26/40 patients (65%) underwent elective resection (median maximum CVR 0.97; median lesion size 4 cm) and 14/40 patients (35%) were observed without resection (median maximum CVR 0.5; median lesion size 3 cm). There was a positive correlation between prenatal CVR and postnatal lesion size, with R-squared = 0.46. Maximum CVRs were better than last CVRs when predicting whether postnatal CT size would fall above or below our institution's level of recommended resection, with an area under the curve of 0.85 and a CVR cut-point of 0.61. CONCLUSIONS For newborns with asymptomatic CLMs, higher maximum CVRs correlated with larger size on postnatal CT. A maximum CVR ≤0.6 was correlated with a smaller postnatal CT size that may be eligible for nonoperative management. While these results are not intended to recommend surgery based on higher CVRs alone, this information could potentially be used to reassure expectant parents whose babies' prenatal imaging demonstrate lower maximum CVRs.
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Affiliation(s)
- Danielle Dougherty
- Section of Pediatric Surgery, Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | | | - Nikhil R Shah
- Section of Pediatric Surgery, Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.
| | - Rachel VanHulle
- Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Maria Ladino-Torres
- Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Marjorie C Treadwell
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, L4001 Women's Hospital, Ann Arbor, Michigan
| | - George B Mychaliska
- Section of Pediatric Surgery, Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Erin E Perrone
- Section of Pediatric Surgery, Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
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Gonçalves E, Sachicola O, Estanislau B, Quifica F, Morais H, Arrais M. Agenesis of the right lung in an adult woman: A case report. Clin Case Rep 2023; 11:e8107. [PMID: 37867534 PMCID: PMC10587648 DOI: 10.1002/ccr3.8107] [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] [Received: 06/30/2023] [Revised: 10/08/2023] [Accepted: 10/12/2023] [Indexed: 10/24/2023] Open
Abstract
Key Clinical Message Pulmonary agenesis is a rare congenital abnormality. Patients with hemithorax white-out on x-rays should be treated with caution, especially in resource-limited countries where chest CT and bronchofibroscopy are not available to confirm the diagnosis. Abstract Pulmonary agenesis is an uncommon congenital abnormality defined by the complete absence of the lung parenchyma, as well as the bronchial and vascular structures. Right-sided pulmonary agenesis is less frequent, has a worse prognosis, and is usually associated with other congenital abnormalities. We reported the clinical case of a 31-year-old woman with right pulmonary agenesis, and no other congenital abnormalities, whose diagnosis was confirmed by thoracic computed tomography and bronchofibroscopy and who has a good prognosis.
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Affiliation(s)
- Elias Gonçalves
- Serviço de PneumologiaComplexo Hospitalar de Doenças Cardiopulmonares, Cardeal Dom Alexandre do NascimentoLuandaAngola
| | - Ofélia Sachicola
- Serviço de PneumologiaComplexo Hospitalar de Doenças Cardiopulmonares, Cardeal Dom Alexandre do NascimentoLuandaAngola
| | - Bartolomeu Estanislau
- Serviço de PneumologiaComplexo Hospitalar de Doenças Cardiopulmonares, Cardeal Dom Alexandre do NascimentoLuandaAngola
| | - Francisca Quifica
- Serviço de PneumologiaComplexo Hospitalar de Doenças Cardiopulmonares, Cardeal Dom Alexandre do NascimentoLuandaAngola
| | - Humberto Morais
- Centro de Estudos Avançados em Educação e Formação Médica, Faculdade de MedicinaAgostinho Neto UniversityLuandaAngola
- Departamento de Cardiologia Hospital Militar Principal/Instituto SuperiorLuandaAngola
| | - Margarete Arrais
- Department of PulmonologyMilitary Hospital LuandaLuandaAngola
- Centro de Investigação em Saúde de Angola (CISA)CaxitoBengoAngola
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Han Z, Yu T, Huang J, Liu D, Fu L, Yang S, Peng Y. Computed tomography findings of communicating bronchopulmonary foregut malformation: a retrospective study of 18 patients. Pediatr Radiol 2023; 53:1063-1075. [PMID: 36847802 DOI: 10.1007/s00247-023-05610-z] [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] [Received: 09/16/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Communicating bronchopulmonary foregut malformation is a rare anomaly characterized by a patent congenital communication between the esophagus or stomach and an isolated portion of the respiratory system. An esophagogram is taken as the gold standard for diagnosis. Compared with esophagography, computed tomography (CT) is more widely used and easily obtained, but CT findings have been described as nonspecific. PURPOSE To describe CT findings in 18 patients with communicating bronchopulmonary foregut malformation to assist with early diagnosis. MATERIAL AND METHODS A retrospective review of 18 patients who had proven communicating bronchopulmonary foregut malformation between January 2006 and December 2021 was conducted. For each patient, the medical records, including demographics, clinical manifestations, upper gastrointestinal radiography, magnetic resonance imaging and CT findings, were reviewed. RESULTS Among the 18 patients, there were 8 males. The right to left ratio was 3.5:1. An entire lung was involved in 10 patients, a lobe or a segment was involved in 7 patients and an ectopic lesion was located in the right neck in 1 patient. The isolated lung may arise from the upper esophagus, mid-esophagus, lower esophagus or stomach, which were detected in 1, 3, 13, and 1 patient, respectively. On chest CT, an extra bronchus which did not arise from the trachea was detected in 14 patients. Contrast-enhanced chest CT was performed in 17 patients, the isolated lung receiving its blood supply from the pulmonary artery in 13 patients, the systemic artery in 11 patients and both pulmonary and systemic arteries in 7 patients. CONCLUSIONS The presence of an extra bronchus, which does not arise from the trachea, highly suggests the diagnosis of communicating bronchopulmonary foregut malformation. Contrast-enhanced chest CT can provide accurate information regarding the airways, lung parenchyma and vascular structures that is useful to plan surgery.
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Affiliation(s)
- Zhonglong Han
- Department of Radiology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, No. 56, Nanlishilu Road, Xicheng District, Beijing, 100045, People's Republic of China
| | - Tong Yu
- Department of Radiology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, No. 56, Nanlishilu Road, Xicheng District, Beijing, 100045, People's Republic of China
| | - Jinshi Huang
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Dingyi Liu
- Department of Thoracic Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Libing Fu
- Department of Pathology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Shuangfeng Yang
- Department of Radiology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, No. 56, Nanlishilu Road, Xicheng District, Beijing, 100045, People's Republic of China
| | - Yun Peng
- Department of Radiology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, No. 56, Nanlishilu Road, Xicheng District, Beijing, 100045, People's Republic of China.
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Sintim-Damoa A, Cohen HL. Fetal imaging of congenital lung lesions with postnatal correlation. Pediatr Radiol 2022; 52:1921-1934. [PMID: 36002772 DOI: 10.1007/s00247-022-05465-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 06/27/2022] [Accepted: 07/21/2022] [Indexed: 11/30/2022]
Abstract
Congenital lung lesions are a rare group of developmental pulmonary abnormalities that are often first identified prenatally on routine second-trimester US. Congenital pulmonary airway malformation (CPAM) is the most common anomaly while others include bronchopulmonary sequestration, congenital lobar overinflation, bronchogenic cyst and bronchial atresia. Clinical presentation is highly variable, ranging from apparent in utero resolution to severe mass effect with resultant hydrops fetalis and fetal demise. Differentiation among these lesions can be challenging because overlapping imaging features are often present. The roles of the radiologist are to identify key imaging findings that help in diagnosing congenital lung lesions and to recognize any ominous features that might require prenatal or perinatal intervention. High-resolution US and complementary rapid-acquisition fetal MRI provide valuable information necessary for lesion characterization. Postnatal US and CT angiography are helpful for lesion evaluation and for possible surgical planning. This article reviews the embryology of the lungs, the normal prenatal imaging appearance of the thorax and its contents, and the prenatal and neonatal imaging characteristics, prognosis and management of various congenital lung lesions.
