CT of Congenital Lung Lesions in Pediatric Patients (original) (raw)
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Congenital lung malformations: can we avoid computed tomography? A five-year study
Polish Journal of Radiology
Purpose: Congenital lung malformations (CLMs) consist of a variety of pulmonary development disorders. In the CLM approach, computed tomography (CT) is considered the gold standard imaging technique due to the high-resolution for the lung parenchyma evaluation, the study of the vascular system after contrast injection, and the multiplanar reconstructions. In the paediatric population CT is considered too invasive due to ionizing radiation and the use of contrast agent. Therefore, the indications for the use of magnetic resonance imaging (MRI) are increasing. The aim of our study is to compare retrospectively MRI and CT in the evaluation of CLMs, to reduce or avoid the use of contrast-enhanced CT in the paediatric population. Material and methods: We retrospectively evaluated 22 paediatric patients with prenatal diagnosis of CLMs. All the patients underwent postnatal MRI in the first 2 weeks of life (except for a patient) and pre-surgery contrast-enhanced CT. A total of 7 blinded radiologists divided into 3 different groups independently reviewed each MRI and CT examination. Sensitivity and specificity of radiologists with different years of experience on the field, as well as of MRI findings regarding every pathology, were evaluated using a ROC curve. The interobserver agreement regarding the MRI findings was also measured. Results: Analysing the ROC curves, we observed that MRI provided a satisfactory accuracy for diagnosing most congenital pulmonary diseases. Conclusions: Our study showed that MRI without contrast agent allows us to reach a CLM diagnosis in good agreement with contrast-enhanced CT, which is considered the gold standard imaging technique.
Imaging of congenital lung diseases presenting in the adulthood: a pictorial review
Insights into Imaging, 2021
Congenital lung diseases in adults are rare diseases that can present with symptoms or be detected incidentally. Familiarity with the imaging features of different types of congenital lung diseases helps both in correct diagnosis and management of these diseases. Congenital lung diseases in adults are classified into three main categories as bronchopulmonary anomalies, vascular anomalies, and combined bronchopulmonary and vascular anomalies. Contrast-enhanced computed tomography, especially 3D reconstructions, CT, or MR angiography, can show vascular anomalies in detail. The tracheobronchial tree, parenchymal changes, and possible complications can also be defined on chest CT, and new applications such as quantitative 3D reconstruction CT images, dual-energy CT (DECT) can be helpful in imaging parenchymal changes. In addition to the morphological assessment of the lungs, novel MRI techniques such as ultra-short echo time (UTE), arterial spin labeling (ASL), and phase-resolved functi...
European Journal of Pediatric Surgery, 2013
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 ΒΌ 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.
What Do You Know About the Imaging Findings in Congenital Pulmonary Malformations in Children?
Scholars Journal of Medical Case Reports
Original Research Article Aim: Determine the epidemiological, radiological, therapeutic and progressive profile of bronchopulmonary malformations. Materials and methods: This is a retrospective study over 10 years (03/2010 to 10/2019), including 20 children hospitalized in our institution for bronchopulmonary malformation. Results: We have identified 7 cases of adenomatoid cystic lung malformations, 3 cases of congenital lobar emphysema,3 cases of pulmonary sequestration in its extra lobar form, 3 cases of bronchogenic cyst, 1case of pulmonary sequestration associated with cystic adenomatoid malformations, 1 case of Pulmonary hypoplasia, 1 case of pulmonary agenesis and 1 case of pulmonary arteriovenous malformation. The prenatal diagnosis was carried out in a single patient, other patient benefited from a postnatal diagnosis with an average age of 26 months. All patients were symptomatic with an average age of 14 months. The symptomatology was dominated by respiratory distress, and respiratory infection. The chest X-ray guided the diagnosis in most cases and the CT scan confirmed the diagnosis of all cases. Lobectomy was performed in 67% of the patients. The pathological examination confirmed the diagnosis of the malformation in all cases. The postoperative and long-term outcome, with a follow-up ranging from 3 months to 3 years, was favorable in most of the patients followed. Conclusion: Imaging has a fundamental role in the management of congenital pulmonary malformations, in their diagnosis and in the assessment of surgical forms. CT is the modality of choice, thanks to its ease of access, its speed of acquisition, its high spatial resolution that it offers.
CT imaging of mass-like nonvascular pulmonary lesions in children
Pediatric Radiology, 2007
The purpose of this pictorial essay is to review the CT imaging findings of both common and rare masslike nonvascular pulmonary lesions in children. Understanding the characteristic CT appearance of mass-like nonvascular pulmonary lesions in children aids in accurate diagnosis and allows unnecessary or inadvisable interventions (biopsies and/or surgery) to be avoided in specific cases.
