Fetal echogenic lung lesions: Prenatal ultrasound diagnosis and outcome

Abstract

The differential diagnosis of echogenic areas in the fetal chest include congenital diaphragmatic hernia (CDH), cystic adenomatoid malformation (CAM), sequestrated lung and tracheal or bronchial atresia. The purpose of this study was to evaluate the accuracy of prenatal diagnosis and document outcome in fetuses with echogenic chest lesions. Seventeen fetuses with echogenic chest masses were seen in our unit between 17 and 36 weeks' gestation over a 5-year period. We reviewed these cases retrospectively for prenatal diagnosis, postnatal diagnosis and outcome. Prenatal diagnosis was correct in 13 fetuses, with CDH in 8, sequestrated lung in 4 and tracheal atresia in 1. Four fetuses had incorrect or uncertain prenatal diagnoses. In three fetuses CDH and CAM could not be differentiated. After delivery two of these had CDH and one had sequestrated lung. One fetus with bilateral lesions had prenatal diagnosis of bilateral CAM. Post-mortem examination revealed tracheal atresia as part of Fraser syndrome. All five babies with sequestrated lung are well and none required surgery. Ten fetuses had CDH, two pregnancies were terminated, one died in utero, five died as neonates and two babies survived following surgery. The study reveals that in a minority of fetuses CDH and CAM could not be differentiated prenatally. We agree with recent reports of fetal sequestrated lung describing sonographic improvement in utero. A large lesion on initial scan does not necessarily predict a poor neonatal outcome in this condition. This, together with the poor outcome in fetuses with echogenic CDH and tracheal atresia, has important implications for prenatal counselling.

Outcome of the Prenatally Diagnosed Congenital Cystic Adenomatoid Lung Malformation: A Canadian Experience

“…The prenatal diagnosis of CCAM cannot be made with certainty [15,16]. CDH may have a very similar appearance as we have seen in some of our cases.…”

“…Finally, these 2 lesions may coexist at different sites in the same patient [3,29]. Two other malformations may have an appearance similar to microcystic CCAMs: congenital lobar emphysema [30] and an atresia of either a main bronchus [15], or of the trachea or larynx [16]. Finally, a bronchogenic cyst may look like a macrocystic CCAM [13].…”

Prenatal thoracoabdominal tumor mimicking pulmonary sequestration: a diagnosis dilemma

“…The detection of an echogenic mass in the thoracoabdominal limits (inframediastinal posterior space) suggests the diagnosis of a neuroblastoma, a lung sequestration, a cystic adenomatoid malformation, a lymphangioma, a congenital diaphragmatic hernia, or a bronchial atresia [1,2,3,4,5,6]. We add angioma as another differential diagnosis.…”

“…Thoracoabdominal masses are among the many congenital anomalies being detected in fetus [1,2]. The differential diagnosis of such anomalies include cystic adenomatoid malformation (CAM), pulmonary sequestration (PS), neuroblastoma, lymphangioma, congenital diaphragmatic hernia, and bronchial atresia [3].…”

Bronchopulmonary foregut malformations: embryology, radiology and quandary

“…Ultrasound is not only useful in diagnosis, but can also offer some pointers to the prenatal and immediately post-natal courses. Most of the lesions are discovered on ultrasound at around the end of the second trimester (range 16-36 weeks) [12,35,36,37,40], although the time of discovery often depends on the date of the first antenatal scan. Ultrasound can then be used to monitor the intra-uterine course of the lesion.…”