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Goussard P, Eber E, Venkatakrishna S, Janson J, Schubert P, Andronikou S. Bronchoscopy findings in children with congenital lung and lower airway abnormalities. Paediatr Respir Rev 2024; 49:43-61. [PMID: 37940462 DOI: 10.1016/j.prrv.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 10/20/2023] [Indexed: 11/10/2023]
Abstract
Congenital lung and lower airway abnormalities are rare, but they are an important differential diagnosis in children with respiratory diseases, especially if the disease is recurrent or does not resolve. The factors determining the time of presentation of congenital airway pathologies include the severity of narrowing, association with other lesions and the presence or absence of congenital heart disease (CHD). Bronchoscopy is required in these cases to assess the airway early after birth or when intubation and ventilation are difficult or not possible. Many of these conditions have associated abnormalities that must be diagnosed early, as this determines surgical interventions. It may be necessary to combine imaging and bronchoscopy findings in these children to determine the correct diagnosis as well as in operative management. Endoscopic interventional procedures may be needed in many of these conditions, ranging from intubation to balloon dilatations and aortopexy. This review will describe the bronchoscopic findings in children with congenital lung and lower airway abnormalities, illustrate how bronchoscopy can be used for diagnosis and highlight the role of interventional bronchoscopy in the management of these conditions.
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Affiliation(s)
- Pierre Goussard
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa.
| | - Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Shyam Venkatakrishna
- Department of Pediatric Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jacques Janson
- Division of Cardiothoracic Surgery, Department of Surgical Sciences, Stellenbosch University, and Tygerberg Hospital, Tygerberg, South Africa
| | - Pawel Schubert
- Division of Anatomical Pathology, Tygerberg Hospital, National Health Laboratory Service, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Savvas Andronikou
- Department of Pediatric Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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2
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Selvaraj S, Gn Y, Wong TG, Ali Khan S. Anaesthesia Management for Neurosurgery in a Patient With Congenital Lung Agenesis. Cureus 2024; 16:e54522. [PMID: 38380108 PMCID: PMC10877663 DOI: 10.7759/cureus.54522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 02/22/2024] Open
Abstract
Congenital lung agenesis is a rare congenital abnormality associated with an absence or under-development of either one or both lungs, and its presentation in adulthood is even rarer. We describe a 40-year-old female patient with a history of congenital agenesis of the right lung and a high-grade glioma in the frontal region of the brain presenting for craniotomy and excision of the tumor in an MRI suite. Lung protective strategies of ventilation were utilized intraoperatively. The remote location of the MRI suite made access to extra manpower support challenging. The patient was managed uneventfully and discharged stable to the high-dependency unit. Our case describes how congenital lung agenesis poses a unique set of challenges for anaesthetic management, particularly in neurosurgical patients, and provides guidance to a multidisciplinary team approach.
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Affiliation(s)
| | - Yingmao Gn
- Anaesthesiology, Singapore General Hospital, Singapore, SGP
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3
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Chen S, Kong L, Ren D, Duan G. Congenital hypoplasia of the left upper lobe with pulmonary cysts: A rare case report. Asian J Surg 2022; 46:1805-1806. [PMID: 36319542 DOI: 10.1016/j.asjsur.2022.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 10/13/2022] [Indexed: 11/02/2022] Open
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4
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Ogunleye E, Olusoji O, Fajolu I, Iwuchukwu P. Ten years experience in surgical management of congenital lung malformations: A prospective, cross sectional study. JOURNAL OF CLINICAL SCIENCES 2022. [DOI: 10.4103/jcls.jcls_53_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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5
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Parry AH, Raheem MAI, Ismail HH, Sharaf O. Late presentation of unilateral lung agenesis in adulthood. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [PMCID: PMC8217785 DOI: 10.1186/s43055-021-00533-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Pulmonary agenesis is a rare congenital anomaly with a reported prevalence of about 1 in 100,000 births. It may be bilateral or unilateral. Among the unilateral form, left lung agenesis is more common (70%); however, it is the right lung agenesis which carries a dismal prognosis due to the frequent association with a gamut of other congenital anomalies and greater degree of mediastinal shift leading to tracheo-bronchial and vascular distortion. The patients of unilateral pulmonary agenesis usually present in infancy or early childhood. Presentation in late adulthood as seen in our patient is rare. We present a case of left pulmonary agenesis that was diagnosed in 4th decade of life. Case presentation A 36-year-old male presented with gradually progressive exertional dyspnea of 1 month duration. Clinical examination revealed tachycardia and tachypnea. Chest radiograph showed opaque left hemithorax with ipsilateral mediastinal shift. Computed tomography clinched the diagnosis by demonstrating absence of left main bronchus, lung and left pulmonary artery with shift of heart, and great mediastinal vessels into left hemithorax. The patient was managed conservatively and discharged with attachment to out-patient department for regular follow-up. Conclusion Presentation of unilateral lung agenesis in late adulthood, as seen in the present case is extremely rare. This case report highlights that, a rare condition like unilateral pulmonary agenesis, should be considered in the list of differentials in an adult presenting with opaque hemithorax with ipsilateral mediastinal shift on radiography.