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Affiliation(s)
- Akosua Sintim-Damoa
- Department of Radiology, LeBonheur Children's Hospital, University of Tennessee Health Science Center, 848 Adams Ave., Memphis, TN, 38103, USA.
| | - Harris L Cohen
- Department of Radiology, LeBonheur Children's Hospital, University of Tennessee Health Science Center, 848 Adams Ave., Memphis, TN, 38103, USA
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Lung and Pleural Findings of Children with Pulmonary Vein Stenosis with and without Aspiration: MDCT Evaluation. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9040543. [PMID: 35455587 PMCID: PMC9025679 DOI: 10.3390/children9040543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 04/01/2022] [Accepted: 04/07/2022] [Indexed: 11/19/2022]
Abstract
Purpose: To retrospectively compare the lung and pleural findings in children with pulmonary vein stenosis (PVS) with and without aspiration on multidetector computed tomography (MDCT). Materials and Methods: All consecutive children (≤18 years old) with PVS who underwent thoracic MDCT studies from August 2004 to December 2021 were categorized into two groups: children with PVS with aspiration (Group 1) and children with PVS without aspiration (Group 2). Two independent pediatric radiologists retrospectively evaluated thoracic MDCT studies for the presence of lung and pleural abnormalities as follows: (1) in the lung (ground-glass opacity (GGO), consolidation, nodule, mass, cyst(s), interlobular septal thickening, and fibrosis) and (2) in the pleura (thickening, effusion, and pneumothorax). Interobserver agreement between the two reviewers was evaluated by the proportion of agreement and the Kappa statistic. Results: The final study population consisted of 64 pediatric patients (36 males (56.3%) and 43 females (43.7%); mean age, 1.7 years; range, 1 day−17 years). Among these 64 patients, 19 patients (29.7%) comprised Group 1 and the remaining 45 patients (70.3%) comprised Group 2. In Group 1 (children with PVS with aspiration), the detected lung and pleural MDCT abnormalities were: GGO (17/19; 89.5%), pleural thickening (17/19; 89.5%), consolidation (16/19; 84.5%), and septal thickening (16/19; 84.5%). The lung and pleural MDCT abnormalities observed in Group 2 (children with PVS without aspiration) were: GGO (37/45; 82.2%), pleural thickening (37/45; 82.2%), septal thickening (36/45; 80%), consolidation (3/45; 6.7%), pleural effusion (1/45; 2.2%), pneumothorax (1/45; 2.2%), and cyst(s) (1/45; 2.2%). Consolidation was significantly more common in pediatric patients with both PVS and aspiration (Group 1) (p < 0.001). There was high interobserver agreement between the two independent reviewers for detecting lung and pleural abnormalities on thoracic MDCT studies (Kappa = 0.98; CI = 0.958, 0.992). Conclusion: Aspiration is common in pediatric patients with PVS who undergo MDCT and was present in nearly 30% of all children with PVS during our study period. Consolidation is not a typical radiologic finding of PVS in children without clinical evidence of aspiration. When consolidation is present on thoracic MDCT studies in pediatric patients with PVS, the additional diagnosis of concomitant aspiration should be considered.
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Kaplan HJ, Lee RE, Coakley BA. Comparison of Endobronchial Intubation Versus Bronchial Blockade for Elective Pulmonary Lobectomy of Congenital Lung Anomalies in Small Children. J Laparoendosc Adv Surg Tech A 2022; 32:800-804. [PMID: 35394363 PMCID: PMC10402695 DOI: 10.1089/lap.2021.0741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Purpose: Resection of many congenital lung lesions is commonly performed under single-lung ventilation, which helps collapse the lung being manipulated and enables a thoracoscopic approach in most cases. We set out to determine whether lung isolation achieved by either main stem intubation or usage of a bronchial blocker was associated with superior clinical outcomes. Materials and Methods: A retrospective review of all patients aged <2 years undergoing elective pulmonary lobectomy for congenital lung malformations at a tertiary-care pediatric hospital from 2011 through 2020 was performed. Demographic data, diagnosis type, type of lung isolation method employed, and perioperative outcomes were recorded. Continuous variables were analyzed with Student's t-tests, whereas categorical variables were analyzed with Fisher's exact tests and chi-square tests. Results: Thirty-two patients were analyzed-17 were managed with a bronchial blocker while 15 underwent main stem intubation. The most common diagnoses were congenital pulmonary airway malformations (53.1%) and intralobar bronchopulmonary sequestrations (34.4%). Patients managed with main stem intubation were slightly younger (P = .06) than those for which a bronchial blocker was used. Thirty-one (96.9%) resections were initiated thoracoscopically. Main stem intubation was associated with shorter operative times (P = .01), shorter anesthetic times (P = .02), and less blood loss (P = .04). No differences in length of stay (P = .64), conversation to thoracotomy (P = .35), intraoperative complications (P = .23), or postoperative complications (P = .49) were observed. Conclusion: Lung isolation through main stem intubation, when compared with bronchial blockers, is associated with shorter operative time, shorter anesthetic exposure, and diminished blood loss in pediatric patients undergoing lobectomy for congenital lung anomalies.
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Affiliation(s)
- Harrison J Kaplan
- The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rebecca E Lee
- Department of Anesthesiology, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brian A Coakley
- Department of Surgery and Pediatrics, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
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9
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El-Ali AM, Strubel NA, Lala SV. Congenital lung lesions: a radiographic pattern approach. Pediatr Radiol 2022; 52:622-636. [PMID: 34716454 DOI: 10.1007/s00247-021-05210-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/29/2021] [Accepted: 09/13/2021] [Indexed: 11/28/2022]
Abstract
Congenital lung malformations represent a spectrum of abnormalities that can overlap in imaging appearance and frequently coexist in the same child. Imaging diagnosis in the neonatal period can be challenging; however, the recognition of several archetypal radiographic patterns can aid in narrowing the differential diagnosis. Major radiographic archetypes include (1) hyperlucent lung, (2) pulmonary cysts, (3) focal opacity and (4) normal radiograph. Here we review the multimodality imaging appearances of the most commonly seen congenital lung malformations, categorized by their primary imaging archetypes. Along with the congenital lung malformations, we present several important imaging mimickers.
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Affiliation(s)
- Alexander Maad El-Ali
- Division of Pediatric Radiology, Department of Radiology, NYU Grossman School of Medicine, 550 First Ave., New York, NY, 10016, USA.
| | - Naomi A Strubel
- Division of Pediatric Radiology, Department of Radiology, NYU Grossman School of Medicine, 550 First Ave., New York, NY, 10016, USA
| | - Shailee V Lala
- Division of Pediatric Radiology, Department of Radiology, NYU Grossman School of Medicine, 550 First Ave., New York, NY, 10016, USA
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Winant AJ, Vargas SO, Jenkins KJ, Callahan R, Rameh V, Krone KA, Johnston PR, Keochakian ML, Lee EY. Pleuropulmonary MDCT Findings: Comparison between Children with Pulmonary Vein Stenosis and Prematurity-Related Lung Disease. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9030355. [PMID: 35327727 PMCID: PMC8947577 DOI: 10.3390/children9030355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/02/2022] [Accepted: 02/18/2022] [Indexed: 01/27/2023]
Abstract
Purpose: To retrospectively compare the pleuropulmonary MDCT findings in children with pulmonary vein stenosis (PVS) and prematurity-related lung disease (PLD). Materials and Methods: All consecutive infants and young children (≤18 years old) who underwent thoracic MDCT studies from July 2004 to November 2021 were categorized into two groups—children with PVS (Group 1) and children with PLD without PVS (Group 2). Two pediatric radiologists independently evaluated thoracic MDCT studies for the presence of pleuropulmonary abnormalities as follows—(1) in the lung (ground-glass opacity (GGO), triangular/linear plaque-like opacity (TLO), consolidation, nodule, mass, cyst(s), interlobular septal thickening, and fibrosis); (2) in the airway (bronchial wall thickening and bronchiectasis); and (3) in the pleura (thickening, effusion, and pneumothorax). Interobserver agreement between the two reviewers was evaluated with the Kappa statistic. Results: There were a total of 103 pediatric patients (60 males (58.3%) and 43 females (41.7%); mean age, 1.7 years; range, 2 days−7 years). Among these 103 patients, 49 patients (47.6%) comprised Group 1 and the remaining 54 patients (52.4%) comprised Group 2. In Group 1, the observed pleuropulmonary MDCT abnormalities were—pleural thickening (44/49; 90%), GGO (39/49; 80%), septal thickening (39/49; 80%), consolidation (4/49; 8%), and pleural effusion (1/49; 2%). The pleuropulmonary MDCT abnormalities seen in Group 2 were—GGO (45/54; 83%), TLO (43/54; 80%), bronchial wall thickening (33/54; 61%), bronchiectasis (30/54; 56%), cyst(s) (5/54; 9%), pleural thickening (2/54; 4%), and pleural effusion (2/54; 4%). Septal thickening and pleural thickening were significantly more common in pediatric patients with PVS (Group 1) (p < 0.001). TLO, bronchial wall thickening, and bronchiectasis were significantly more frequent in pediatric patients with PLD without PVS (Group 2) (p < 0.001). There was high interobserver kappa agreement between the two independent reviewers for detecting pleuropulmonary abnormalities on thoracic MDCT angiography studies (k = 0.99). Conclusion: Pleuropulmonary abnormalities seen on thoracic MDCT can be helpful for distinguishing PVS from PLD in children. Specifically, the presence of septal thickening and pleural thickening raises the possibility of PVS, whereas the presence of TLO, bronchial wall thickening and bronchiectasis suggests PLD in the pediatric population.
