Congenital Lung Lesions: Preoperative Three-Dimensional Reconstructed CT Scan as the Definitive Investigation and Surgical Management

Abstract

Aim of Study The aim of this study was to review our experience of postnatal investigations and management of congenital lung lesions. Methods All children with antenatal diagnosis undergoing surgical management were identified from hospital records. Antenatal diagnosis and serial antenatal ultrasound findings were noted, postnatal chest X-ray (CXR) and computed tomographic (CT) scan were reviewed. Pearson correlation coefficient (r) was used to look into relation between CT scan and per-operative findings. Surgical management and outcome of these lesions were assessed. Results A total of 38 children were identified between January 2000 and December 2011; 22 were males and 16 were females. The mean gestational age at diagnosis was 21 weeks (range18 to 26 weeks). Five children showed complete resolution antenatally. Four children were symptomatic at birth. Postnatal CXR showed an abnormality in only 17 infants. CT scan with three-dimensional (3D) reconstructions was performed at the mean age of 7.7 months (range 1 day to 42 months). CT scan correlated well with per-operative findings and provided adequate anatomical information r ¼ 0.98. Open thoracotomy and lobectomy/excision was performed in 23, and 15 had thoracoscopic lobectomy/excision. The mean age of operation was 18 months (range 2 days to 96 months). Twenty patients had signs of recurrent preoperative infection with pleural adhesions and hilar thickening resulting in conversion of 10 thoracoscopic cases to open surgery. Histology confirmed 26 congenital cystic adenomatoid malformations, 2 hybrid lesions, 7 sequestrations, and 3 bronchopulmonary malformations. Conclusions Antenatal resolution and normal postnatal CXR are not reliable indicators of resolution of the lesion. Early postnatal CT scan preferably with 3D reconstruction and early surgical treatment are suggested, as delaying the operation may result in repeated infection making thoracoscopic approach more difficult.

Surgical treatment of congenital cystic adenomatoid malformation: a retrospective study of single tertiary center experience

“…On one hand, it can discern some imminent threats to life, such as emphysema, which is consistent with previous study [11]. On the other hand, it also guided the surgeon in planning surgery [12]. In our series, 11 cystic lesions showed complete resolution on antenatal scans in our study, yet postnatal investigation with CT scan showed the persistence of the lesions.…”

“…In our series, 11 cystic lesions showed complete resolution on antenatal scans in our study, yet postnatal investigation with CT scan showed the persistence of the lesions. It was reported that CXR has high false-negative rates, 60% patients did not show lesion on the postnatal CXR [12], 57 cases (49.6%) showed lesion in our series. Our results shows the symptoms of CCAM that were positively correlated with CXR, and two dead cases had abnormal imagines, which supported the concept that it may be useful in showing urgent situation such as congenital lobar emphysema, mediastinal shift or a small pneumothorax [13].…”

Visualization of pleural fissures in infants on computed tomography

“…Preoperative CT is performed for congenital lung lesions to confirm diagnosis and delineate the relationship between the lung lesion and the normal anatomical structures 16. The hypothesis of this study was that the CT visibility of lung fissures increases with infant age, and the results of this study supported the hypothesis.…”

Congenital lung lesions: Postnatal management and outcome

“…They will require further radiological imaging, namely, CT scan with IV contrast for its anatomical localization. 27,44,45 These neonates are referred to pediatric surgeons for assessment and management. Our management protocol borne out of our experiences and literature evidence is to operate asymptomatic lesion after 6 months following CT scan with IV Contrast (Figure 3).…”