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6
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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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7
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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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8
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Le TB, Huyen TNHH, Ngo DHA, Le MT, Nguyen VP, Nguyen TT, Le TK. Isolated arterial pulmonary malinosculation without sequestration in an adult: A case report and literature review. Respir Med Case Rep 2021; 34:101514. [PMID: 34540582 PMCID: PMC8441071 DOI: 10.1016/j.rmcr.2021.101514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/15/2021] [Accepted: 09/07/2021] [Indexed: 11/28/2022] Open
Abstract
Abnormal connections between systemic and pulmonary vascular systems are rare conditions and have been mostly documented in the pediatric population. We report a case of type B isolated arterial pulmonary malinosculation in an adult. The patient's chief complaint was intermittent hemoptysis during physical exertion. He had a dual arterial supply from the anomalous systemic artery and the pulmonary artery to the left lower lobe and the venous drainage was through the pulmonary vein. The bronchial connection appeared normal. The fistula was identified on chest computed tomography and was treated endovascularly. The patient remains asymptomatic at 1-year follow-up.
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Affiliation(s)
- Trong Binh Le
- Department of Radiology, Hue University of Medicine and Pharmacy, Hue University, Hue city, Viet Nam
| | - Ton Nu Hong Hanh Huyen
- Department of Radiology, Hue University of Medicine and Pharmacy Hospital, Hue city, Viet Nam
| | - Dac Hong An Ngo
- Department of Radiology, Hue University of Medicine and Pharmacy, Hue University, Hue city, Viet Nam
| | - Minh Tuan Le
- Department of Radiology, Hue University of Medicine and Pharmacy, Hue University, Hue city, Viet Nam
| | - Vu Phong Nguyen
- Department of Cardiology, Hue University of Medicine and Pharmacy Hospital, Hue city, Viet Nam
| | - Thanh Thao Nguyen
- Department of Radiology, Hue University of Medicine and Pharmacy, Hue University, Hue city, Viet Nam
| | - Trong Khoan Le
- Department of Radiology, Hue University of Medicine and Pharmacy, Hue University, Hue city, Viet Nam
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9
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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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10
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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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11
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Marquis KM, Raptis CA, Rajput MZ, Steinbrecher KL, Henry TS, Rossi SE, Picus DD, Bhalla S. CT for Evaluation of Hemoptysis. Radiographics 2021; 41:742-761. [PMID: 33939537 DOI: 10.1148/rg.2021200150] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Hemoptysis, which is defined as expectoration of blood from the alveoli or airways of the lower respiratory tract, is an alarming clinical symptom with an extensive differential diagnosis. CT has emerged as an important noninvasive tool in the evaluation of patients with hemoptysis, and the authors present a systematic but flexible approach to CT interpretation. The first step in this approach involves identifying findings of parenchymal and airway hemorrhage. The second step is aimed at determining the mechanism of hemoptysis and whether a specific vascular supply can be implicated. Hemoptysis can have primary vascular and secondary vascular causes. Primary vascular mechanisms include chronic systemic vascular hypertrophy, focally damaged vessels, a dysplastic lung parenchyma with systemic arterial supply, arteriovenous malformations and fistulas, and bleeding at the capillary level. Evaluating vascular mechanisms of hemoptysis at CT also entails determining if a specific vascular source can be implicated. Although the bronchial arteries are responsible for most cases of hemoptysis, nonbronchial systemic arteries and the pulmonary arteries are important potential sources of hemoptysis that must be recognized. Secondary vascular mechanisms of hemoptysis include processes that directly destroy the lung parenchyma and processes that directly invade the airway. Understanding and employing this approach allow the diagnostic radiologist to interpret CT examinations accurately in patients with hemoptysis and provide information that is best suited to directing subsequent treatment. ©RSNA, 2021.