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Affiliation(s)
- Abbey J. Winant
- Department of Radiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA; (A.J.W.); (V.R.); (P.R.J.)
| | - Sara O. Vargas
- Department of Pathology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA;
| | - Kathy J. Jenkins
- Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA; (K.J.J.); (R.C.); (M.L.K.)
| | - Ryan Callahan
- Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA; (K.J.J.); (R.C.); (M.L.K.)
| | - Vanessa Rameh
- Department of Radiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA; (A.J.W.); (V.R.); (P.R.J.)
| | - Katie A. Krone
- Division of Pulmonary Medicine, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA;
| | - Patrick R. Johnston
- Department of Radiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA; (A.J.W.); (V.R.); (P.R.J.)
| | - Mirjam L. Keochakian
- Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA; (K.J.J.); (R.C.); (M.L.K.)
| | - Edward Y. Lee
- Department of Radiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA; (A.J.W.); (V.R.); (P.R.J.)
- Correspondence: ; Tel.: +1-617-935-9997
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11
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Murray-Torres TM, Winch PD, Naguib AN, Tobias JD. Anesthesia for thoracic surgery in infants and children. Saudi J Anaesth 2021; 15:283-299. [PMID: 34764836 PMCID: PMC8579498 DOI: 10.4103/sja.sja_350_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 11/19/2022] Open
Abstract
The management of infants and children presenting for thoracic surgery poses a variety of challenges for anesthesiologists. A thorough understanding of the implications of developmental changes in cardiopulmonary anatomy and physiology, associated comorbid conditions, and the proposed surgical intervention is essential in order to provide safe and effective clinical care. This narrative review discusses the perioperative anesthetic management of pediatric patients undergoing noncardiac thoracic surgery, beginning with the preoperative assessment. The considerations for the implementation and management of one-lung ventilation (OLV) will be reviewed, and as will the anesthetic implications of different surgical procedures including bronchoscopy, mediastinoscopy, thoracotomy, and thoracoscopy. We will also discuss pediatric-specific disease processes presenting in neonates, infants, and children, with an emphasis on those with unique impact on anesthetic management.
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Affiliation(s)
- Teresa M Murray-Torres
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, Missouri, USA.,Department of Anesthesiology, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Peter D Winch
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, Missouri, USA.,Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Aymen N Naguib
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, Missouri, USA.,Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Joseph D Tobias
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, Missouri, USA.,Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
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12
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Imaging of congenital lung diseases presenting in the adulthood: a pictorial review. Insights Imaging 2021; 12:153. [PMID: 34716817 PMCID: PMC8557233 DOI: 10.1186/s13244-021-01095-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/13/2021] [Indexed: 11/15/2022] Open
Abstract
Congenital lung diseases in adults are rare diseases that can present with symptoms or be detected incidentally. Familiarity with the imaging features of different types of congenital lung diseases helps both in correct diagnosis and management of these diseases. Congenital lung diseases in adults are classified into three main categories as bronchopulmonary anomalies, vascular anomalies, and combined bronchopulmonary and vascular anomalies. Contrast-enhanced computed tomography, especially 3D reconstructions, CT, or MR angiography, can show vascular anomalies in detail. The tracheobronchial tree, parenchymal changes, and possible complications can also be defined on chest CT, and new applications such as quantitative 3D reconstruction CT images, dual-energy CT (DECT) can be helpful in imaging parenchymal changes. In addition to the morphological assessment of the lungs, novel MRI techniques such as ultra-short echo time (UTE), arterial spin labeling (ASL), and phase-resolved functional lung (PREFUL) can provide functional information. This pictorial review aims to comprehensively define the radiological characteristics of each congenital lung disease in adults and to highlight differential diagnoses and possible complications of these diseases.
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13
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Pimenta DA, Aguiar FL, Fernandes BC, Rolo R. Late diagnosis of pulmonary agenesis. BMJ Case Rep 2021; 14:e245233. [PMID: 34706915 PMCID: PMC8552127 DOI: 10.1136/bcr-2021-245233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 11/04/2022] Open
Abstract
Pulmonary agenesis is defined as the complete absence of one or both lungs, including the bronchi, bronchioles, vasculature and lung parenchyma. Most of these malformations are detected in early childhood. A residual number remains asymptomatic and undiagnosed until adulthood. The clinical presentation is wide, ranging from asymptomatic to respiratory complaints like dyspnoea, respiratory distress and a history of recurrent lung infections. This case presents a 54-year-old woman with complaints of coughing, dyspnoea for medium exertion and wheezing for a couple of months. Based on the results of complementary diagnosis methods, right pulmonary agenesis was diagnosed without other malformations. Simultaneously, an asthma diagnosis was also performed. The treatment of pulmonary agenesis is symptomatic. Simultaneous cardiovascular malformations could require surgical interventions. This case demonstrates that pulmonary agenesis may remain undiagnosed, be identified incidentally, and have a good and long prognosis.
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Affiliation(s)
| | | | | | - Rui Rolo
- Pneumology, Hospital de Braga, Braga, Portugal
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14
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Lee EY, Vargas SO, Park HJ, Plut D, Das KM, Winant AJ. Thoracic Multidetector Computed Tomography Evaluation of Inflammatory Myofibroblastic Tumor of the Lung in Pediatric Patients in the Era of Modern Diagnosis. J Thorac Imaging 2021; 36:310-317. [PMID: 33814535 DOI: 10.1097/rti.0000000000000589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to investigate the characteristic thoracic multidetector computed tomography (MDCT) findings of pathologically proven inflammatory myofibroblastic tumor (IMT) of the lung in children in the era of modern understanding based on refined pathologic diagnosis. MATERIALS AND METHODS All pediatric patients (age 18 y and above) with a known pathologic diagnosis of IMT of the lung who underwent thoracic MDCT studies from May 2008 to December 2020 were included. Two pediatric radiologists independently evaluated thoracic MDCT studies for the presence of abnormalities in the lung (nodule, mass, cyst, ground-glass opacity, consolidation), pleura (pleural effusion, pneumothorax), and mediastinum and hilum (lymphadenopathy). When a lung abnormality was present, the number, size, composition (solid, cystic, or combination of both), location (laterality, lobar distribution, and intraparenchymal vs. pleural-based), borders (well-circumscribed vs. ill-defined), the presence and type of associated calcification (punctate, dense, curvilinear, or flocculent), the presence of associated cavitation, contrast enhancement pattern (homogeneous, heterogenous, central, or peripheral), and other associated findings (neural foramen involvement, anomalous vessels, mass effect, and invasion of adjacent thoracic structures) were also evaluated. Interobserver agreement between 2 independent reviewers was evaluated with κ statistics. RESULTS In all, 12 thoracic MDCT studies from 12 individual pediatric patients (5 males [42%] and 7 females [58%]; mean age: 9.9 y; SD: 4.4 y; range: 2 to 16 y) comprised the final study population. All 12 thoracic MDCT studies (100%) were performed with intravenous contrast. The most frequent MDCT finding of IMT of the lung in children is a solitary (92%), pleural-based (83%), well-circumscribed (100%), solid (92%) mass with heterogenous contrast enhancement (100%), often with dense calcification (50%), which occurred in both lungs and all lobes with similar frequency. No pleural abnormality (pleural effusion, pneumothorax) or mediastinal abnormality (lymphadenopathy) was detected. In addition, although mass effect on adjacent thoracic structures was frequently seen (42%), no invasion, neural foramen involvement, or associated anomalous vessels was identified. There was excellent interobserver κ agreement between 2 independent reviewers for detecting abnormalities on thoracic MDCT studies (κ>0.95). CONCLUSIONS IMT of the lung in children typically presents as a solitary, pleural-based, well-circumscribed, solid mass with heterogenous contrast enhancement, often with dense calcification, without significant laterality or lobar preference. In addition, pleural or mediastinal abnormalities are characteristically absent. These notable MDCT attributes of IMT of the lung are an important and novel finding, with great potential to help differentiate pediatric IMT of the lung from other thoracic masses in children.
