Congenital lung malformations: can we avoid computed tomography? A five-year study (original) (raw)
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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.
Accuracy of prenatal and postnatal imaging for management of congenital lung malformations
Journal of Pediatric Surgery, 2020
The purpose of this study was to compare the accuracy of prenatal and postnatal imaging modalities for evaluation and management of congenital lung malformations (CLMs). Methods: A retrospective review was performed of all fetuses evaluated for a CLM between December 2001 and January 2018. Pre and postnatal imaging findings, operative treatment, and patient outcomes were collected. Patients were included in analysis if they had fetal imaging (US and/or fetal MRI), a postnatal chest CT, and surgical pathology. Results: Over the study period, we identified 157 patients with prenatal imaging that also had a follow-up with postnatal chest CT at a median age of 2.1 [1.4, 3.2] months. Of these, 75% (n = 117) had surgical resection. Diagnostic accuracy (DA) for localization of unilobar lesions was 100% for pre-and postnatal imaging and 97% vs 98% for multilobar disease, respectively. On comparison for identification of aberrant vasculature and pathology prediction, pre-and postnatal imaging DAs were similar. However, postnatal CT had the highest specificity for diagnosing lesions overall (p b 0.05). Conclusion: Prenatal imaging provides valuable information for counseling and possible fetal intervention. However, this study suggests that postnatal CT scan continues to provide important information for preoperative counseling and surgical management.
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.
CT of Congenital Lung Lesions in Pediatric Patients
American Journal of Roentgenology, 2004
ongenital lung lesions in children may involve the lung parenchyma, bronchi, arterial supply, and venous drainage. Such lesions may present with respiratory symptoms at birth or may be detected incidentally either before or after birth. Chest radiography may detect many of these lesions. CT may be useful in confirming the presence of the lesion, determining the extent of the lesion, and defining associated abnormalities. Reconstructed data from CT examinations displayed in either
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.
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.
Prenatal diagnosis of congenital lung malformations
Pediatric Radiology, 2012
Prenatal diagnosis of congenital lung anomalies has increased in recent years as imaging methods have benefitted from technical improvements. The purpose of this pictorial essay is to illustrate typical imaging findings of a wide spectrum of congenital lung anomalies on prenatal US and MRI. Moreover, we propose an algorithm based on imaging findings to facilitate the differential diagnosis, and suggest a follow-up algorithm during pregnancy and in the immediate postnatal period.
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...
Congenital lung abnormality quantification by computed tomography: The CLAQ method
Pediatric Pulmonology
Introduction: To date, no consensus has been reached on the optimal management of congenital lung abnormalities, and factors predicting postnatal outcome have not been identified. We developed an objective quantitative computed tomography (CT) scoring method, and assessed its value for clinical decision-making. Methods: Volumetric CT-scans of all patients born with a congenital lung abnormality between January 1999 and 2018 were assessed. Lung disease was quantified using the newly-developed congenital lung abnormality quantification (CLAQ) scoring method. In 20 equidistant axial slices, cells of a square grid were scored according to the abnormality within. The scored CT parameters were used to predict development of symptoms, and SD scores for spirometry and exercise tolerance (Bruce treadmill test) at 8 years of age. Results: CT-scans of 124 patients with a median age of 5 months were scored. Clinical diagnoses included congenital pulmonary airway malformation (49%), bronchopulmonary sequestration (27%), congenital lobar overinflation (22%), and bronchogenic cyst (1%). Forty-four patients (35%) developed symptoms requiring surgery of whom 28 (22%) patients became symptomatic before a CT-scan was scheduled. Lesional hyperdensity was found as an important predictor of symptom development and decreased exercise tolerance. Using receiver operating characteristic analysis, an optimal cutoff value for developing symptoms was found at 18% total disease. Conclusion: CT-quantification of congenital lung abnormalities using the CLAQ method is an objective and reproducible system to describe congenital lung abnormalities on chest CT. The risk for developing symptoms may increase when more than a single lung lobe is affected.
Congenital lung malformations: a novel application for lung ultrasound?
Journal of Ultrasound, 2019
Congenital lung malformations (CLMs) include a group of different disorders. With widespread use of antenatal ultrasonography (aUS) and increased use of pre-natal magnetic resonance imaging (MRI), CLMs are increasingly detected, nevertheless the best postnatal imaging approach is not yet well defined: newborns usually undergo several chest X-rays and eventually computed tomography to confirm the diagnosis. In this case series, we show lung ultrasound features of three different cases of congenital lung malformations, describing prenatal and postnatal images comparing different imaging techniques.