Prenatal detection and evaluation of an extralobar pulmonary sequestration in the posterior mediastinum
Department of Surgery, University of North Carolina, School of Medicine, Chapel Hill, NC, USA.Ultrasound in Obstetrics and Gynecology (Impact Factor: 3.85). 02/2006; 27(2):214-6. DOI: 10.1002/uog.2667
Extralobar pulmonary sequestration (EPS) is a rare developmental anomaly with aberrant nonfunctioning parenchymal tissue, associated with an increased risk of perinatal morbidity and, rarely, mortality owing to possible neonatal respiratory distress. In most cases supernumerary lobes are detected as isolated intra- or extrapleural lesions with independent systemic arterial blood supply. We report an atypical case of prenatal detection and perinatal outcome of a mediastinal EPS. Copyright © 2006 ISUOG. Published by John Wiley & Sons, Ltd.
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ABSTRACT: Extralobar pulmonary sequestrations (ELS) are masses of non-functioning lung tissue that are supplied by an anomalous systemic artery and do not have a bronchial connection to the native tracheobronchial tree. On prenatal ultrasonography, an ELS appears as a well-defined echodense, homogeneous mass. Detection by color flow Doppler ultrasonography of a systemic artery from the aorta to the fetal lung lesion is a pathognomonic feature of fetal ELS. In this case report, we describe the sonographic diagnosis of an ELS in a fetus at 22 weeks' gestation with a review of the available literature.
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ABSTRACT: To describe the antenatal findings and outcome of fetuses with echogenic lung lesions. This was a retrospective study of the prenatal sonographic features, antenatal management and outcome of 193 fetuses with an echogenic lung lesion diagnosed at 18-35 weeks of gestation. There were nine cases of congenital high airway obstruction syndrome (CHAOS), 170 cases of cystic adenomatoid malformation (CAM) and 14 cases of pulmonary sequestration (PS). A literature search was also carried out to compare our data with those of previous series. The prognosis in our series of fetuses with CHAOS was invariably poor, but the literature describes a handful of survivors after delivery by Cesarean section and ex-utero intrapartum therapy (EXIT). Of the cases in our series with PS and no pleural effusions, more than 95% survived; in half of these cases the lesion resolved antenatally and in the other half sequestrectomy was carried out postnatally. In cases with PS and pleural effusions, successful treatment was provided by the placement of thoracoamniotic shunts or occlusion of the feeding blood vessel by ultrasound-guided laser coagulation or injection of sclerosants. In cases with CAM and no hydrops, there was more than 95% survival and in up to half of the cases there was sonographic evidence of spontaneous antenatal resolution of the hyperechogenic lesion, which was confirmed by postnatal imaging in about 60% of the cases. Of the cases with CAM with hydrops managed expectantly, more than 95% died before or after birth. Of the cases with macrocystic CAM with hydrops, two-thirds survived after placement of a thoracoamniotic shunt. In cases with microcystic CAM with hydrops, there is some evidence that open fetal surgery with lobectomy could improve survival but such treatment is highly invasive for the mother. CHAOS is a severe abnormality, whereas CAM and PS are associated with a good prognosis. In a high proportion of fetuses with hyperechogenic lung lesion, there is spontaneous antenatal resolution and the underlying pathology may be transient bronchial obstruction.