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Affiliation(s)
| | - Sara O Vargas
- Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | | | - Domen Plut
- Department of Pediatric Radiology, Clinical Radiology Institute, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Karuna M Das
- Department of Radiology, College of Medicine and Health Sciences, Al Ain, United Arab Emirates
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15
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Lee EY, Vargas SO, Park HJ, Plut D, Krone KA, Winant AJ. Thoracic MDCT findings of a combined congenital lung lesion: Bronchial atresia associated with congenital pulmonary airway malformation. Pediatr Pulmonol 2021; 56:2903-2910. [PMID: 34196512 DOI: 10.1002/ppul.25556] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 06/03/2021] [Accepted: 06/24/2021] [Indexed: 11/10/2022]
Abstract
PURPOSE To investigate the characteristic thoracic multidetector computed tomography (MDCT) findings of pathologically proven combined congenital lung lesion consisting of bronchial atresia (BA) and congenital pulmonary airway malformation (CPAM) in children. MATERIALS AND METHODS All pediatric patients (age ≤ 18 years) with a known pathological diagnosis of a combined BA-CPAM congenital lung lesion, who underwent thoracic MDCT studies from January 2011 to January 2021 were included. Two pediatric radiologists independently evaluated thoracic MDCT studies for the presence of abnormalities in the lung, including nodule, mass, cyst, ground-glass opacity, and consolidation. When a lung abnormality was present, the number, size, composition (solid, cystic, or combination of both), borders (well-circumscribed vs. ill-defined), contrast enhancement pattern (nonenhancement vs. enhancement), and location (laterality, and lobar distribution) were also evaluated. Interobserver agreement between two independent reviewers was evaluated with κ statistics. RESULTS Eighteen contrast-enhanced thoracic MDCT studies from 18 individual pediatric patients (8 males (44%) and 10 females (56%); mean age: 4.9 months; SD: 2.6; range: 1-10 months) with a pathological diagnosis of combined BA-CPAM congenital lung lesion comprised the final study population. The most frequent MDCT finding of combined BA-CPAM congenital lung lesion in children was a solitary (18/18; 100%), well-circumscribed (18/18; 100%), both solid and cystic (17/18; 94%) lesion with nonenhancing (17/17; 100%) nodule, reflecting the underlying BA component, adjacent to a well-circumscribed multicystic mass (18/18; 100%), representing the underlying CPAM component. This combined congenital lung lesion occurred in all lobes with similar frequency. There was almost perfect interobserver κ agreement between the two independent reviewers for detecting abnormalities on thoracic MDCT studies (k = 0.98). CONCLUSION The characteristic thoracic MDCT findings of a combined BA-CPAM congenital lung lesion are a solitary, well-circumscribed solid and multicystic mass, with a nonenhancing nodule, reflecting the BA component, adjacent to a cystic mass, representing the CPAM component. Accurate recognition of these characteristic MDCT findings of combined BA-CPAM congenital lung lesion has great potential to help differentiate this combined congenital lung lesion from other thoracic pathology in children.
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Affiliation(s)
- Edward Y Lee
- Department of Radiology, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Sara O Vargas
- Department of Pathology, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Halley J Park
- Department of Radiology, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Domen Plut
- Department of Pediatric Radiology, Clinical Radiology Institute, Faculty of Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Katie A Krone
- Department of Medicine, Division of Pulmonary Medicine, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Abbey J Winant
- Department of Radiology, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA
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16
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Tivnan P, Winant AJ, Johnston PR, Plut D, Smith K, MacCallum G, Lee EY. Thoracic CTA in infants and young children: Image quality of dual-source CT (DSCT) with high-pitch spiral scan mode (turbo flash spiral mode) with or without general anesthesia with free-breathing technique. Pediatr Pulmonol 2021; 56:2660-2667. [PMID: 33914408 DOI: 10.1002/ppul.25446] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/05/2021] [Accepted: 04/25/2021] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine whether diagnostic quality thoracic computed tomography angiography (CTA) studies can be obtained without general anesthesia (GA) in infants and young children using dual-source computed tomography (DSCT) with turbo flash spiral mode (TFSM) and free-breathing technique. MATERIALS AND METHODS All consecutive infants and young children (≤ 6 years old) who underwent thoracic CTA studies from January 2018 to October 2020 for suspected congenital thoracic disorders were categorized into two groups: with GA (Group 1) and without GA (Group 2). All thoracic CTA studies were performed on a DSCT scanner using TFSM and free-breathing technique. Two pediatric thoracic radiologists independently evaluated motion artifact in three lung zones (upper, mid, and lower). Degree of motion artifact was graded 0-3 (0, none; 1, mild; 2, moderate; and 3, severe). Logistic models adjusted for age and gender were used to compare the degree of motion artifact between lung zones. Interobserver agreement between reviewers was evaluated with kappa statistics. RESULTS There were a total of 73 pediatric patients (43 males (59%) and 30 females (41%); mean age, 1.4 years; range, 0-5.9 years). Among these 73 patients, 42 patients (58%) underwent thoracic CTA studies with GA (Group 1) and the remaining 31 patients (42%) underwent thoracic CTA studies without GA (Group 2). Overall, the degree of motion artifact was higher for Group 2 (without GA). However, only a very small minority (1/31, 3%) of Group 2 (without GA) thoracic CTA studies had severe motion artifact. There was no significant difference between the two groups with respect to the presence of severe motion artifact (odds ratio [OR] = 6, p = .222). When two groups were compared with respect to the presence of motion artifact for individual lung zones, motion artifact was significantly higher in the upper lung zone for Group 2 (without GA) (OR = 20, p = .043). Interobserver agreement for motion artifact was high, the average Kappa being 0.81 for Group 1 and 0.95 for Group 2. CONCLUSION Although the degree of motion artifact was higher in the group without GA, only a small minority (3%) of thoracic CTA studies performed without GA had severe motion artifact, rendering the study nondiagnostic. Therefore, the results of this study support the use of thoracic CTA without GA using DSCT with TFSM and free-breathing in infants and young children. In addition, given that motion artifact was significantly higher in the upper lung zone without GA, increased stabilization in the upper chest and extremities should be considered.
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Affiliation(s)
- Patrick Tivnan
- Department of Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Abbey J Winant
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Patrick R Johnston
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Domen Plut
- Department of Pediatric Radiology, Clinical Radiology Institute, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Katherine Smith
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Gail MacCallum
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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17
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Ceylan KC, Batihan G, Üçvet A, Gürsoy S. Surgery in congenital lung malformations: the evolution from thoracotomy to VATS, 10-year experience in a single center. J Cardiothorac Surg 2021; 16:131. [PMID: 34001173 PMCID: PMC8130166 DOI: 10.1186/s13019-021-01511-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 05/05/2021] [Indexed: 11/25/2022] Open
Abstract
Background Congenital lung malformation is an umbrella term and consist of various kind of parenchymal and mediastinal pathologies. Surgical resection is often required for diagnosis and curative treatment. We aimed to review our experience in surgical treatment for congenital lung disease and present the role of minimally invasive surgery. Methods Surgical resections performed for benign lesions of the lung and mediastinum between January 2009 and May 2019 were retrospectively analyzed. Patients who were found to have congenital lung malformation as a result of pathological examination were included in our study. Distribution characteristics of the patients according to congenital lung malformation subtypes, differences in surgical approach and postoperative results were investigated. Results A total of 94 patients who underwent surgical resection and were diagnosed with the bronchogenic cyst, sequestration, bronchial atresia, congenital cystic adenomatoid malformation (CCAM), or enteric cyst as a result of pathological examination were included the study. There were no significant differences between pathological subtypes in the postoperative length of hospital stay and drainage duration however, perioperative complication rate was higher in the sequestration group. In addition, in the first three days postoperatively, the mean pain score was found to be lower in the VATS group compared to thoracotomy. Conclusions Congenital lung malformations consist of a heterogeneous group of diseases and the surgical treatment in these patients can range from a simple cyst excision to pneumonectomy. Video-assisted thoracoscopic surgery should be considered as the first choice in the surgical treatment of these patients in experienced centers.
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Affiliation(s)
- Kenan C Ceylan
- Department of Thoracic Surgery, University of Health Sciences Dr Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital Izmir, 35110, Yenişehir, Gaziler Street, 331, Izmir, Turkey
| | - Güntuğ Batihan
- Department of Thoracic Surgery, University of Health Sciences Dr Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital Izmir, 35110, Yenişehir, Gaziler Street, 331, Izmir, Turkey.
| | - Ahmet Üçvet
- Department of Thoracic Surgery, University of Health Sciences Dr Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital Izmir, 35110, Yenişehir, Gaziler Street, 331, Izmir, Turkey
| | - Soner Gürsoy
- Department of Thoracic Surgery, University of Health Sciences Dr Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital Izmir, 35110, Yenişehir, Gaziler Street, 331, Izmir, Turkey
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18
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de Melo ASA. Diagnostic imaging in bronchial atresia. Radiol Bras 2021; 54:V. [PMID: 33854270 PMCID: PMC8029932 DOI: 10.1590/0100-3984.2021.54.2e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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19
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Puglia EBMD, Rodrigues RS, Daltro PA, Souza AS, Paschoal MM, Labrunie EM, Irion KL, Hochhegger B, Zanetti G, Marchiori E. Tomographic findings in bronchial atresia. Radiol Bras 2021; 54:9-14. [PMID: 33574627 PMCID: PMC7863713 DOI: 10.1590/0100-3984.2019.0136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective To evaluate computed tomography (CT) findings in 23 patients with bronchial atresia. Materials and Methods The CT images were reviewed by two radiologists who reached decisions by consensus. We included only patients who presented with abnormalities on CT and in whom the diagnosis had been confirmed by pathological examination of the surgical specimen (if the lesion was resected). The CT scans were assessed in order to identify the main findings and to map the distribution of the lesions (i.e., to determine whether the pulmonary involvement was unilateral or bilateral). Results The main CT finding was the combination of bronchocele and hyperinflation of the distal lung. That combination was observed in all of the patients. The lesions were unilateral in all 23 cases, being seen predominantly in the left upper lobe, followed by the right lower lobe, right upper lobe, middle lobe, and left lower lobe. Conclusion The diagnosis of bronchial atresia can be reliably made on the basis of a finding of bronchocele accompanied by hyperinflation of the adjacent lung parenchyma.
