HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Pumberger, W. Articles by Horcher, E. Search for Related Content PubMed PubMed Citation Articles by Pumberger, W. Articles by Horcher, E. Related Collections Lung - other

Eur J Cardiothorac Surg 2003;24:703-711
© 2003 Elsevier Science NL

Longitudinal observation of antenatally detected congenital lung malformations (CLM): natural history, clinical outcome and long-term follow-up

^a Department of Pediatric Surgery, Landes-Kinderklinik Linz, Krankenhausstr. 26, A-4020 Linz, Austria
^b Department of Clinical Radiology, University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
^c Department of Prenatal Diagnosis and Treatment, University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
^d Division of Pediatric Surgery, University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria

Received 7 January 2003; received in revised form 4 August 2003; accepted 6 August 2003.

^* Corresponding author. Tel.: +43-1-732-6923; fax: +43-1-732-1109
e-mail: wolfgang.pumberger{at}gespag.at

Objective: The objective of the study is to present longitudinal observations in antenatally detected congenital lung malformations (CLM), particularly pulmonary sequestration (PS) and cystic adenomatoid malformation (CAM). Methods: Fetuses found to have a CLM on prenatal ultrasound (US) were included in this study and followed up until delivery. In all newborns radiographs and computerized tomography (CT) studies of the thorax were performed. Surgical procedures included sequesterectomy, lobectomy, segmentectomy, and non-anatomic resection. Based on prenatal US findings, intrauterine course, postpartum chest radiographs and CT scans, as well as clinical signs and surgical findings patients were divided into six groups. Results: Over a period of 6 years, routine prenatal US revealed suggestion of CLM in a series of 35 consecutive fetuses. In six cases pregnancy was terminated or the fetuses suffered fetal demise. Another four fetuses became symptomatic in utero when sequential scanning revealed hydrops, hydrothorax, and enlargement of cysts or polyhydramnios. Three cases in this group received serial therapeutic amniocentesis and serial puncture of either the hydrothorax or intrapulmonary cysts. After postpartum treatment in the intensive care unit surgical procedures were performed uneventfully and confirmed the diagnosis of CAM, PS or hybrid type lesions. In 11 patients US findings were considered to demonstrate spontaneous resolution of the lesion, but disappearance without sequelae could be confirmed only in six infants. Five infants were shown to have persistent CLM on postpartum CT scans. These infants underwent resection of the lesion within the first year of life. In 11 fetuses CLM were continuously demonstrated during pregnancy with only slight changes in size and structure. Postpartum the infants were asymptomatic and were subjected to a systematic plan of diagnostic work-up and treatment. Surgery in these infants revealed a large number of hybrid type lesions (n=5). In three infants, the primary diagnosis of PS or CAM had to be corrected during the diagnostic and therapeutic work-up. Conclusion: CLM are diagnosed antenatally with an increasing frequency and are shown to be quite different from previously applied concepts. The expected clinical outcome is far better than thought to be possible.

Key Words: Prenatal ultrasound diagnosis • Congenital lung malformations • Spontaneous regression • Postpartum multi-slice CT scan • Thoracic surgery