1
|
Navallas M, Chiu P, Amirabadi A, Manson DE. Preoperative delineation of pulmonary fissural anatomy at multi-detector computed tomography in children with congenital pulmonary malformations and impact on surgical complications and postoperative course. Pediatr Radiol 2020; 50:636-645. [PMID: 31993708 DOI: 10.1007/s00247-020-04618-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/10/2019] [Accepted: 01/10/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Delineation of the anatomy and integrity of the pulmonary fissures at CT is important because anomalous or incomplete fissures might increase the risk of surgery and of postoperative complications. OBJECTIVE To preoperatively evaluate the integrity of the pleural fissures in children with congenital lung malformations and determine whether anomalous fissural anatomy is a risk factor for a more complicated surgery and postoperative course. MATERIALS AND METHODS We reviewed preoperative multi-detector CT scans of consecutive children who underwent open or thoracoscopic resection of a congenital pulmonary malformation from 2008 to 2018, to determine the integrity of the fissural anatomy, and compared these findings with the surgical report. We correlated postoperative factors including operating room time, days in hospital and chest tube with the operating room documented fissural integrity. RESULTS We saw a significant association between the radiologically determined fissural integrity at CT and the operative findings independently for the right, left and both lungs combined (P<0.001). The sensitivity of CT to determine fissural integrity was 76.9%, specificity 95.2%, positive predictive value 95.2%, negative predictive value 76.9%, and accuracy 85.1%. There was a statistically significant association between size of the pulmonary malformation and the integrity of the fissure(s) (P=0.024). Larger lesions also resulted in a significantly longer hospitalization (P=0.024). CONCLUSION Chest CT showed high accuracy for delineating fissural anatomy in children with congenital pulmonary malformations, with a good interobserver correlation. Incomplete lung fissures were found more often in children with larger congenital pulmonary malformations. In addition, larger lesions were associated with longer hospital stays. Therefore, children with incomplete fissures may have a longer postoperative course. Analysis of the fissural anatomy should be included in the CT report.
Collapse
Affiliation(s)
- María Navallas
- Department of Diagnostic Imaging, Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada. .,Department of Medical Imaging, Division of Pediatric Imaging, University of Toronto, Toronto, ON, Canada.
| | - Priscilla Chiu
- Department of Pediatric Surgery, Hospital for Sick Children, Toronto, ON, Canada
| | - Afsaneh Amirabadi
- Department of Diagnostic Imaging, Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.,Department of Medical Imaging, Division of Pediatric Imaging, University of Toronto, Toronto, ON, Canada
| | - David E Manson
- Department of Diagnostic Imaging, Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.,Department of Medical Imaging, Division of Pediatric Imaging, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
2
|
Oliver ER, DeBari SE, Giannone MM, Pogoriler JE, Johnson AM, Horii SC, Gebb JS, Howell LJ, Adzick NS, Coleman BG. Going With the Flow: An Aid in Detecting and Differentiating Bronchopulmonary Sequestrations and Hybrid Lesions. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:371-383. [PMID: 28795424 DOI: 10.1002/jum.14346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 04/30/2017] [Accepted: 05/05/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To assess the ability of prenatal ultrasound (US) in identifying systemic feeding arteries in bronchopulmonary sequestrations and hybrid lesions and report the ability of US in classifying bronchopulmonary sequestrations as intralobar or extralobar. METHODS Institutional Review Board-approved radiology and clinical database searches from 2008 to 2015 were performed for prenatal lung lesions with final diagnoses of bronchopulmonary sequestrations or hybrid lesions. All patients had detailed US examinations, and most patients had ultrafast magnetic resonance imaging (MRI). Lesion location, size, and identification of systemic feeding arteries and draining veins were assessed with US. RESULTS The study consisted of 102 bronchopulmonary sequestrations and 86 hybrid lesions. The median maternal age was 30 years. The median gestational age was 22 weeks 5 days. Of bronchopulmonary sequestrations, 66 had surgical pathologic confirmation, and 100 had postnatal imaging. Bronchopulmonary sequestration locations were intrathoracic (n = 77), intra-abdominal (n = 19), and transdiaphragmatic (n = 6). Of hybrid lesions, 84 had surgical pathologic confirmation, and 83 had postnatal imaging. Hybrid lesion locations were intrathoracic (n = 84) and transdiaphragmatic (n = 2). Ultrasound correctly identified systemic feeding arteries in 86 of 102 bronchopulmonary sequestrations and 79 of 86 hybrid lesions. Of patients who underwent MRI, systemic feeding arteries were reported in 62 of 92 bronchopulmonary sequestrations and 56 of 81 hybrid lesions. Ultrasound identified more systemic feeding arteries than MRI in both bronchopulmonary sequestrations and hybrid lesions (P < .01). Magnetic resonance imaging identified systemic feeding arteries that US did not in only 2 cases. In cases in which both systemic feeding arteries and draining veins were identified, US could correctly predict intrathoracic lesions as intralobar or extralobar in 44 of 49 bronchopulmonary sequestrations and 68 of 73 hybrid lesions. CONCLUSIONS Ultrasound is most accurate for systemic feeding artery detection in bronchopulmonary sequestrations and hybrid lesions and can also type the lesions as intralobar or extralobar when draining veins are evaluated.