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Affiliation(s)
- Elazir Barbosa Mota Di Puglia
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.,Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, RJ, Brazil
| | - Rosana Souza Rodrigues
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.,Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, RJ, Brazil
| | | | - Arthur Soares Souza
- Faculdade de Medicina de São José do Rio Preto (Famerp), São José do Rio Preto, SP, Brazil
| | | | | | | | - Bruno Hochhegger
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Gláucia Zanetti
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Edson Marchiori
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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20
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Sun J, Li H, Yang L, Zhou Z, Li M, Peng Y. Application of 70 kVp in abdominal CT angiography to reduce both radiation and contrast dosage and improve patient comfort for children. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2021; 29:813-821. [PMID: 34151881 DOI: 10.3233/xst-210896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Low-tube voltage scanning improves CT attenuation value of contrast medium (CM). Thus, we hypothesized that 70 kVp in pediatric abdominal CT angiography (CTA) could be used to reduce both radiation and CM dose and improve patient comfort at the same time. OBJECTIVE To evaluate the feasibility of using 70 kVp in pediatric abdominal CTA to reduce radiation dose and CM dose and improve patient care for children. MATERIALS AND METHODS Forty-six children needing abdominal CTA were enrolled in the study group using low-dose scanning protocol with 70 kVp and 0.7-1.1 ml/kg contrast dose, and reconstructed with 50%ASIR-V. They were compared with other 46 children in control group with matching body weight and underwent conventional CT scans with 100 kVp, 1.2-1.8 ml/kg contrast dose and reconstructed using 50%ASIR. Image quality of large vessels was evaluated using a 5-point scale. CT value and standard deviation of descending aorta (Ao) was measured, and signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Radiation dose, contrast dose, the maximum injection pressure between the two groups were also compared. RESULTS Score for displaying large vessels by 70 kVp images was 3.91±0.28, lower than that (4.17±0.38) of the control group (p < 0.05), but fully met the diagnostic requirements. CT value of Ao was 390.87±86.79HU in study group, which is higher than 343.93±49.94HU in control group, while there was no difference in SNR and CNR between two groups; the radiation dose, contrast dosage and injection pressure of the study group were 1.23±0.39mGy, 12.67±7.27 ml and 43.83±17.16psi, respectively, which are significantly lower than the 1.95±0.37mGy, 22.67±7.39 ml, and 77.59±19.68psi of control group. CONCLUSION Use of 70 kVp in pediatric abdominal CTA provides diagnostic quality images while significantly reduce radiation and contrast dose, as well as injection pressure to improve patient comfort for children.
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Affiliation(s)
- Jihang Sun
- Imaging Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Haoyan Li
- Imaging Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Lixin Yang
- Imaging Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zuofu Zhou
- Department of Radiology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Michelle Li
- Department of Human Biology, Stanford University, Stanford, CA, USA
| | - Yun Peng
- Imaging Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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21
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Qi Y, Huo H, Ma M, Wu J, Li X, Liu B. Prenatal diagnosis of pulmonary artery sling associated with tracheal agenesis: A case report. Echocardiography 2020; 37:2148-2151. [PMID: 33145790 DOI: 10.1111/echo.14875] [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: 07/11/2020] [Revised: 08/27/2020] [Accepted: 09/13/2020] [Indexed: 11/30/2022] Open
Abstract
Pulmonary artery sling (PAS) and tracheal agenesis (TA) are rare diseases, and most cases of PAS are associated with tracheal bronchial malformations. However, PAS associated with TA is yet to be reported. We report a case of PAS with TA diagnosed prenatally. Due to the extremely low incidence, physicians do not have sufficient understanding of these diseases and it is challenging to diagnose these diseases by prenatal ultrasound, with high rates of misdiagnosis. Prenatal examination of the pulmonary artery branches, trachea, and esophagus is useful; therefore, improving the accuracy of prenatal diagnosis will help in perinatal management and counseling.
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Affiliation(s)
- Yanhua Qi
- Department of Ultrasound, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Huanhuan Huo
- Department of Ultrasound, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Miaoyan Ma
- Department of Ultrasound, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jinfang Wu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaopeng Li
- Department of Ultrasound, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Baomin Liu
- Department of Ultrasound, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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22
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Caruselli M, Galvagni D, Boubnova J, Michel1 F. Anesthetic management of pulmonary surgery in newborns and infants. Pediatr Rep 2020; 12:8595. [PMID: 32922712 PMCID: PMC7461635 DOI: 10.4081/pr.2020.8595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/24/2020] [Indexed: 11/28/2022] Open
Abstract
The main congenital pulmonary airways malformations in newborns and infants requiring surgery are cystic adenoid malformation, congenital lobar emphysema and bronchogenic cyst. The surgical treatment preferably via thoracoscopy is recommended within the first year of life to avoid the risk of pneumopathy. A monopulmonary ventilation is then required by the surgeon to operate the diseased lung. The anesthetic management of intraoperative mono-pulmonary ventilation in newborns and infants is always challenging for the anesthesiologist. The main objective of this study was to describe anesthetic protocol for thoracoscopy and variations of monitored parameters during a mono-pulmonary ventilation procedure in newborns and infants.
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Affiliation(s)
- Marco Caruselli
- Anesthesia and Intensive Care Unit, La Timone Children’s Hospital, AP-HM, Marseille
| | - Daniele Galvagni
- Anesthesia and Intensive Care Unit, La Timone Children’s Hospital, AP-HM, Marseille
| | - Julia Boubnova
- Diaphragmatic Hernias Reference Center, Pediatric Visceral Surgery Unit, La Timone Children’s Hospital, AP-HM, Marseille
| | - Fabrice Michel1
- AMU UMR ADES 7268, Mediterranean Ethical Space, Timone Adults, Marseille, France
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Abdel-Bary M, Abdel-Naser M, Okasha A, Zaki M, Abdel-Baseer K. Clinical and surgical aspects of congenital lobar over-inflation: a single center retrospective study. J Cardiothorac Surg 2020; 15:102. [PMID: 32429981 PMCID: PMC7236189 DOI: 10.1186/s13019-020-01145-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/04/2020] [Indexed: 12/04/2022] Open
Abstract
Background Congenital lobar overinflation (CLOI) is one of the most important causes of infantile respiratory distress (RD). We aim to evaluate our experience in CLOI management emphasizing on clinical features, diagnostic modalities, surgery and outcomes. Methods This is a retrospective study for all CLOI cases undergoing surgical management at Qena University Hospital. Demographic data, clinical data, radiographic findings, surgery and postoperative follow-up were reviewed. Results A total of 37 neonates and infants with CLOI were presented to our center between January 2015 and January 2019; their mean age was 111.43 ± 65.19 days and 22 were males. All cases presented with RD; and cyanosis in 19 cases. 15 cases presented with recurrent pneumonia and fever. Diminished breath sounds on the affected side and wheezes were the main clinical findings in 30 and 22 cases respectively. On CXR, emphysema was detected in all cases. A confirmatory CT chest was done for all cases. Left upper lobe was affected in 23 cases, right middle lobe in 7 and right upper lobe in 7 cases. Lobectomy was done in thirty-one cases; their mean age at surgery was 147.58 ± 81.49 days and 19 were males. Postoperative complications were noted in 5 cases and postoperative ventilation was required for 2 of them. No morbidity or mortality was reported. The follow-up duration ranged from 3 months to 1 year and all patients were doing well except one case that lost follow up after 3 months. Conclusion CLOI is a rare bronchopulmonary malformation that requires a high index of clinical suspicion, especially in persistent and recurrent infantile RD. CT chest is the most useful diagnostic modality. Early management of CLOI improves outcome and avoid life-threatening complications. Surgical management is the treatment of choice in our center without recorded mortality.
