Results of surgical treatment of congenital cystic lung disease

A rare case of congenital lobar emphysema presenting as recurrent pneumonia in early adulthood: A case report and literature review

INTRODUCTION AND SIGNIFICANCE

Congenital lobar emphysema (CLE) is a rare but important lung malformation typically discovered in the newborn period. Some rare cases are reported in adults. It can present with various respiratory symptoms. Diagnosis relies primarily on chest CT scans, and the main treatment is surgery.

CASE PRESENTATION

We present a case of a young girl with recurrent respiratory infections who was misdiagnosed with a pneumothorax. A chest tube was inserted. Later, CLE was identified, and the affected lung lobe was surgically removed.

CLINICAL DISCUSSION

This case highlights the importance of including CLE in the differential diagnosis for hyperinflation of a lung lobe. A CT scan is crucial for confirmation.

CONCLUSION

Congenital lobar emphysema is a rare disease that primarily affects children. Most children with CLE experience symptoms and require surgery. In adults, CLE is uncommon, and surgery is based on the severity of symptoms and radiological findings.

Symptom development in originally asymptomatic CPAM diagnosed prenatally: a systematic review

PURPOSE

For the approximately three quarters of patients with a prenatal diagnosis of congenital pulmonary airway malformation (CPAM) who are asymptomatic at birth, the chance of eventually developing symptoms is unknown. We sought to explore the natural history of asymptomatic CPAM.

METHODS

We searched EMBASE, MEDLINE, and the first 50 results from Google Scholar. Studies describing the natural history of prenatally diagnosed, initially asymptomatic CPAM were included. For asymptomatic patients initially managed non-surgically, we tabulated the proportion who went on to develop symptoms as well as the median age at symptom development.

RESULTS

We included data from 19 retrospective studies on 353 patients. Of the 128 patients managed expectantly, 31 (24.2%) developed symptoms requiring surgical intervention. The median age at symptom development was 7.5 months (range 15 days-5 years).

CONCLUSION

The risk for developing respiratory symptoms exists with originally asymptomatic CPAM patients, but the exact risk is difficult to predict. Parents may be given the value of approximately 1 in 4 as an estimate of the proportion of asymptomatic CPAM patients who go on to develop symptoms, which will help them make an informed decision regarding the option of elective surgery.

Association between Congenital Lung Malformations and Lung Tumors in Children and Adults: A Systematic Review

INTRODUCTION

The appropriate management of asymptomatic congenital pulmonary malformations (CPMs) remains controversial. Prophylactic surgery is recommended to avoid the risk for development of pulmonary infections and to prevent the highly debated development of malignancy. However, the true risk for development of malignancy remains unknown. A systematic review analyzed all cases in which lung tumors associated with CPMs in both the pediatric and adult populations were described.

METHODS

A comprehensive literature search was carried out; it included all the cases in which an association between CPMs and malignant pulmonary lesions was reported.

RESULTS

In all, 134 publications were eligible for inclusion. In 168 patients CPM was found associated with lung tumor. The diagnosis was made in 76 children at a mean age of 3.68 ± 3.4, whereas in the adult population (n = 92) it was made at a mean age of 44.62 ± 16.09. Cough was the most frequent presenting symptom both in children and in adults. Most of the patients underwent lobectomy. The tumor most often associated with CPM was pleuropulmonary bastoma in children (n = 31) and adenocarcinoma (n = 20) or bronchioloalveolar carcinoma (n = 20) in adults. The CPM most frequenty associated with tumors in children was congenital cystic adenomatoid malformation (n = 37), especially type 1 (n = 21), whereas in adults it was bronchogenic cyst (n = 25), followed by congenital cystic adenomatoid malformation (n = 21).

CONCLUSIONS

CPMs should be followed up and never underestimated because they may conceal a tumor. Apparently, there is no age limit for malignant progression of CPMs and no limit of the interval between first detection of the CPM and appearance of the associated tumor.

Congenital pulmonary airway malformation and sequestration: Two standpoints for a single condition

In adults, congenital pulmonary malformations are candidates for surgery due to symptoms. A pre-natal diagnosis is simple and effective, and allows an early thoracoscopic surgical treatment. A retrospective study was performed to assess management in two different populations of adults and children to define the best strategy.

Congenital cystic adenomatoid malformation: is there a need for pregnancy termination?

