Disappearing lung echogenicity in fetal bronchopulmonary malformations: A reassuring sign?

Abstract

Congenital bronchopulmonary malformations detectable on prenatal ultrasound include cystic adenomatoid malformation (CAM), lobar sequestration, and upper airway atresia. We describe three fetuses with prenatally detected intrathoracic lesions in which the associated pulmonary hyperechogenicity disappeared before delivery. In the first case of pulmonary sequestration, the infant was asymptomatic after birth. However, in a case of CAM and another with laryngeal atresia, respiratory distress developed after delivery, despite recent scans showing apparently normal lung fields. This experience suggests that ultrasonic resolution of hyperechogenic lung lesions in utero does not necessarily indicate resolution of the underlying pathology.

Large fetal congenital cystic adenomatoid malformations: growth trends and patient survival

“…Although there may be some slight variation in the definition of hydrops at a given institution, the precise reasons for the more positive outcomes obtained in our study remain unclear. Moreover, there have been at least a dozen reported cases documenting resolution of fetal CCAMs with fluid noted in the pleural and/or abdominal cavities [2,[19][20][21][22][23][24][25]. Anecdotally, the administration of antenatal steroid therapy may also facilitate resolution of these lesions in the setting of hydrops [26].…”

Fetal lung masses: prenatal course and outcome.

“…Interestingly, in the majority of these fetuses the sonographic appearance was that of a solid echogenic mass, which had been thought to carry a poor prognosis.1.S,6,8 Although the fetuses in our study who had resolution of their chest masses did well, Meager and colleagues report several cases in which lung echogenicity improved with persistent underlying pathologic processes and respiratory distress at birth. 12 Meizner and Rosenak report a case of an intrathoracic mass thought to be a pulmonary sequestration, which resolved in utero. The newborn infant had significant respiratory distress and was diagnosed has having a large mucous plug.…”

Laryngeal atresia presenting as fetal ascites, olygohydramnios and lung appearance mimicking cystic adenomatoid malformation in a 25-week-old fetus with Fraser syndrome

“…, Meagher et al (1993) and Kalache et al (1997) suggested that the diagnosis of laryngeal abnormalities in the fetus is difficult even when prenatal ultrasonography shows increased echogenicity of the lungs and fetal ascites. The prenatal ultrasonography should be examined by a clinical geneticist and post-mortem examination should be performed by a fetal pathologist.…”