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Affiliation(s)
- Mohamed Abdel-Bary
- Department of Cardiothoracic Surgery, Qena Faculty of Medicine, South Valley University, Safaga Road, Qena, 83523, Egypt.
| | - Mohamed Abdel-Naser
- Department of Anaesthesia and ICU, Assiut Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed Okasha
- Department of Radiology, Qena Faculty of Medicine, South Valley University, Qena, Egypt
| | - Mohammed Zaki
- Department of Radiology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Khaled Abdel-Baseer
- Department of Pediatrics, Qena Faculty of Medicine, South Valley University, Qena, Egypt
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Schooler GR, Restrepo R, Mas RP, Lee EY. Congenital Incidental Findings in Children that Can Be Mistaken as True Pathologies in Adults. Radiol Clin North Am 2020; 58:639-652. [DOI: 10.1016/j.rcl.2020.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Ganescu O, Petroze RT, Puligandla PS. Unilateral Lung Agenesis in an infant with prenatal diagnosis of Congenital Lobar Emphysema. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2019.101359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Liszewski MC, Ciet P, Lee EY. Lung and Pleura. PEDIATRIC BODY MRI 2020. [PMCID: PMC7245516 DOI: 10.1007/978-3-030-31989-2_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Hermelijn SM, Zwartjes RR, Tiddens HAWM, Cochius-den Otter SCM, Reiss IKM, Wijnen RMH, Schnater JM. Associated Anomalies in Congenital Lung Abnormalities: A 20-Year Experience. Neonatology 2020; 117:697-703. [PMID: 32841951 DOI: 10.1159/000509426] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/09/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION A congenital lung abnormality (CLA) is often found in conjunction with other abnormalities but screening guidelines for newborns with CLA have not yet been reported. We aimed to assess the incidence of associated anomalies in CLA patients born or followed up at our centre and the need for additional screening of newborns with a CLA. METHODS From a retrospective chart review of all patients born with a CLA between January 1999 and January 2019, we identified patients diagnosed with a congenital pulmonary airway malformation, bronchopulmonary sequestration, congenital lobar overinflation, bronchogenic cyst, or lung agenesis. Associated anomalies were noted and categorized according to the affected organ system. RESULTS Twenty-eight (14%) of 196 CLA patients had a major associated anomaly. This was most frequent in conjunction with a lung agenesis (100%) or bronchogenic cyst (29%). Congenital heart defects (32%) and gastrointestinal defects (18%) were the most frequently associated anomalies. Examination of newborns with a CLA should focus on the cardiovascular and gastrointestinal tract, and a chest and abdominal radiograph may be useful to assess signs of major associated anomalies, regardless of the clinical course.
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Affiliation(s)
- Sergei M Hermelijn
- Department of Paediatric Surgery and Intensive Care, Erasmus University Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Rutger R Zwartjes
- Department of Paediatric Pulmonology, Erasmus University Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Harm A W M Tiddens
- Department of Paediatric Pulmonology, Erasmus University Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Suzan C M Cochius-den Otter
- Department of Paediatric Surgery and Intensive Care, Erasmus University Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Irwin K M Reiss
- Department of Neonatology, Erasmus University Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - René M H Wijnen
- Department of Paediatric Surgery and Intensive Care, Erasmus University Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - J Marco Schnater
- Department of Paediatric Surgery and Intensive Care, Erasmus University Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands,
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Cuppari C, Cutrupi MC, Salpietro A, Sallemi A, Fusco M, Parisi GF, Salpietro C. Genetic Anomalies of the Respiratory Tract. CURRENT RESPIRATORY MEDICINE REVIEWS 2020. [DOI: 10.2174/1573398x15666191022100525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Hereditary lung diseases can affect the airways, parenchyma and vasculature of the lung.
Such diseases comprehend simple monogenic disorders such as Kartagener syndrome and
α1-antitrypsin deficiency, in which mutations of critical genes are sufficient to induce well‐defined
disease phenotypes. A major comprehension of the genetic basis of pulmonary diseases has produced
new investigations into their underlying pathophysiology and contributed sometimes to clarify on
more frequent sporadic forms. The presence of these structural abnormalities of the respiratory tract
can be fatal, so that the identification of causative genes has allowed prenatal diagnosis for many
diseases giving a greater hope of survival thanks to a more adequate and prompt management.
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Affiliation(s)
- Caterina Cuppari
- Department of Human Pathology of the Adult and Developmental Age “Gaetano Barresi”, Unit of Pediatric Emergency, University of Messina, Messina, Italy
| | - Maria Concetta Cutrupi
- Department of Human Pathology of the Adult and Developmental Age “Gaetano Barresi”, Unit of Pediatric Emergency, University of Messina, Messina, Italy
| | | | - Alessia Sallemi
- Department of Human Pathology of the Adult and Developmental Age “Gaetano Barresi”, Unit of Pediatric Emergency, University of Messina, Messina, Italy
| | - Monica Fusco
- Department of Human Pathology of the Adult and Developmental Age “Gaetano Barresi”, Unit of Pediatric Emergency, University of Messina, Messina, Italy
| | - Giuseppe Fabio Parisi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Carmelo Salpietro
- Department of Human Pathology of the Adult and Developmental Age “Gaetano Barresi”, Unit of Pediatric Emergency, University of Messina, Messina, Italy
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Cherian SV, Kumar A, Ocazionez D, Estrada -Y- Martin RM, Restrepo CS. Developmental lung anomalies in adults: A pictorial review. Respir Med 2019; 155:86-96. [PMID: 31326738 DOI: 10.1016/j.rmed.2019.07.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 06/03/2019] [Accepted: 07/05/2019] [Indexed: 11/16/2022]
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Narayanasamy S, Adler E, Mahmoud M, Burkley M, Lim FY, Subramanyam R. Airway management of congenital pulmonary airway malformation resection in neonates and infants: A case cohort study. Paediatr Anaesth 2019; 29:808-813. [PMID: 31013391 DOI: 10.1111/pan.13648] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/21/2019] [Accepted: 04/13/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Anesthestic management of congenital pulmonary airway malformation has not been well described in the literature. It is not clear whether one-lung ventialtion is indicated during thoracoscopic lobectomy and if so, what is the best technique achieve it. AIMS We describe the variables with the two commonly performed surgical techniques, thoracoscopic lobectomy and open thoracotomy, from our institutional database to assess the role of lung isolation and the preferable method of lung isolation technique for congenital pulmonary airway malformation resections. METHODS After institutional review board approval, fetal center records were reviewed retrospectively from January 2010 to July 2016 for patients who underwent congenital pulmonary airway malformation resection. The primary goal was to describe the anesthesia induction-airway management techniques with emphasis on one-lung ventilation techniques. RESULTS Among the 65 resections, one-lung ventilation was performed in 30 resections (46%) and was primarily achieved by endobronchial intubation in most cases (80%). One-lung ventilation was performed in a greater number of resections with thoracoscopic lobectomy (96%) compared to open thoracotomies. CONCLUSION From our institution cohort, one-lung ventilation was more commonly used during thoracoscopic resections and was most commonly achieved with endobronchial intubation. Most patients were induced with inhalational anesthesia (sevoflurane), nondepolarizing neuromuscular blocker, and gentle positive pressure ventilation for intubation.
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Affiliation(s)
| | - Elena Adler
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Mohamed Mahmoud
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Meghan Burkley
- Department of Anesthesiology, Le Bonheur Children's Hospital, Memphis, TN
| | - Foong-Yen Lim
- Department of Surgical Services, Cincinnati Fetal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Rajeev Subramanyam
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Arkoudis NA, Pastroma A, Velonakis G, Tsochatzis A, Mazioti A, Vakaki M, Alexopoulou E. Solitary round pulmonary lesions in the pediatric population: a pictorial review. Acta Radiol Open 2019; 8:2058460119851998. [PMID: 31210963 PMCID: PMC6545655 DOI: 10.1177/2058460119851998] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 04/30/2019] [Indexed: 11/16/2022] Open
Abstract
The purpose of this current pictorial review is to define the solitary round pulmonary lesion (SRPL), to familiarize with its prevalence in the pediatric population, and, moreover, to educate radiologists on its vast differential diagnosis and imaging manifestations. Furthermore, by highlighting valuable clues, it intends to assist radiologists efficiently partake in its diagnosis, work-up, and follow-up in order to narrow down the differential diagnosis by working alongside the clinician and combining clinical information, lab results, and radiological findings.
