Fetal cystic lung lesions: Evaluation with magnetic resonance imaging

Liu, Yu-Peng; Chen, Chih‐Ping; Shih, Shou-Chuan; Chen, Yifang; Yang, Fei-Shih; Chen, Su-Chiu

doi:10.1002/ppul.21226

Cited by 55 publications

(29 citation statements)

References 27 publications

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“…(15,26) In patients with CCAM, there is a broad spectrum of variation in terms of the evolution of the condition, which can be as severe as perinatal death (from hydrops fetalis or pulmonary hypoplasia) or as mild as asymptomatic lesions or spontaneous resolution of symptomatic lesions. (22,27,33,34) The most common symptoms are recurrent infections, (4,27,35) and there have been reports of malignant transformation (to of all CCAMs, (5,15,32,39) and can affect an entire lung or, more rarely, both lungs. (5) The cut-off surface of type III CCAM is firm and generally does not present with cystic lesions; when such lesions are present, they are no larger than 0.5 cm in diameter.…”

Section: Ccammentioning

confidence: 99%

“…(5) Nuclear magnetic resonance imaging can be useful in clarifying the diagnosis in such cases. (22) Extralobar pulmonary sequestration accounts for approximately 23% of the pulmonary lesions that are diagnosed in the prenatal period. (18) Of those, up to 68% can disappear over the course of the prenatal radiological follow-up period.…”

Section: Ccammentioning

confidence: 99%

“…(50) In the prenatal period, congenital lobar emphysema can be diagnosed by ultrasound, and there have been case reports of spontaneous volume reduction and resolution, occasionally even in utero. (22,46) Congenital lobar emphysema is generally diagnosed at birth, on the basis of a profile of respiratory failure, or through routine chest X-rays taken during routine medical visits; a routine chest X-ray reveals a hyperinflated lung lobe, sometimes accompanied by lung herniation across the midline, mediastinal shift, and areas of atelectasis in the adjacent lung parenchyma. (4) The affected lobe can appear opacified because of amniotic fluid retention.…”

Section: Ccammentioning

confidence: 99%

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Malformações pulmonares congênitas

2011

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Congenital lung malformations are rare and vary widely in their clinical presentation and severity, depending mostly on the degree of lung involvement and their location in the thoracic cavity. They can manifest at any age and can be the source of significant morbidity and mortality in infants and children. Individuals with congenital lung malformations can present with respiratory symptoms at birth or can remain asymptomatic for long periods. Recently, there has been an increase in the early diagnosis of these malformations, a change that is attributable to the routine use of prenatal ultrasound. The clinical manifestation of these malformations varies from respiratory distress in the immediate postnatal period to an incidental finding on chest X-rays. Early diagnosis and prompt treatment offer the possibility of absolutely normal lung development. The treatment of asymptomatic patients with lung malformations is controversial, because the prognosis of these diseases is unpredictable. The management of these lesions depends on the type of malformation and symptoms. Because of the risk of complications, most authors recommend resection of the lesion at the time of diagnosis. Lobectomy is the procedure of choice and yields excellent long-term results. This article describes the principal congenital lung malformations, their diagnosis, and the controversies regarding treatment.Keywords: Cystic adenomatoid malformation of lung, congenital; Bronchopulmonary sequestration; Pulmonary surgical procedures; Diagnosis. ResumoAs malformações congênitas do pulmão são raras e variam muito na sua forma de apresentação clínica e gravidade, dependendo principalmente do grau de envolvimento pulmonar e de sua localização na cavidade torácica. Elas podem se manifestar em qualquer idade e podem ser fonte de importante morbidade e mortalidade em lactentes e crianças. Os indivíduos com malformações congênitas do pulmão podem apresentar sintomas respiratórios ao nascimento, enquanto outros podem permanecer assintomáticos por longos períodos. Atualmente, com o uso rotineiro da ultrassonografia pré-natal, vem ocorrendo um aumento no diagnóstico mais precoce dessas malformações. A manifestação clínica dessas malformações varia desde uma disfunção respiratória pós-natal imediata a um achado acidental na radiografia de tórax. O diagnóstico precoce e o tratamento imediato oferecem a possibilidade de um desenvolvimento pulmonar absolutamente normal. Quando assintomáticos, a conduta para o tratamento dos pacientes com malformações pulmonares ainda é controversa, uma vez que o prognóstico dessas afecções é imprevisível. O manejo dessas lesões depende do tipo de malformação e de sintomas. Devido ao risco de complicação, a maioria dos autores sugere a ressecção da lesão no momento em que essa é identificada. A lobectomia é o procedimento de escolha, fornecendo excelentes resultados a longo prazo. Este artigo descreve as principais malformações pulmonares congênitas, seu diagnóstico e controvérsias quanto o tratamento. (5) is covered by ...