Aim. Congenital cystic adenomatoid lung malformation is a rare unilateral dysplasia of the lung. Three pathologic types are described in the literature: type I with cysts >2 cm, type II with cysts <1 cm, and type III with microcysts. The aim of this paper is to present a case of a fetus with congenital cystic adenomatoid lung malformation and discuss the necessity for pregnancy termination according to its prognosis and future mortality. Case. A 36-year-old pregnant woman (para: 1, gravida: 1) presented in our department for anatomy ultrasound screening at 20 + 1 weeks of gestation. The ultrasound detected a cystic adenomatoid right lung malformation measuring 1.45 × 1.67 cm which caused mediastinal shift of the heart and the lung to the left side. Other findings were cysts of the choroid plexus and echogenic intracardiac foci. The parents after genetic counseling decided pregnancy termination. The pregnant received cabergoline for ablactation. Conclusion. Congenital cystic adenomatoid lung malformation has different prognosis according to the type (69% in type I, 0% in types II and III). Fetal hydrops, cardiac and skeletal anomalies, Potter's syndrome, and gastrointestinal atresia are common cofindings. Genetic counseling is necessary, and pregnancy termination is proposed to the cases with poor prognosis.

Management of fetal bronchogenic lung cysts: a case report and short review of literature

Congenital malformations of the lung (CML) are rare with similar embryological and clinical spectra and could result in mortality if left untreated. Bronchogenic cysts are formed during the budding of the tracheal diverticula and ventral foregut in the embryological period. In this paper we want to present a case of bronchogenic cyst with continuous intrauterine cyst aspiration follow-up. After the baby birth was operated and the postoperative period was uneventful. The pathological examination revealed a bronchogenic cyst.

Long-term outcome of asymptomatic patients with congenital cystic adenomatoid malformation

PURPOSE

Congenital cystic adenomatoid malformation (CCAM) represents a rare congenital anomaly of the lung. It remains controversial whether patients with asymptomatic lesions warrant early surgical intervention. Our aim was to review the outcome of asymptomatic CCAM patients at a paediatric tertiary centre.

METHODS

The medical case notes of all children with CCAM presenting to our institution between 1986 and 2007 were reviewed. Data on pre- and post-natal investigations, clinical presentation, lesion site, type of surgical procedure, timing, and outcomes of surgery were reviewed.

RESULTS

A total of 35 patients were diagnosed with CCAM during the 21-year study period (1986-2007). Sixty percent (n = 21) were asymptomatic at birth including eight patients with prenatal ultrasound scan confirming CCAM. In this group, 18 patients (86%) subsequently developed symptoms (median age 2 years, range 1 month-13 years) and required surgery. Symptoms included pneumonia with or without infected CCAM (43%), respiratory distress (14%) and spontaneous pneumothorax (14%). Eight patients underwent multiple hospital presentations with complications related to CCAM. Of the 21 initially asymptomatic patients, 17 (81%) underwent surgical resection. Only one of these patients was completely asymptomatic prior to surgery. There were eight post-operative complications and no mortality. One patient underwent a second thoracotomy for residual CCAM. The median length of hospital stay was 9 days (range 3-32 days).

CONCLUSION

This study suggests patients who present with asymptomatic CCAM will subsequently become symptomatic. Early surgical referral and intervention may be beneficial to avoid the development of complications.

Congenital cystic lung lesions: is surgical resection essential?

Can all congenital cystic lung lesions be treated conservatively, without the need for surgery? Our purpose here is to present the morbidity associated with symptomatic cystic lung lesions which have failed to respond to medical treatment. In the past 8 years, 22 consecutive cystic thoracic lesions were retrospectively assessed for clinical presentation, diagnostic modalities, operative findings, technical tribulations, and outcome. The endpoint was complete cessation of recurrent pneumonia and dysphagia. Age at presentation was 7.7 +/- 2.2 years, with 4 +/- 2 episodes per year of lower respiratory tract infection, which had been treated for the past 2.6 +/- 0.3 years. Cough and dyspnea (100%) were the common symptoms, with episodes of cyanosis occurring in 58%. Other significant clinical presentations were dysphagia (55%), failure to thrive (55%), chest pain (46%), haemoptysis (18%), and pleuritic pain (18%). Definitive growth was seen in 91% of the excised specimens. Preoperative morbidity resulted from intractable pneumonia, dysphagia, and failure to thrive. Surgical excision was curative. All 22 children after resection are thriving, with an absence of pneumonia and dysphagia, with normal ventilation/perfusion scans, at 48 +/- 6 months of follow-up. In conclusion, surgical excision of a symptomatic cystic lung lesion that has not responded to medical treatment is recommended.