The Use of Fetal Bronchoscopy in the Diagnosis and Management of a Suspected Obstructive Lung Mass

Abstract

Etiologies of fetal lung anomalies include congenital pulmonary airway malformation (CPAM), intra- or extralobar pulmonary sequestration, congenital high airway obstruction syndrome (CHAOS), bronchogenic cyst, and bronchial atresia. Fetal tracheobronchoscopy has been reported both as a diagnostic and therapeutic procedure in the setting of severe congenital lung lesions. In this case report, prenatal imaging of a fetus with a large chest mass was suspicious for an obstructive bronchial lesion. The absence of visible normal lung tissue on the right side and mass effect on the left side raised the concern for pulmonary hypoplasia. After antenatal betamethasone and a period observation, hydropic changes developed. Fetal tracheobronchoscopy was then performed in an effort to identify and decompress the suspected obstructive bronchial lesion. Other than release of bronchial debris, no anatomical abnormalities were visualized. However, the right lung lesion and mediastinal shift both decreased after the fetal bronchoscopy. The newborn underwent postnatal resection of a CPAM Type II and is doing well. We hypothesize that fetal tracheobronchoscopy provided the following potential diagnostic and therapeutic benefits: (1) exclusion of an obstructive bronchial lesion; (2) disimpaction of bronchial debris from the saline lavage that we posit may have contributed to the rapid reduction in CPAM size.

<p>Congenital lobar emphysema: diagnosis and treatment options</p>

“…Thus, in older patients and in patients, who are planned to be treated conservatively, it can be used to remove bronchial plugs, to evaluate anatomical variations, or to distinguish foreign bodies. Figure 3 shows a bronchoscopic image of a bronchomalacia in the right middle lobe in a patient with CLE 20,63,64Figure 3Bronchoscopic image of bronchomalacia in the right middle lobe.…”

In utero Treatment of Congenital High Airway Obstruction Syndrome via Fetal Laryngoscopy and EXIT Procedure

“…Fetoscopic evaluation of the fetal airway with subsequent intervention has been described for a variety of indications including: (1) fetal intubation attempt prior to delivery for prenatally diagnosed airway obstruction in lieu of the more invasive outright EXIT procedure [5,12], (2) fetal endoscopic tracheal balloon occlusion in the setting of moderate or severe congenital diaphragmatic hernia [13][14][15], and (3) surgical recanalization or decom-pression of the fetal airway in the setting of CHAOS, tracheal cyst or bronchia atresia [16][17][18][19][20][21].…”