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Affiliation(s)
- Kaitlin M Marquis
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (K.M.M., C.A.R., M.Z.R., K.L.S., D.D.P., S.B.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (T.S.H.); and Department of Radiology, Centro Rossi, Buenos Aires, Argentina (S.E.R.)
| | - Constantine A Raptis
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (K.M.M., C.A.R., M.Z.R., K.L.S., D.D.P., S.B.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (T.S.H.); and Department of Radiology, Centro Rossi, Buenos Aires, Argentina (S.E.R.)
| | - M Zak Rajput
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (K.M.M., C.A.R., M.Z.R., K.L.S., D.D.P., S.B.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (T.S.H.); and Department of Radiology, Centro Rossi, Buenos Aires, Argentina (S.E.R.)
| | - Kacie L Steinbrecher
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (K.M.M., C.A.R., M.Z.R., K.L.S., D.D.P., S.B.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (T.S.H.); and Department of Radiology, Centro Rossi, Buenos Aires, Argentina (S.E.R.)
| | - Travis S Henry
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (K.M.M., C.A.R., M.Z.R., K.L.S., D.D.P., S.B.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (T.S.H.); and Department of Radiology, Centro Rossi, Buenos Aires, Argentina (S.E.R.)
| | - Santiago E Rossi
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (K.M.M., C.A.R., M.Z.R., K.L.S., D.D.P., S.B.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (T.S.H.); and Department of Radiology, Centro Rossi, Buenos Aires, Argentina (S.E.R.)
| | - Daniel D Picus
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (K.M.M., C.A.R., M.Z.R., K.L.S., D.D.P., S.B.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (T.S.H.); and Department of Radiology, Centro Rossi, Buenos Aires, Argentina (S.E.R.)
| | - Sanjeev Bhalla
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (K.M.M., C.A.R., M.Z.R., K.L.S., D.D.P., S.B.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (T.S.H.); and Department of Radiology, Centro Rossi, Buenos Aires, Argentina (S.E.R.)
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12
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Gabelloni M, Faggioni L, Accogli S, Aringhieri G, Neri E. Pulmonary sequestration: What the radiologist should know. Clin Imaging 2020; 73:61-72. [PMID: 33310586 DOI: 10.1016/j.clinimag.2020.11.040] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/13/2020] [Accepted: 11/24/2020] [Indexed: 12/11/2022]
Abstract
Pulmonary sequestration consists of a nonfunctioning mass of lung tissue, either sharing the pleural envelope of the normal lung (intralobar) or with its own pleura (extralobar), lacking normal communication with the tracheobronchial tree and receiving its arterial supply by one or more systemic vessels. It is the second most common congenital lung anomaly according to pediatric case series, but its real prevalence is likely to be underestimated, and imaging plays a key role in the diagnosis and treatment management of the condition and its potential complications. We will give a brief overview of the pathophysiology, clinical presentation and imaging findings of intra- and extralobar pulmonary sequestration, with particular reference to multidetector computed tomography as part of a powerful and streamlined diagnostic approach.
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Affiliation(s)
- Michela Gabelloni
- Diagnostic and Interventional Radiology, Department of Translational Research, University of Pisa, Via Roma, 67, 56126 Pisa, Italy
| | - Lorenzo Faggioni
- Diagnostic and Interventional Radiology, Department of Translational Research, University of Pisa, Via Roma, 67, 56126 Pisa, Italy.
| | - Sandra Accogli
- Diagnostic and Interventional Radiology, Department of Translational Research, University of Pisa, Via Roma, 67, 56126 Pisa, Italy
| | - Giacomo Aringhieri
- Diagnostic and Interventional Radiology, Department of Translational Research, University of Pisa, Via Roma, 67, 56126 Pisa, Italy
| | - Emanuele Neri
- Diagnostic and Interventional Radiology, Department of Translational Research, University of Pisa, Via Roma, 67, 56126 Pisa, Italy
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13
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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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14
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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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16
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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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Cherian SV, Girvin F, Naidich DP, Machnicki S, Brown KK, Ryu JH, Gupta N, Mehta V, Estrada-Y-Martin RM, Narasimhan M, Oks M, Raoof S. Lung Hyperlucency: A Clinical-Radiologic Algorithmic Approach to Diagnosis. Chest 2019; 157:119-141. [PMID: 31356811 DOI: 10.1016/j.chest.2019.06.037] [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: 02/04/2019] [Revised: 05/27/2019] [Accepted: 06/10/2019] [Indexed: 11/24/2022] Open
Abstract
Areas of diminished lung density are frequently identified both on routine chest radiographs and chest CT examinations. Colloquially referred to as hyperlucent foci of lung, a broad range of underlying pathophysiologic mechanisms and differential diagnoses account for these changes. Despite this, the spectrum of etiologies can be categorized into underlying parenchymal, airway, and vascular-related entities. The purpose of this review is to provide a practical diagnostic algorithmic approach to pulmonary hyperlucencies incorporating clinical history and characteristic imaging patterns to narrow the differential.