Congenital lung malformation: Evaluation of prenatal and postnatal radiological findings
Respirology, 2009
Background and objective: This study evaluated the accuracy of prenatal MRI and postnatal CT imaging in the identification of congenital cystic adenomatoid malformation and bronchopulmonary sequestration by comparison with histological analysis. Methods: Over a 3-year period, 15 patients with lung malformations diagnosed prenatally by ultrasound were referred for prenatal MRI, and all were investigated postnatally by chest CT. All asymptomatic newborns with unresolved lesions underwent elective surgery by thoracoscopy. All surgical specimens were analysed histologically. Results: Among the 15 patients with an abnormality diagnosed by ultrasound, prenatal MRI findings differed from the final histological diagnosis with respect to extent (n = 3), type of lesion (n = 1) and aberrant vessel identification (n = 4). Postnatal chest CT failed to visualize the aberrant vessel in one patient. Complete regression of the lesion was noted in two patients with bronchopulmonary sequestration, and in one patient with congenital cystic adenomatoid malformation and was confirmed by CT. Elective thoracoscopic lobectomy of the affected lobe was performed for 12 patients. Two conversions to thoracotomy were required.All operated patients had an uneventful hospital course. Conclusions: Prenatal MRI is less accurate than postnatal CT scan, which remains the most reliable diagnostic modality to specify the location and extent and kind of lesions.
Polish journal of radiology, 2017
Computed tomography with its excellent spatial and temporal resolution remains a valuable diagnostic modality in pediatrics. On the other hand an increasing attention has been placed on the radiation risks associated with CT imaging, especially in children. In recent years, many advances in CT hardware and software, for example, automatic exposure control tools and iterative reconstruction techniques, have allowed for a reduction of applied radiation doses while maintaining image quality. The purpose of this paper is to present our protocol for chest CT imaging in the youngest age group, together with a pictorial review of congenital pathologies of the chest, and to emphasize factors that optimize postnatal CT imaging in infants. In our opinion, modern CT imaging with the use of dose reduction techniques and iterative reconstructions allows for a proper visualization of chest pathologies in small children, which has no influence on observer performance. The presented review of low-d...
Management of congenital lung lesions
Early Human Development, 2006
Antenatally diagnosed lung lesions are most commonly congenital cystic adenomatiod malformations (CCAMs) or bronchopulmonary sequestrations (BPS). Congenital lobar emphysema and bronchogenic cysts occur rarely. CCAMs and BPS can only be truly distinguished on histopathological assessment. CCAMs can be defined using either Stocker's histological classification, or the clinically more useful dmacrocysticT and dmicrocysticT subtypes introduced by Adzick. Adverse pathophysiological effects (e.g. lung hypoplasia, mediastinal shift, caval obstruction and hydrops) can occur with those of larger volume in the developing fetus and are associated with a poor outcome (~5%). In centres with appropriate expertise, antenatal intervention (e.g. thoracoamniotic shunting) should be considered for such cases. In the postnatal period, early radiological evaluation (e.g. CT scan) is essential as many cases which apparently dregressT antenatally are still detectable and may be a cause of later morbidity. Early surgical excision is required for symptomatic cases and should also be considered for asymptomatic antenatally diagnosed lesions, because of the risks of later infection and the possibility of malignant transformation. An excellent outcome following surgery can be expected.
Paediatric lung imaging: the times they are a-changin
European respiratory review : an official journal of the European Respiratory Society, 2018
Until recently, functional tests were the most important tools for the diagnosis and monitoring of lung diseases in the paediatric population. Chest imaging has gained considerable importance for paediatric pulmonology as a diagnostic and monitoring tool to evaluate lung structure over the past decade. Since January 2016, a large number of papers have been published on innovations in chest computed tomography (CT) and/or magnetic resonance imaging (MRI) technology, acquisition techniques, image analysis strategies and their application in different disease areas. Together, these papers underline the importance and potential of chest imaging and image analysis for today's paediatric pulmonology practice. The focus of this review is chest CT and MRI, as these are, and will be, the modalities that will be increasingly used by most practices. Special attention is given to standardisation of image acquisition, image analysis and novel applications in chest MRI. The publications discu...
Magnetic resonance imaging for congenital lung malformations
Pediatric Radiology
Congenital lung malformations are most often identified on prenatal US screening. Fetal MRI is often performed to further evaluate these lesions. Although some of these lesions might cause prenatal or early postnatal symptoms that require urgent management, the majority are asymptomatic at birth and might be subtle or invisible on chest radiographs. Postnatal imaging is frequently deferred until 3-6 months of age, when surgery or long-term conservative management is contemplated. High-quality imaging and interpretation is needed to assist with appropriate decision-making. Contrast-enhanced chest CT, typically with angiographic technique, has been the usual postnatal imaging choice. In this review, the author discusses and illustrates the indications and use of postnatal MR imaging for bronchopulmonary malformations as well as some differential diagnoses and the advantages and disadvantages of MR versus CT.