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Affiliation(s)
- Nikolaos-Achilleas Arkoudis
- Second Department of Radiology, University General Hospital of Athens "Attikon," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Angeliki Pastroma
- Second Department of Radiology, University General Hospital of Athens "Attikon," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Velonakis
- Radiology and Medical Imaging Research Unit, Second Department of Radiology, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Tsochatzis
- Second Department of Radiology, University General Hospital of Athens "Attikon," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Argyro Mazioti
- Second Department of Radiology, University General Hospital of Athens "Attikon," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Marina Vakaki
- Department of Radiology, P & A Kyriakou Children's Hospital, Athens, Greece
| | - Efthymia Alexopoulou
- Second Department of Radiology, University General Hospital of Athens "Attikon," Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Liszewski MC, Ciet P, Lee EY. MR Imaging of Lungs and Airways in Children:. Magn Reson Imaging Clin N Am 2019; 27:201-225. [DOI: 10.1016/j.mric.2019.01.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Zirpoli S, Munari AM, Primolevo A, Scarabello M, Costanzo S, Farolfi A, Lista G, Zoia E, Zuccotti GV, Riccipetitoni G, Righini A. Agreement between magnetic resonance imaging and computed tomography in the postnatal evaluation of congenital lung malformations: a pilot study. Eur Radiol 2019; 29:4544-4554. [PMID: 30796572 DOI: 10.1007/s00330-019-06042-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 12/20/2018] [Accepted: 01/24/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To compare postnatal magnetic resonance imaging (MRI) with the reference standard computed tomography (CT) in the identification of the key features for diagnosing different types of congenital lung malformation (CLM). METHODS Respiratory-triggered T2-weighted single-shot turbo spin echo (ss-TSE), respiratory-triggered T1-weighted turbo field echo (TFE), balanced fast field echo (BFFE), and T2-weighted MultiVane sequences were performed at 1.5 T on 20 patients prospectively enrolled. Two independent radiologists examined the postnatal CT and MRI evaluating the presence of cysts, hyperinflation, solid component, abnormal arteries and/or venous drainage, and bronchocele. Diagnostic performance of MRI was calculated and the agreement between the findings was assessed using the McNemar-Bowker test. Interobserver agreement was measured with the kappa coefficient. RESULTS CT reported five congenital pulmonary airway malformations (CPAMs), eight segmental bronchial atresias, five bronchopulmonary sequestrations (BPS), one congenital lobar overinflation, one bronchogenic cyst, and three hybrid lesions. MRI reported the correct diagnosis in 19/20 (95%) patients and the malformation was correctly classified in 22/23 cases (96%). MRI correctly identified all the key findings described on the CT except for the abnormal vascularization (85.7% sensitivity, 100% specificity, 100% PPV, 94.1% NPV, 95% accuracy for arterial vessels; 57.1% sensitivity, 100% specificity, 100% PPV, 84.2% NPV, 87% accuracy for venous drainage). CONCLUSIONS MRI can represent an effective alternative to CT in the postnatal assessment of CLM. In order to further narrow the gap with CT, the use of contrast material and improvements in sequence design are needed to obtain detailed information on vascularization, which is essential for surgical planning. KEY POINTS • Congenital lung malformations (CLMs) can be effectively studied by MRI avoiding radiation exposure. • Crucial features of CLM have similar appearance when comparing CT with MRI. • MRI performs very well in CLM except for aberrant vessel detection and characterization.
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Affiliation(s)
- Salvatore Zirpoli
- Pediatric Radiology and Neuroradiology, ASST Fatebenefratelli-Sacco Milano, Children's Hospital V. Buzzi, Via Castelvetro 32, 20154, Milan, Italy.
| | - Alice Marianna Munari
- Pediatric Radiology and Neuroradiology, ASST Fatebenefratelli-Sacco Milano, Children's Hospital V. Buzzi, Via Castelvetro 32, 20154, Milan, Italy
| | | | - Marco Scarabello
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Sara Costanzo
- Department of Pediatric Surgery, ASST Fatebenefratelli-Sacco Milano, Children's Hospital V. Buzzi, Via Castelvetro 32, 20154, Milan, Italy
| | - Andrea Farolfi
- Department of Pediatrics, ASST Fatebenefratelli-Sacco Milano, Children's Hospital V. Buzzi, Via Castelvetro 32, 20154, Milan, Italy
| | - Gianluca Lista
- Neonatal Intensive Care Unit, ASST Fatebenefratelli-Sacco Milano, Children's Hospital V. Buzzi, Via Castelvetro 32, 20154, Milan, Italy
| | - Elena Zoia
- Pediatric Intensive Care Unit, ASST Fatebenefratelli-Sacco Milano, Children's Hospital V. Buzzi, Via Castelvetro 32, 20154, Milan, Italy
| | - Gian Vincenzo Zuccotti
- Department of Pediatrics, ASST Fatebenefratelli-Sacco Milano, Children's Hospital V. Buzzi, Via Castelvetro 32, 20154, Milan, Italy
| | - Giovanna Riccipetitoni
- Department of Pediatric Surgery, ASST Fatebenefratelli-Sacco Milano, Children's Hospital V. Buzzi, Via Castelvetro 32, 20154, Milan, Italy
| | - Andrea Righini
- Pediatric Radiology and Neuroradiology, ASST Fatebenefratelli-Sacco Milano, Children's Hospital V. Buzzi, Via Castelvetro 32, 20154, Milan, Italy
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Abstract
RATIONALE Congenital pulmonary dysplasia (CPD), a congenital lung anomaly, is a heterogeneous group of developmental disorders with diverse clinical and imaging manifestations, including pulmonary agenesis, pulmonary aplasia, and pulmonary hypoplasia. Patients with CPD always have recurrent respiratory tract infections, dyspnea, and/or wheezing. To the best of the author's knowledge, no case of CPD with mild to moderate hemoptysis has been reported so far. Considering the rarity of this presentation, we herein report a case of hemoptysis caused by CPD. PATIENT CONCERNS We report on an 11-year-old girl who survived for 11 years with hypoplasia of the left lung without any associated complications except hemoptysis. DIAGNOSIS Left pulmonary hypoplasia. INTERVENTIONS The patient underwent left lower pulmonary lobe resection. OUTCOMES The patient recovered favorably after the operation, and no complications were observed. The hemoptysis was controlled and the cough disappeared after the surgery. LESSONS CPD is a life-threatening disorder rarely encountered in the clinic, which plays an important role in various pediatric respiratory diseases. Misdiagnosis or delayed diagnosis of pulmonary malformations results in unnecessary treatments and hospitalization. The patients should undergo pulmonary contrast-enhanced CT and bronchoscopy for accurate and timely diagnosis, followed by surgical treatment.
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Affiliation(s)
| | - Tao Ai
- Pediatric Pulmonology Department
| | - Li Wang
- Pediatric Pulmonology Department
| | - Libin Zhang
- The First Department of Pediatric Surgery, Chengdu Women's and Children's Central Hospital, Chengdu, Sichuan, China
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Sabri YY, Yamamah HGAEN, Taymour TA. Role of multislice computed tomography in evaluation of congenital tracheobronchial branching anomalies. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Winant AJ, Ngo AV, Phillips GS, Lee EY. Computed Tomography of Congenital Lung Malformations in Children: A Primer for Radiologists. Semin Roentgenol 2018; 53:187-196. [DOI: 10.1053/j.ro.2018.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Abstract
OBJECTIVE Lung disease is a common indication for neonates to require medical attention, and neonatal chest radiographs are among the most common studies interpreted by pediatric radiologists. Radiographic features of many neonatal lung disorders overlap, and it may be difficult to differentiate among conditions. CONCLUSION This review presents an up-to-date practical approach to the radiologic diagnosis of neonatal lung disorders, with a focus on pattern recognition and consideration of clinical history, patient age, and symptoms.
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Liszewski MC, Stanescu AL, Phillips GS, Lee EY. Respiratory Distress in Neonates. Radiol Clin North Am 2017; 55:629-644. [DOI: 10.1016/j.rcl.2017.02.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Nakagawa H, Nishihara M, Horiike M, Harumoto K. An infected cyst due to a congenital pulmonary airway malformation. IDCases 2017; 8:73-74. [PMID: 28491811 PMCID: PMC5423322 DOI: 10.1016/j.idcr.2017.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 02/21/2017] [Accepted: 02/24/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hidenori Nakagawa
- Department of Pediatrics, Yodogawa Christian Hospital, Yodogawa Christian Hospital, 1-7-50 Kunijima, Higashiyodogawa-ku, Osaka 533-0024, Japan
| | - Masato Nishihara
- Department of Pediatrics, Yodogawa Christian Hospital, Yodogawa Christian Hospital, 1-7-50 Kunijima, Higashiyodogawa-ku, Osaka 533-0024, Japan
| | - Masaki Horiike
- Department of Pediatric Surgery, Yodogawa Christian Hospital, 1-7-50 Kunijima, Higashiyodogawa-ku, Osaka 533-0024, Japan
| | - Ken Harumoto
- Department of Pediatric Surgery, Yodogawa Christian Hospital, 1-7-50 Kunijima, Higashiyodogawa-ku, Osaka 533-0024, Japan
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PATOLOGÍA PULMONAR CONGÉNITA: EVALUACIÓN Y MANEJO PERINATAL. REVISTA MÉDICA CLÍNICA LAS CONDES 2016. [DOI: 10.1016/j.rmclc.2016.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Manson DE. Magnetic resonance imaging of the mediastinum, chest wall and pleura in children. Pediatr Radiol 2016; 46:902-15. [PMID: 27229507 DOI: 10.1007/s00247-016-3598-7] [Citation(s) in RCA: 10] [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: 09/28/2015] [Revised: 01/10/2016] [Accepted: 02/25/2016] [Indexed: 02/03/2023]
Abstract
The acceptance of applications for the use of chest MRI in children has been somewhat slow and selective. The use of MRI to image chest wall lesions is likely the most common and widely used indication, aside from the widespread and somewhat sophisticated use of MRI in imaging the cardiovascular structures of the chest. In this respect, fairly standard variations of T1-W, T2-W and contrast-enhanced imaging can be used, similar to the sequences used for musculoskeletal lesions elsewhere in the body. Imaging of the anterior mediastinal masses should be performed in conjunction with a detailed pre-test clinical examination to determine potential cardiovascular compromise. MRI in the setting of middle mediastinal adenopathy, congenital mediastinal cysts or posterior mediastinal masses, however, has been shown to be more effective and more comprehensive than multidetector CT. Although sonographic imaging is the initial modality of choice for pleural abnormalities, MR imaging is extremely effective and clinically useful in the setting of a potentially ambiguous sonographic examination. Faster imaging protocols are likely to increase the acceptance of MRI to replace multidetector CT for many pediatric chest lesions.