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Affiliation(s)
- Sujith V Cherian
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Texas Health - McGovern Medical School, Houston, TX
| | - Francis Girvin
- Department of Radiology, Division of Thoracic Radiology, NYU Langone Health, New York, NY
| | - David P Naidich
- Department of Radiology, Division of Thoracic Radiology, NYU Langone Health, New York, NY
| | | | - Kevin K Brown
- Department of Medicine, National Jewish Health, Denver, CO
| | - Jay H Ryu
- Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Nishant Gupta
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH
| | - Vishisht Mehta
- Division of Pulmonary Medicine, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rosa M Estrada-Y-Martin
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Texas Health - McGovern Medical School, Houston, TX
| | - Mangala Narasimhan
- Division of Pulmonary, Critical Care and Sleep Medicine, Long Island Jewish Medical Center, New Hyde Park, NY
| | - Margarita Oks
- Medicine and Radiology, Barbara and Donald Zuckerberg School of Medicine at Hofstra/Northwell, New York, NY
| | - Suhail Raoof
- Pulmonary, Critical Care & Sleep Medicine, Lenox Hill Hospital, New York, NY; Medicine and Radiology, Barbara and Donald Zuckerberg School of Medicine at Hofstra/Northwell, New York, NY.
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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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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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20
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Abad P, Mesa S, Llamas R. Síndrome de la cimitarra en resonancia magnética cardiovascular. REVISTA COLOMBIANA DE CARDIOLOGÍA 2018. [DOI: 10.1016/j.rccar.2017.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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21
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Liew Z, Thomas V, Eastham K. 'It's just a fluid level'. Arch Dis Child Educ Pract Ed 2016; 101:198. [PMID: 26310958 DOI: 10.1136/archdischild-2014-308087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 07/30/2015] [Indexed: 11/04/2022]
Affiliation(s)
- ZheYi Liew
- Department of Paediatrics, Sunderland Royal Hospital, Sunderland, UK Department of Paediatric Respiratory Medicine, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Victoria Thomas
- Department of Paediatrics, Sunderland Royal Hospital, Sunderland, UK
| | - Katherine Eastham
- Department of Paediatrics, Sunderland Royal Hospital, Sunderland, UK
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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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Zucker EJ, Epelman M, Newman B. Perinatal Thoracic Mass Lesions: Pre- and Postnatal Imaging. Semin Ultrasound CT MR 2015; 36:501-21. [PMID: 26614133 DOI: 10.1053/j.sult.2015.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Chest masses present a common problem in the perinatal period. Advances in prenatal ultrasound, supplemented by fetal magnetic resonance imaging, now allow early detection and detailed characterization of many thoracic lesions in utero. As such, in asymptomatic infants, assessment with postnatal computed tomography or magnetic resonance imaging can often be delayed for several months until the time at which surgery is being contemplated. Bronchopulmonary malformations comprise most of the thoracic masses encountered in clinical practice. However, a variety of other pathologies can mimic their appearances or produce similar effects such as hypoplasia of a lung or both lungs. Understanding of the key differentiating clinical and imaging features can assist in optimizing prognostication and timely management.
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Affiliation(s)
- Evan J Zucker
- Department of Radiology, Stanford University School of Medicine, Lucile Packard Children's Hospital, Stanford, CA.
| | - Monica Epelman
- Department of Medical Imaging, Nemours Children's Hospital, Orlando, FL
| | - Beverley Newman
- Department of Radiology, Stanford University School of Medicine, Lucile Packard Children's Hospital, Stanford, CA
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Macias L, Ojanguren A, Dahdah J, Gossot D. Thoracoscopic anatomical resection of congenital lung malformations in adults. J Thorac Dis 2015; 7:486-9. [PMID: 25922729 DOI: 10.3978/j.issn.2072-1439.2015.01.50] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 12/04/2014] [Indexed: 11/14/2022]
Abstract
Congenital lung malformations (CLM) are a heterogeneous group of disorders that may require surgical resection to prevent complications. Thoracoscopic resection of CLM has been reported in infants. Our goal was to state whether it can also be a viable option in adults. Between 2007 and 2014, 11 patients had a thoracoscopic resection of a CLM (six lobectomies and five anatomic segmentectomies) with satisfactory results. Although being more challenging in adults due to infectious sequellae, this approach is safe.
