Congenital Lobar Overinflation: A Rare Enigmatic Lung Lesion on Prenatal Ultrasound and Magnetic Resonance Imaging

Oliver, Edward R.; DeBari, Suzanne E.; Horii, Steven C.; Pogoriler, Jennifer; Victoria, Teresa; Khalek, Nahla; Howell, Lori J.; Adzick, N. Scott; Coleman, Beverly G.

doi:10.1002/jum.14801

Cited by 24 publications

(20 citation statements)

References 21 publications

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“…In a recent review of proven postnatal CLE cases at our institution in a span of 14 years, CLE presented as homogeneously echogenic or T2 hyperintense lesions, usually with no cysts and no bronchoceles (Figure ) . Bronchial elements, defined as small T2 hyperintense tubular structures with a diameter smaller than its accompanying vessel and without connection to the central airway, were found and thought to represent small obstructed peripheral bronchi.…”

Section: Introductionmentioning

confidence: 99%

Imaging of fetal tumors and other dysplastic lesions: A review with emphasis on MR imaging

et al. 2020

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Fetal tumors and other dysplastic masses are relatively rare. They are usually the result of failure of differentiation and maturation during embryonic or fetal life; dysplastic lesions may be the consequence of an obstruction sequence. In this review, we present the most commonly encountered tumors and masses seen during fetal life. Imaging characteristics, tumoral organ of origin, and its effect on the surrounding organs and overall fetal hemodynamics are descriptors that must be relayed to the fetal surgeon and maternal fetal medicine expert, in order to institute most accurate parental counseling and appropriate perinatal treatment plan.

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Section: Introductionmentioning

confidence: 99%

Imaging of fetal tumors and other dysplastic lesions: A review with emphasis on MR imaging

et al. 2020

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“…The confirmation of the diagnosis was good but obtained only for the operated cases (11/13), because no systematic CT scans were performed after birth, leading to an incomplete analysis. In these 3 series no case of CLE was reported, whereas it is now recognized as one of the main causes of prenatal hyperechoic lesions 22,23 . Based on systematic post‐natal imaging, our series shows in detail that various congenital lung malformations can have a prenatal hyperechoic aspect: CLE, PCM, BC, BPS and hybrid malformation.…”

Section: Discussionmentioning

confidence: 72%

Ultrasound detected prenatal hyperechoic lung lesions and concordance with postnatal findings: A common aspect for multiple diagnoses

et al. 2020

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Objective Hyperechoic lung lesions are largely detected prenatally but their underlying etiology is still poorly defined. The aim of the study was to determine the concordance between pre and postnatal diagnosis of hyperechoic lung lesions. Methods Prenatal ultrasound (US) evaluation was performed by a fetal medicine specialist. Postnatal diagnosis was based on CT‐scan. Pre‐ and postnatal features were retrieved from medical charts. Results Seventy five patients were included from January 2009 to December 2018. Main prenatal diagnoses were bronchopulmonary sequestrations (BPS) (n = 24%‐32%), pulmonary cystic malformations (PCM) (n = 19%‐25%), congenital lobar emphysemas (CLE) (n = 15%‐20%). Mediastinal shift was observed in 18 cases (24%). The prenatal detection of a systemic arterial supply had a diagnostic accuracy of 90%, while the prenatal detection of a cystic component had a diagnostic accuracy of 76.5%. All 16 neonates with prenatal isolated mediastinal shift were asymptomatic at birth. Seven neonates showed respiratory distress that was not predicted prenatally. Conclusions Hyperechoic lung malformations reflect a heterogeneous group of lesions with a good concordance for bronchopulmonary sequestration, but not a satisfying prediction for cystic lesions.

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“…CLFO is also known as congenital lobar emphysema and is a rare cystic lung lesion characterized by overinfl ation of lung tissue. 25,26 Th e proposed etiological causes are bronchial cartilage hypoplasia or absence, and intrinsic or extrinsic bronchial obstruction producing a one-way valve eff ect resulting in air-trapping and progressive lobar and segmental alveolar hyperinfl ation. 10,20,25,26 Th e most common US fi nding is a solid-appearing uniformly hyperechoic lesion with absence of identifi able cyst and a systemic blood supply.…”

Section: Discussionmentioning

confidence: 99%

“…25,26 Th e proposed etiological causes are bronchial cartilage hypoplasia or absence, and intrinsic or extrinsic bronchial obstruction producing a one-way valve eff ect resulting in air-trapping and progressive lobar and segmental alveolar hyperinfl ation. 10,20,25,26 Th e most common US fi nding is a solid-appearing uniformly hyperechoic lesion with absence of identifi able cyst and a systemic blood supply. 26 Prenatal MR imaging fi ndings were a homogeneous hyperintense lesion with or without mass eff ect on mediastinum and intact lung architecture with stretching or elongation of non-displaced hilar vessels.…”