Collapse
Affiliation(s)
- Edward R Oliver
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Suzanne E DeBari
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Mariann M Giannone
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jennifer E Pogoriler
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Pathology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ann M Johnson
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Steven C Horii
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Juliana S Gebb
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lori J Howell
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - N Scott Adzick
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Beverly G Coleman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| |
Collapse
|
3
|
Seear M, Townsend J, Hoepker A, Jamieson D, McFadden D, Daigneault P, Glomb W. A review of congenital lung malformations with a simplified classification system for clinical and research use. Pediatr Surg Int 2017; 33:657-664. [PMID: 28204920 DOI: 10.1007/s00383-017-4062-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Congenital lung abnormalities are rare malformations increasingly detected early by prenatal ultrasound. Whether management of these frequently asymptomatic lesions should be surgical or conservative is an unresolved issue. The necessary prospective studies are limited by the absence of a widely accepted practical classification system. Our aim was to develop a simple, clinically relevant system for classifying and studying congenital lung abnormalities. MATERIALS AND METHODS We based our proposed grouping on a detailed analysis of clinical, radiological, and histological data from well-documented cases, plus an extensive review of the literature. RESULTS The existence of hybrid lesions and common histological findings suggested a unified embryological mechanism-possibly obstruction of developing airways with distal dysplasia. Malformations could be classified by their anatomical and pathological findings; however, a system based on the prenatal ultrasound plus initial chest X-ray findings had greater clinical relevance: Group 1-Congenital solid/cystic lung malformation, Group 2-Congenital hyperlucent lobe, Group 3-Congenital small lung. CONCLUSIONS Pathological classification is academically important but is unnecessarily complex for clinical and research use. Our simple radiological-based system allows unambiguous comparison between the results of different studies and also guides the choice of necessary investigations specific to each group.
Collapse
Affiliation(s)
- Michael Seear
- Divisions of Respiratory Medicine, British Columbia's Children's Hospital, Room 1C 31, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.
| | - Jennifer Townsend
- Divisions of Respiratory Medicine, British Columbia's Children's Hospital, Room 1C 31, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada
| | - Amy Hoepker
- Divisions of Respiratory Medicine, British Columbia's Children's Hospital, Room 1C 31, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada
| | - Douglas Jamieson
- Divisions of Radiology, British Columbia's Children's Hospital, Vancouver, Canada
| | - Deborah McFadden
- Divisions of Pathology, British Columbia's Children's Hospital, Vancouver, Canada
| | - Patrick Daigneault
- Division of Pediatric Respirology, Centre Mere-Enfant du CHUQ, Universite Laval, Quebec, Canada
| | - William Glomb
- Division of Pediatric Pulmonology, University of Texas Medical Branch, Austin, USA
| |
Collapse
|
4
|
Wu WJ, Shih JC, Sago H, Chen M. Complete resolution of hydrops by placement of double basket catheter in a case of macrocystic type multilocular pulmonary sequestration. Taiwan J Obstet Gynecol 2017; 56:402-405. [DOI: 10.1016/j.tjog.2017.04.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2017] [Indexed: 12/23/2022] Open
|
5
|
D'Eufemia MD, Cianci S, Di Meglio F, Di Meglio L, Di Meglio L, Vitale SG, Laganà AS, Chiofato B, Rapisarda AMC, Padula F, La Rosa V, Coco C, Vascone C. Congenital high airway obstruction syndrome (CHAOS): discussing the role and limits of prenatal diagnosis starting from a single-center case series. J Prenat Med 2016; 10:4-7. [PMID: 28725339 DOI: 10.11138/jpm/2016.10.1.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES we aimed to report our experience about congenital high airway obstruction syndrome (CHAOS) that is a rare and fatal congenital anomaly; laryngeal atresia is the most frequent cause. Sonographic findings are enlarged echogenic lungs, dilated trachea, and ascites. METHODS we performed a single-center case series analysis collecting antenatally through ultrasound examination, and some of them confirmed by autopsy. RESULTS we report six cases of CHAOS diagnosed by antenatal ultrasonography between 2007 and 2013. CONCLUSION to date literature provides very few individual case reports. This work describes typical sonographic findings of this syndrome and it underlines the importance of early prenatal diagnosis to improve prognosis thought an ex utero intrapartum treatment, that seems to be the only chance of survival for the affected fetus.