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Affiliation(s)
- Lidia Macias
- Thoracic Department, Institut Mutualiste Montsouris, 42 Bd Jourdan, F-75014 Paris, France
| | - Amaia Ojanguren
- Thoracic Department, Institut Mutualiste Montsouris, 42 Bd Jourdan, F-75014 Paris, France
| | - Julien Dahdah
- Thoracic Department, Institut Mutualiste Montsouris, 42 Bd Jourdan, F-75014 Paris, France
| | - Dominique Gossot
- Thoracic Department, Institut Mutualiste Montsouris, 42 Bd Jourdan, F-75014 Paris, France
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Pelizzo G, Mimmi MC, Ballico M, Marotta M, Goruppi I, Peiro JL, Zambaiti E, Costanzo F, Andreatta E, Tonin E, Calcaterra V. Congenital pulmonary malformations: metabolomic profile of lung phenotype in infants. J Matern Fetal Neonatal Med 2014; 29:143-7. [PMID: 25471172 DOI: 10.3109/14767058.2014.991708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The main hydrosoluble metabolites in three different human congenital pulmonary malformations are described by nuclear magnetic resonance (NMR) spectroscopy. METHODS Bronchogenic cyst (BC), congenital lobar emphysema (CLE) and intrapulmonary sequestration (IPS), were analyzed with respect to a control sample. The extracted metabolites were submitted to high-resolution (1)H NMR-spectroscopy. RESULTS Congenital lung malformations showed free choline, phosphocoline and myoinositol high levels. IPS and CLE were found increased in lactic acid/glucose ratio. Lactic acid and glucose values resulted to be more elevated in control sample. CONCLUSIONS Congenital lung lesions showed different metabolomic profiles useful for early diagnosis.
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Affiliation(s)
- Gloria Pelizzo
- a Department of the Mother and Child Health, Pediatric Surgery Unit , IRCCS Policlinico San Matteo Foundation Pavia and University of Pavia , Pavia , Italy
| | - Maria Chiara Mimmi
- b Department of Medical and Biological Sciences , University of Udine , Udine , Italy
| | - Maurizio Ballico
- b Department of Medical and Biological Sciences , University of Udine , Udine , Italy
| | - Mario Marotta
- c Cincinnati Fetal Center, Pediatric Surgery Division, CCHMC , Cincinnati , OH , USA .,d Fetal Surgery Program, Congenital Malformations Research Group, Research Institute of Hospital Universitari Vall d'Hebron , Edifici Infantil , Barcelona , Spain
| | - Ilaria Goruppi
- a Department of the Mother and Child Health, Pediatric Surgery Unit , IRCCS Policlinico San Matteo Foundation Pavia and University of Pavia , Pavia , Italy
| | - Jose Louis Peiro
- c Cincinnati Fetal Center, Pediatric Surgery Division, CCHMC , Cincinnati , OH , USA .,d Fetal Surgery Program, Congenital Malformations Research Group, Research Institute of Hospital Universitari Vall d'Hebron , Edifici Infantil , Barcelona , Spain
| | - Elisa Zambaiti
- a Department of the Mother and Child Health, Pediatric Surgery Unit , IRCCS Policlinico San Matteo Foundation Pavia and University of Pavia , Pavia , Italy
| | - Federico Costanzo
- a Department of the Mother and Child Health, Pediatric Surgery Unit , IRCCS Policlinico San Matteo Foundation Pavia and University of Pavia , Pavia , Italy
| | - Erika Andreatta
- a Department of the Mother and Child Health, Pediatric Surgery Unit , IRCCS Policlinico San Matteo Foundation Pavia and University of Pavia , Pavia , Italy
| | - Elena Tonin
- a Department of the Mother and Child Health, Pediatric Surgery Unit , IRCCS Policlinico San Matteo Foundation Pavia and University of Pavia , Pavia , Italy
| | - Valeria Calcaterra
- e Department of the Mother and Child Health, Pediatric Unit , IRCCS Policlinico San Matteo Foundation Pavia , Pavia , Italy , and.,f Department of Internal Medicine University of Pavia , Pavia , Italy
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