Systematic review and meta-analysis of the postnatal management of congenital cystic lung lesions

Stanton, Michael; Njere, Ike; Ade-Ajayi, Niyi; Patel, Shailesh; Davenport, Mark

doi:10.1016/j.jpedsurg.2008.10.118

Cited by 233 publications

(230 citation statements)

References 54 publications

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“…11 Un metanálisis sobre el manejo posnatal de las lesiones congénitas quísti-cas pulmonares concluyó que, si bien el riesgo de presentar síntomas en los pacientes asintomáticos es bajo, la cirugía programada se asocia a mejores resultados que si se realiza en pacientes sintomá-ticos, y sugiere que la intervención se practique antes de los 10 meses, ya que esta es la edad promedio del inicio de los síntomas. 12 …”

Section: Discussionunclassified

Neumotórax hipertensivo como forma de presentación de una malformación adenomatoidea quística pulmonar

Pumara¹,

Ma²

2013

Arch Argent Pediat

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Arch Argent Pediatr 2013;111(2):e54-e57 / e54 RESUMENEl propósito de este trabajo es examinar el caso de un paciente con una forma de presentación no habitual y grave de una patología poco frecuente, como la malformación adenomatoidea quística pulmonar. Se trata de un lactante de 50 días de vida que ingresó en la unidad de cuidados intensivos pediátricos con insuficiencia respiratoria y colapso circulatorio refractario a la expansión de volumen y los inotrópicos. La radiografía de tórax mostró una imagen radiolúcida, homogénea, en la base pulmonar derecha, que parecía corresponder a una lesión bullosa en el lóbulo inferior derecho, asociada a neumotórax homolateral. Se realizó drenaje con colocación de un tubo de avenamiento pleural y se observó una mejoría clínica posterior. Se efectuó la resección del quiste mediante lobectomía inferior derecha; el diagnóstico histopatológico fue malformación adenomatoidea quística de la vía aérea de tipo 4 (clasificación de Stocker). El paciente evolucionó favorablemente. Palabras clave: malformación adenomatoidea quística congénita del pulmón, neumotórax, lactante. SUMMARYThe purpose of this paper is to examine the case of a 50-day-old patient with an unusual and severe presentation of a rare disease: congenital cystic adenomatoid malformation of the lung. The infant was admitted to the pediatric intensive care unit with respiratory failure and circulatory collapse refractory to intravenous fluids and inotropic drugs. Chest X-ray showed a radiolucent homogeneous image in the right lung base, suggesting bullous lesion of the right lower lobe associated with ipsilateral pneumothorax. Drainage was performed by placing a chest tube with subsequent clinical improvement. Later the cyst was resected by right lower lobectomy; the histopathological diagnosis was congenital cystic adenomatoid malformation type 4 (Stocker classification). The patient evolved favorably.

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Section: Discussionunclassified

Neumotórax hipertensivo como forma de presentación de una malformación adenomatoidea quística pulmonar

Pumara¹,

Ma²

2013

Arch Argent Pediat

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“…As mentioned above, the clinical symptoms of neonates with CCAM vary in severity. Neonates with severe and symptomatic cases, including in utero development of nonimmune hydrops or polyhydramnios require ventilatory support, and sometimes high-frequency ventilation or even ECMO shortly after birth because of hypoplasia of the lungs [24,25]. Initially asymptomatic neonates with isolated CCAM, in the absence of hydrops, may develop, shortly after birth, recurrent respiratory tract infections (10%) [15,23].…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, nonhydropic fetuses with isolated CCAM have little or no hypoplasia of the lungs and, therefore, a much better prognosis [26][27][28][29]. Irrespective of the absence or presence of symptoms, close prenatal surveillance, carefully planned delivery, and rigorous postnatal evaluation at a facility with ECMO capability and pediatric surgical care all contribute to favorable outcome [21][22][23][24][25]. Aggressive in utero management, using both thoracoamniotic shunting (for macrocystic malformations) and intrauterine laser therapy or fetal surgery (for microcystic solid malformations), has been proposed in cases with a poor prognosis [7][8][9][10].…”

Section: Discussionmentioning

confidence: 99%

“…However, compared to noninterventional obstetric care, open fetal surgery has failed to improve survival rates [7,13]. Antenatal high-risk CCAM fetuses (with either mediastinal shifting or progressive non-immune hydrops) and symptomatic CCAM neonates (with respiratory insufficiency) require immediate postnatal emergency surgery [7][8][9][10]25].…”

