Hidden Infection in Asymptomatic Congenital Lung Malformations—A Decade Retrospective Study

Abstract

BackgroundWhether to operate on asymptomatic patients with congenital lung malformations (CLMs) remains controversial. Our study intended to find out the proportion of hidden infection in CLMs and its effect on surgery, to provide help for the management of asymptomatic CLMs patients.MethodsA retrospective review of the medical records of patients with asymptomatic CLMs from January 2011 to December 2020 was performed in our center. Selected asymptomatic patients were divided into a non-hidden infection group (NHI) and a hidden infection group (HI).ResultsA total of 581 asymptomatic CLMs patients were included in this study. Thirty-two percent of asymptomatic CLMs patients had hidden infection in the lesion. Among various CLMs diseases, intralobular pulmonary sequestration had the highest percentage of hidden infection (48.8%). With age, the proportion of HI gradually increased. Patients in the HI and NHI groups were 223 and 121. The incidence of pleural adhesion and focal abscess in the HI group were 14.9 and 7.4%. Statistical significances were shown between the two groups in intraoperative blood loss (p = 0.002), operation time (p = 0.045), chest tube drainage time (p < 0.001), postoperative hospital stay (p < 0.001), and air leak (p = 0.012).ConclusionThe proportion of HI detected by postoperative pathological results was high and they could increase the difficulty and risk of surgery. Therefore, early surgery may be a more appropriate choice for the management of asymptomatic CLMs patients.

Does Timing of Resection Influence the Presence of Inflammation within Congenital Lung Malformations?

“…102 patients underwent resection at age 14 months (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). 80% of children were asymptomatic in the neonatal period and 22% of these went on to develop a respiratory symptom.…”

“…14 The presence of inflammation has been reported on histological examination in up to 50% of resected asymptomatic lesions and is found more frequently with increasing age at time of resection. [15][16][17][18] In asymptomatic lesions, inflammation may be a sequela of subclinical infection but can also be chronic without evidence of infection. 17 Malignancy is reported to have occurred in the setting of CPAMs 19,20 and BCs, 21 and there is an association between chronic inflammation and tumourigenesis.…”

“…Fisher's exact test and logistic regression were used to look for correlation between age at resection and (1) histological inflammation and/or (2) preoperative LRTI. Results A total of 102 patients underwent resection at age 14 months (interquartile range: [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. Eighty percent of children were asymptomatic in the neonatal period and 22% of these went on to develop a respiratory symptom.…”

The optimal timing of surgery for asymptomatic congenital pulmonary airway malformation in children: a meta analysis

“…The appearance of these symptoms indicates the need for immediate surgical resection, however, the treatment plan for patients with prenatal diagnosis of CPAM who are asymptomatic is less clear. The study by Liu Chenyu et al 7 found that 32% of 581 asymptomatic Congenital Lung Malformations patients had hidden infection(HI) in postoperative pathology, and the proportion of HI was high, which would increase the difficulty and risk of surgery,so early surgery was advocated. Stanton et al 8 , Laberge et al 6 and Esposito et al 9 recommend surgery in patients with congenital lung malformations by the first year of life,and the consensus of experts in China recommend surgery should be performed between 3 months and 1 year old 10 , because patients who undergo early resection are thought to experience compensatory lung growth to reduce the risk of complication,to make the procedure technically easier and decrease radiation exposure and related risks 9,11 .However,some scholars believe that delaying surgery to later in infancy is beneficial as older children have a decreased anaesthetic and surgical risk 12,13 .The primary objective of our systematic review is to evaluate if age at surgical treatment of asymptomatic paediatric CPAM patients is associated with outcomes to determine the optimal age for surgical intervention and optimize treatment.The primary objective of our systematic review was to assess whether age at surgical treatment is associated with outcome in asymptomatic pediatric CPAM patients to determine the optimal age for surgical intervention and optimize treatment.…”

Prognosis of infants with congenital pulmonary airway malformations after surgery: a short and mid-term evaluation

“…Most infants with CPAM are asymptomatic at birth, but symptoms such as fever, cough, pneumothorax and recurrent pneumonia infections may occur later in life [3]. The probability of lung infection increases over time and may have a risk of malignant transformation, which makes surgery more difficult, so early surgery is advocated [4][5][6].…”