Section: Discussionmentioning

confidence: 99%

“…10,20,25,26 Th e most common US fi nding is a solid-appearing uniformly hyperechoic lesion with absence of identifi able cyst and a systemic blood supply. 26 Prenatal MR imaging fi ndings were a homogeneous hyperintense lesion with or without mass eff ect on mediastinum and intact lung architecture with stretching or elongation of non-displaced hilar vessels. 20,25,26 Prenatal diff erential diagnosis of cystic lung lesions may not be possible based on imaging fi ndings alone.…”

Section: Discussionmentioning

confidence: 99%

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Congenital Thoracic Abnormalities: Contribution of Prenatal Magnetic Resonance İmaging to Ultrasound Diagnosis

Dinç¹,

Öztürk²

2021

Sakarya Medical Journal

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Objective We aimed to evaluate the contribution of prenatal magnetic resonance (MR) imaging to ultrasound (US) in the diagnosis of congenital thoracic abnormalities. Materials and MethodsThirty-three out of 984 pregnant women, with fetal thoracic anomalies detected at US and subsequently underwent fetal MR imaging were analyzed retrospectively. In the present methodological study, prenatal MR imaging and US findings are compared with postnatal imaging, autopsy, surgical pathologic examination, physical examination or clinical follow-up. Diagnostic sensitivities were calculated for US, MR imaging and combinations of both methods by comparing US and MR results with postnatal definite diagnoses. Results The sensitivities of US and MR imaging in detecting thoracic anomalies were 53.3% and 66.7%, respectively. Both US and MRI findings were consistent in prenatal imaging in a total 27 (82%) of cases. Both US and MR imaging made correct diagnosis in 48% of cases. MR imaging confirmed the suspected US diagnosis in 3%. Prenatal MR imaging positively contributed to US with revealing additional findings such as pulmonary hypoplasia and mediastinal shift in 30% cases. Main contribution (90%) of MR imaging to US was in congenital diaphragmatic hernia (CDH) cases. In all cases with CDH, MRI showed reduction in T2 signal consistent with pulmonary hypoplasia. MR imaging completely altered the diagnosis in 9% of cases. Total contribution rate of prenatal MR imaging to US was 42%. Sixty-seven percent of prenatally detected congenital cystic adenomatoid malformation (CCAM) and congenital lobar fluid overload (CLFO) cases exhibited spontaneous resolution before birth. Conclusion MR imaging as a complementary to US can be used successfully in the prenatal diagnosis of congenital thoracic pathologies. It can provide additional findings, confirm the suspected diagnosis or completely alter the prenatal US diagnosis. The most additional contribution of MRI to US was provided in cases of CDH. Keywords prenatal diagnosis; magnetic resonance imaging; ultrasound; thorax abnormalities Öz Amaç Çalışmada konjenital torasik anomalikleri olan fetüslerde prenatal manyetik rezonans görüntüleme (MRG)'nin prenatal ultrason (US)'na olan katkısını ortaya koymayı amaçladık. Gereç ve Yöntemler Prenatal dönemde ultrason (US) de fetal torasik anomaliler tespit edilen ve ardından fetal MRG yapılan 984 gebenin 33'ü retrospektif olarak analiz edildi. Metadolojik çalışmada, prenatal MR görüntüleme ve US bulguları doğum sonrası görüntüleme, otopsi, cerrahi patolojik inceleme, fizik muayene veya klinik takip ile karşılaştırıldı. US, MRG ve her iki yöntemin kombinasyonları için tanısal duyarlılıklar, US ve MR sonuçları, doğum sonrası kesin tanılarla karşılaştırılarak hesaplandı. Bulgular US ve MRG'nin torasik anomalileri saptamadaki duyarlılıkları sırasıyla % 53.3 ve % 66.7 bulundu. Prenatal görüntülemede olguların %82'sinde hem MR hem de US bulguları birbiriyle uyumluydu. Olguların %48'inde hem MR hem de US doğru tanıyı koydu. MRG, %3 olguda şüpheli US tanısını ...

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Congenital Lobar Overinflation: A Rare Enigmatic Lung Lesion on Prenatal Ultrasound and Magnetic Resonance Imaging

Cited by 24 publications

References 21 publications

Imaging of fetal tumors and other dysplastic lesions: A review with emphasis on MR imaging

Imaging of fetal tumors and other dysplastic lesions: A review with emphasis on MR imaging

Ultrasound detected prenatal hyperechoic lung lesions and concordance with postnatal findings: A common aspect for multiple diagnoses

Congenital Thoracic Abnormalities: Contribution of Prenatal Magnetic Resonance İmaging to Ultrasound Diagnosis

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