Section: Discussionmentioning

confidence: 99%

“…A consensus seems to be growing against the simple monitoring "wait and see" approach in cases of asymptomatic CCAM, because postnatal spontaneous resolution may not occur. Elective resection within the first 3 to 6 months of life has also been suggested, given the lifelong risk of recurrent lung infections and occult malignant lung cell proliferation [3,10,[25][26][27]. The youngest described patient with malignant malformation due to CCAM was 13 months old [30].…”

Section: Discussionmentioning

confidence: 99%

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Antenatal and postnatal management of congenital cystic adenomatoid lung malformation diagnosed by ultrasound and Magnetic Resonance Imaging (MRI)

Gruessner¹,

Hertel²,

Bültmann³

et al. 2012

OJOG

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Purpose: Antenatal diagnosis of congenital cystic adenomatoid lung malformation (CCAM) is vital for disease surveillance and postnatal care. Ultrasonography (US) has been the imaging gold standard for antenatal CCAM assessment. However, one of the limitations of US is the "vanishing phenomenon" caused by isoechogenicity of CCAM tissue and adjacent normal lung parenchyma. Methods: Antenatal serial US were concurrently used with magnetic resonance imaging (MRI) to monitor macro-and microcystic lesions. Results: In both pregnant women, antenatal US and MRI confirmed the presence, in the fetus, of cystic lesions and predicted disease regression/progression as well as the need for postnatal surgical intervention. Several advantages were detected by using both-serial US and MRI (over serial US alone)-including improved signal intensity, exact volume size measurements, precise CCAM location in particular for patients with adverse ultrasound conditions. Both neonates underwent surgical resection and had an uneventful post-operative course. Conclusions: Antenatal use of MRI as well as serial US improved information regarding tissue resolution and delineation of CCAM. The information from two imaging modalities was complementary. Our literature review confirmed the emerging role of prenatal MRI for postnatal monitoring and management of CCAM.

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A 9‐year audit of fetal chest masses in an Australian maternal—fetal medicine cohort

Gopikrishna

Henry

Kaur

et al. 2019

Australas J Ultrason Med

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Introduction: To assess fetal vs. neonatal diagnoses, pregnancy outcomes and need for surgery in babies prenatally diagnosed with congenital pulmonary airway malformation (CPAM) or bronchopulmonary sequestration (BPS). Methods: Retrospective single-centre cohort study of fetuses with a prenatal diagnosis of CPAM or BPS between 2006 and 2014. Data collected included serial antenatal ultrasound information and neonatal/infant diagnoses and outcomes. Results: Initial ultrasound diagnosis (n = 63) was CPAM in 51 and BPS in 12: nineteen (30%) fetuses had mediastinal shift and 2 (3%) had hydrops. All neonates with known birth outcome (n = 56) were liveborn. Final diagnosis in 52 infants (83%) with neonatal imaging and/or histopathology confirmed CPAM in 17/44 (39%) and BPS in 6/9 (67%). Of 34 prenatally suspected but unconfirmed CPAM lesions: 10 had no lesion on neonatal imaging, one no neonatal imaging performed, five confirmed BPS, 11 other lung/thoracic lesions, seven were lost to follow-up. There was one infant death. 27/63 infants (43%) had post-natal surgery. More neonates requiring neonatal respiratory support/resuscitation had surgery compared to those who did not (67% vs. 29%, P = 0.008). Patients with suspected CPAM or BPS on both initial and final ultrasound were more likely to have post-natal surgical management than when a lesion was no longer visible on final antenatal ultrasound (68% vs. 23%, P = 0.001). Conclusions: Over 50% of antenatally suspected CPAM/BPS either regressed or had an alternate post-natal diagnosis. Perinatal outcome was good, with the majority of neonates/infants conservatively managed. Persistently visible antenatal lesion and need for neonatal respiratory support predicted ultimate surgical management.

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Systematic review and meta-analysis of the postnatal management of congenital cystic lung lesions

Cited by 233 publications

References 54 publications

Neumotórax hipertensivo como forma de presentación de una malformación adenomatoidea quística pulmonar

Neumotórax hipertensivo como forma de presentación de una malformación adenomatoidea quística pulmonar

Antenatal and postnatal management of congenital cystic adenomatoid lung malformation diagnosed by ultrasound and Magnetic Resonance Imaging (MRI)

A 9‐year audit of fetal chest masses in an Australian maternal—fetal medicine cohort

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