Collapse
Affiliation(s)
- Maria Diletta D'Eufemia
- Department of Woman, Child and General and Specialistics Surgery, Second University of Naples, Italy
| | - Stefano Cianci
- Department of Medical Surgical Specialties, Gynecology and Obstetrics Section, University of Catania, Italy
| | - Filippo Di Meglio
- Department of Gynaecological-Obstetrical Sciences and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Letizia Di Meglio
- Clinical Department of Gynaecology and Obstetrics of Physiopathology Reproduction, "Federico II" University of Naples, Italy
| | - Lavinia Di Meglio
- Clinical Department of Gynaecology and Obstetrics of Physiopathology Reproduction, "Federico II" University of Naples, Italy
| | - Salvatore Giovanni Vitale
- Unit of Gynaecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina, Italy
| | - Antonio Simone Laganà
- Unit of Gynaecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina, Italy
| | - Benito Chiofato
- Unit of Gynaecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina, Italy
| | | | - Francesco Padula
- Department of Prenatal Diagnosis, Altamedica Fetal Maternal Medical Centre, Rome, Italy
| | - Valentina La Rosa
- Unit of Psychodiagnostics and Clinical Psychology, University of Catania, Italy
| | - Claudio Coco
- Department of Prenatal Diagnosis, Altamedica Fetal Maternal Medical Centre, Rome, Italy
| | - Carmine Vascone
- Department of Woman, Child and General and Specialistics Surgery, Second University of Naples, Italy
| |
Collapse
|
6
|
Rodríguez MR, de Vega VM, Alonso RC, Arranz JC, Ten PM, Pedregosa JP. MR Imaging of Thoracic Abnormalities in the Fetus. Radiographics 2012; 32:E305-21. [DOI: 10.1148/rg.327125053] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
7
|
Witlox RS, Lopriore E, Oepkes D. Prenatal interventions for fetal lung lesions. Prenat Diagn 2011; 31:628-36. [PMID: 21618254 DOI: 10.1002/pd.2778] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Revised: 04/20/2011] [Accepted: 04/20/2011] [Indexed: 11/08/2022]
Abstract
The widespread availability of high resolution ultrasound equipment and almost universal routine anatomy scanning in all pregnant women in the developed world has lead to increased detection of abnormalities in the fetal thorax. Already in the 1980s, large pleural effusions and significant macrocystic lesions in the fetus were easily detected on ultrasound. However, smaller lung tumours were often missed. Nowadays, fetal medicine centres receive many referrals for evaluation of fetal lung lesions, of which the most common are congenital cystic adenomatoid malformation and bronchopulmonary sequestration. Almost invariably, both the parents and the referring physicians experience anxiety after detection of large lung masses in the fetus. However, the vast majority of the currently detected fetal lung lesions have an excellent prognosis without the need for prenatal intervention. In the small group of fetuses in which the prognosis is poor, almost exclusively those with concomitant fetal hydrops and cardiac failure, several options for fetal therapy exist, often with a more than 50% survival rate. Indications, techniques, complications and outcomes of these interventions will be described in this review.
Collapse
Affiliation(s)
- Ruben S Witlox
- Department of Paediatrics, Division of Neonatology, Leiden University Medical Centre, Leiden, The Netherlands.
| | | | | |
Collapse
|
8
|
Triulzi F, Manganaro L, Volpe P. Fetal magnetic resonance imaging: indications, study protocols and safety. Radiol Med 2011; 116:337-50. [DOI: 10.1007/s11547-011-0633-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 09/02/2010] [Indexed: 12/17/2022]
|
9
|
Biyyam DR, Chapman T, Ferguson MR, Deutsch G, Dighe MK. Congenital Lung Abnormalities: Embryologic Features, Prenatal Diagnosis, and Postnatal Radiologic-Pathologic Correlation. Radiographics 2010; 30:1721-38. [PMID: 21071385 DOI: 10.1148/rg.306105508] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Deepa R Biyyam
- Department of Radiology, University of Washington Medical Center, Seattle, WA 98195, USA.
| | | | | | | | | |
Collapse
|
10
|
Fetal tumors: imaging features. Pediatr Radiol 2010; 40:1263-73; quiz 1321-2. [PMID: 20309537 DOI: 10.1007/s00247-010-1571-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 12/29/2009] [Accepted: 01/22/2010] [Indexed: 10/19/2022]
Abstract
Although fetal tumors are rare, the prognostic and decision-making implications are substantial. The purpose of this pictorial essay is to highlight the most common tumors encountered during fetal imaging and to discuss the respective typical imaging findings. When appropriate, limited additional information regarding further considerations for patient care will be included.
Collapse
|
11
|
Norris M. Congenital cystic adenomatoid malformation. Australas J Ultrasound Med 2009; 12:39-41. [PMID: 28191061 PMCID: PMC5024837 DOI: 10.1002/j.2205-0140.2009.tb00059.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Mary Norris
- Nepean Hospital; Penrith New South Wales Australia
| |
Collapse
|
12
|
Sepulveda W. Perinatal imaging in bronchopulmonary sequestration. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:89-94. [PMID: 19106364 DOI: 10.7863/jum.2009.28.1.89] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Waldo Sepulveda
- Fetal Medicine Center, Department of Obstetrics and Gynecology, Clinica Las Condes, Santiago, Chile.
| |
Collapse
|