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Affiliation(s)
- David E Manson
- Department of Diagnostic Imaging, Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
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Gorospe Sarasúa L, Ayala Carbonero AM, Fernández-Méndez MÁ. Asociación de tres anomalías del desarrollo pulmonar en un adulto. Arch Bronconeumol 2016; 52:113-4. [DOI: 10.1016/j.arbres.2014.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 12/18/2014] [Accepted: 12/23/2014] [Indexed: 11/26/2022]
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Developmental lung malformations in children: recent advances in imaging techniques, classification system, and imaging findings. J Thorac Imaging 2015; 30:29-43; quiz 44-5. [PMID: 25525781 DOI: 10.1097/rti.0000000000000125] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Congenital lung anomalies represent a diverse group of developmental malformations of the lung parenchyma, arterial supply, and venous drainage, which may present anywhere from the prenatal period through adulthood. It is imperative for radiologists to be aware of imaging techniques and imaging appearance of these anomalies across the pediatric age range. This review presents the spectrum of these lesions that are often encountered in daily clinical practice. Each anomaly is discussed in terms of underlying etiology, clinical presentation, and imaging characterization with emphasis on the most up-to-date research and treatment. Knowledge of these areas is essential for accurate, timely diagnosis, which aids in optimizing patient outcomes.
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Baez JC, Ciet P, Mulkern R, Seethamraju RT, Lee EY. Pediatric Chest MR Imaging. Magn Reson Imaging Clin N Am 2015; 23:337-49. [DOI: 10.1016/j.mric.2015.01.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Irodi A, Prabhu SM, John RA, Leena R. Congenital bronchopulmonary vascular malformations, "sequestration" and beyond. Indian J Radiol Imaging 2015; 25:35-43. [PMID: 25709164 PMCID: PMC4329686 DOI: 10.4103/0971-3026.150138] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Congenital bronchopulmonary vascular malformations (BPVMs) include a broad spectrum of disorders that involve abnormalities in the form of disruptions of normal communication and/or presence of abnormal communication between one or more of the three main systems of the lung, namely, the airways, arteries, and veins. The establishment of abnormal communications by means of small openings or anastomoses is termed as malinosculation. The aim of this pictorial essay is to illustrate the imaging appearances of the various types of pulmonary malinosculation.
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Affiliation(s)
- Aparna Irodi
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Shailesh M Prabhu
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Reetu Amrita John
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rv Leena
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
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Evaluation of Contrast Injection Site Effectiveness: Thoracic CT Angiography in Children With Hand Injection of IV Contrast Material. AJR Am J Roentgenol 2015; 204:423-7. [DOI: 10.2214/ajr.14.12810] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Siegert-Olivares AI, Penchyna Grub J, Jamaica Balderas L, Jaramillo González C, Sáenz Gómez J, Karam Bechara J. [Pulmonary aplasia: report of two cases]. BOLETIN MEDICO DEL HOSPITAL INFANTIL DE MEXICO 2015; 72:66-70. [PMID: 29421183 DOI: 10.1016/j.bmhimx.2015.02.004] [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: 12/11/2014] [Revised: 01/30/2015] [Accepted: 02/03/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Pulmonary aplasia is a rare disorder of lung development characterized by the presence of a rudimentary main bronchus in the absence of lung and pulmonary artery. It is generally associated with other congenital defects and must be suspected in the presence of a total radiopaque hemithorax. CASE REPORTS We describe two cases of pulmonary aplasia diagnosed in the Hospital Infantil de México "Federico Gómez" in the last 5 years. The first case was a female who presented respiratory distress from birth with a radiopaque left hemithorax in which the diagnosis of pulmonary aplasia was completed with bronchoscopy and lung scan. Her evolution has been insidious, characterized by chronic respiratory symptoms, oxygen dependence and pneumonias. The second case is a 5 year old female, who remained asymptomatic untill the age of two years when she was hospitalized for gastroeteritis. She underwet chest X-rays with findings suspicious of right diaphragmatic hernia. She was then transferred to our hospital. She underwent surgery at which time diaphragmatic eventration and no ipsilateral lung were found. The diagnosis was completed with a blind bottom main right bronchus in bronchoscopy. CONCLUSIONS Pulmonary aplasia is an uncommon pathology. Due to great variability in clinical presentation, there must be a high index of suspicion in the presence of a fully radiopaque hemithorax. Among the diagnostic methods, X-rays, tomography and lung scan are useful. Bronchoscopy is required for diagnostic confirmation. Surgical removal of the stump and translocation of the diaphragm have been proposed as surgical options.
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Affiliation(s)
| | - Jaime Penchyna Grub
- Servicio de Endoscopia y Cirugía de Tórax, Hospital Infantil de México Federico Gómez, México D.F., México
| | | | | | - Jessica Sáenz Gómez
- Servicio de Neumología, Hospital Infantil de México Federico Gómez, México D.F., México
| | - José Karam Bechara
- Servicio de Neumología, Hospital Infantil de México Federico Gómez, México D.F., México
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Liu YL, Wu PS, Tsai LP, Tsai WH. Pediatric round pneumonia. Pediatr Neonatol 2014; 55:491-4. [PMID: 23597522 PMCID: PMC7102776 DOI: 10.1016/j.pedneo.2013.01.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 06/13/2012] [Accepted: 01/22/2013] [Indexed: 11/25/2022] Open
Abstract
"Round pneumonia" or "spherical pneumonia" is a well-characterized clinical entity that seems to be less addressed by pediatricians in Taiwan. We herein report the case of a 7-year-old boy who presented with prolonged fever, cough, and chest X-rays showing a well-demarcated round mass measuring 5.9 × 5.6 × 4.3 cm in the left lower lung field, findings which were typical for round pneumonia. The urinary pneumococcal antigen test was positive, and serum anti-Mycoplasma pneumoniae antibody titer measurement using a microparticle agglutination method was 1:160 (+). After oral administration of antibiotics including azithromycin and amoxicillin/clavulanate, which was subsequently replaced by ceftibuten due to moderate diarrhea, the fever subsided 2 days later and the round patch had completely resolved on the 18th day after the diagnosis. Recent evidence suggests treating classical round pneumonia with antibiotics first and waiving unwarranted advanced imaging studies, while alternative etiologies such as abscesses, tuberculosis, nonbacterial infections, congenital malformations, or neoplasms should still be considered in patients with atypical features or poor treatment response.
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Affiliation(s)
- Yen-Lin Liu
- Department of Pediatrics, Buddhist Tzu Chi General Hospital, Taipei Branch, Xindian, New Taipei, Taiwan,Ph.D. of Translational Medicine Program, National Taiwan University and Academia Sinica, Taipei, Taiwan,Department of Pediatrics, Taipei Medical University Hospital, Taipei, Taiwan
| | - Ping-Sheng Wu
- Department of Pediatrics, Buddhist Tzu Chi General Hospital, Taipei Branch, Xindian, New Taipei, Taiwan
| | - Li-Ping Tsai
- Department of Pediatrics, Buddhist Tzu Chi General Hospital, Taipei Branch, Xindian, New Taipei, Taiwan,Department of Medicine, College of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Wen-Hsin Tsai
- Department of Pediatrics, Buddhist Tzu Chi General Hospital, Taipei Branch, Xindian, New Taipei, Taiwan; Department of Medicine, College of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan.
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Abstract
The management of congenital lung malformations is controversial both in the prenatal and postnatal periods. This article attempts to inform best practice by reviewing the level of evidence with regard to prenatal diagnosis, prognosis, and management and postnatal management, including imaging, surgical indication, surgical approach, and risk of malignancy. We present a series of clinically relevant statements along those topics and analyze the evidence for each. In the end, we make a plea for an adequate description of the lesions, both before and after birth, which will allow future comparisons between management options and the initiation of prospective registries.
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Affiliation(s)
- Robert Baird
- Department of Pediatric Surgery, McGill University, Montreal Children׳s Hospital, McGill University Health Center, Montreal, QC, Canada
| | - Pramod S Puligandla
- Department of Pediatric Surgery, McGill University, Montreal Children׳s Hospital, McGill University Health Center, Montreal, QC, Canada; Department of Pediatrics, McGill University, Montreal Children׳s Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Jean-Martin Laberge
- Department of Pediatric Surgery, McGill University, Montreal Children׳s Hospital, McGill University Health Center, Montreal, QC, Canada.
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