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Section: Ccammentioning

confidence: 99%

Section: Ccammentioning

confidence: 99%

Section: Ccammentioning

confidence: 99%

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Malformações pulmonares congênitas

2011

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“…Many studies indicate that PS may regress either partially or completely, or stabilize in size in utero. Partially regressed PS tends to show decreased, inhomogeneous signal intensity, while nearly complete regressed PS tends to show a very small-sized mass; thick-slab T2-weighted images are useful for detection of these conditions because of the high water content of the associated lesions (2).…”

Section: Commentmentioning

confidence: 99%

Spontaneous regression of pulmonary sequestration: prenatal and postnatal imaging findings.

et al. 2012

Journal of the Belgian Society of Radiology

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A 28-year-old woman at 24 weeks gestation was referred to our hospital for evaluation of a fetal lung mass. The differential diagnosis initially included pulmonary sequestration (PS) and microcystic congenital cystic adenomatoid malformation (CCAM), the latter because 2D color Doppler ultrasonography (US) showed no systemic artery feeding into the fetal lung lesion. At 25 weeks' gestation, a complementary magnetic resonance imaging (MRI) scan showed a hyperintense left-sided triangular mass with a systemic feeding artery arising from the descending thoracic aorta (Fig. A, arrows), thereby indicating fetal PS. In a thick-slab T2-weighted image, the lesion showed hyperintensity in the left lower thorax (Fig. B, arrows). Follow-up MRI was performed 10 weeks later, and it showed partial regression of the sequestered lung with decreased, inhomogeneous signal intensity (Fig. C and D, arrows). Multidetector computed tomography (MDCT) angiography was arranged for preoperative evaluation on postnatal day 3, and it showed partial regression of the left lower lung PS as compared to prenatal MRI performed at 35 weeks' gestation, a systemic feeding artery arising from the descending thoracic aorta ( CommentPS is a congenital malformation consisting of a nonfunctioning lung tissue. This tissue lacks normal communication with the bronchial system, and it is supplied by aberrant vessels arising from the descending thoracic aorta or other systemic arteries and drained into the pulmonary vein, inferior vena cava, azygos system, or other systemic drainage. Intralobar PS is confined within the normal pulmonary visceral pleura and has been suggested to be an acquired lesion that is caused by recurrent infections. Extralobar PS is characterized by a complete separation of the embryonic tissue that is enclosed in its own pleura, and it is universally accepted to be a congenital anomaly.Prenatally, US is the primary imaging modality for diagnosis and differentiation of PS from CCAM by revealing the feeding artery arising from the aorta to the fetal lung mass. MRI can be a useful complementary tool to US in differentiating fetal PS by visualizing the systemic feeding artery (1, 2). The characteristic MRI pattern of fetal PS during the second trimester includes a well-defined, triangular, homogeneous, hyperintense mass with intensity more than the normal lung but lower than the amniotic fluid, with the feeding artery and possible drainage veins. Many studies indicate that PS may regress either partially or completely, or stabilize in size in utero. Partially regressed PS tends to show decreased, inhomogeneous signal intensity, while nearly complete regressed PS tends to show a very small-sized mass; thick-slab T2-weighted images are useful for detection of these conditions because of the high water content of the associated lesions (2).Postnatally, various imaging techniques such as conventional angiography, MRI, color Doppler US, and MDCT angiography have been reported to aid the visualization of the abnormal feeding artery of PS. Fur...

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“…In contrast, the advantages of magnetic resonance imaging (MRI) especially in cases of attenuate ultrasound signals include exact measurement of the lesion(s)-tolung volume ratio, superior tissue resolution, with determination of disease progression or regression and precise determination of CCAM location, and need for a low number of studies [17][18][19].…”

Section: Introductionmentioning

confidence: 99%

Antenatal and postnatal management of congenital cystic adenomatoid lung malformation diagnosed by ultrasound and Magnetic Resonance Imaging (MRI)

Gruessner¹,

Hertel²,

Bültmann³

et al. 2012

OJOG

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Purpose: Antenatal diagnosis of congenital cystic adenomatoid lung malformation (CCAM) is vital for disease surveillance and postnatal care. Ultrasonography (US) has been the imaging gold standard for antenatal CCAM assessment. However, one of the limitations of US is the "vanishing phenomenon" caused by isoechogenicity of CCAM tissue and adjacent normal lung parenchyma. Methods: Antenatal serial US were concurrently used with magnetic resonance imaging (MRI) to monitor macro-and microcystic lesions. Results: In both pregnant women, antenatal US and MRI confirmed the presence, in the fetus, of cystic lesions and predicted disease regression/progression as well as the need for postnatal surgical intervention. Several advantages were detected by using both-serial US and MRI (over serial US alone)-including improved signal intensity, exact volume size measurements, precise CCAM location in particular for patients with adverse ultrasound conditions. Both neonates underwent surgical resection and had an uneventful post-operative course. Conclusions: Antenatal use of MRI as well as serial US improved information regarding tissue resolution and delineation of CCAM. The information from two imaging modalities was complementary. Our literature review confirmed the emerging role of prenatal MRI for postnatal monitoring and management of CCAM.

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Fetal cystic lung lesions: Evaluation with magnetic resonance imaging

Abstract: Prenatal MRI is useful as a diagnostic tool complementary to US for evaluating fetal cystic lung lesions. Smaller lung lesions (<60%) may regress completely.

Cited by 55 publications

References 27 publications

Malformações pulmonares congênitas

Malformações pulmonares congênitas

Spontaneous regression of pulmonary sequestration: prenatal and postnatal imaging findings.

Antenatal and postnatal management of congenital cystic adenomatoid lung malformation diagnosed by ultrasound and Magnetic Resonance Imaging (MRI)

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