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Congenital intrapulmonary bronchogenic cyst in the neonate--perinatal management
J Dembinski1, M Kaminski, R Schild
1Department of Neonatology, University of Bonn, Germany.
Insights
Congenital lung malformations like bronchogenic cysts (BC) require early diagnosis. This case highlights the need for prompt intervention, even after prenatal treatment, to prevent severe postnatal complications.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Congenital Malformations
Background:
- Bronchogenic cysts (BC) represent approximately 50% of congenital lung malformations.
- BC are often asymptomatic, delaying diagnosis and potentially leading to complications like pneumothorax and recurrent infections.
Observation:
- A case of a prenatally diagnosed intrapulmonary BC in the right lung is presented.
- Initial in utero thoracocentesis led to transient regression of the cyst.
- Severe postnatal symptoms, including hyperinflation and mediastinal shifting, developed rapidly.
Findings:
- Early surgical intervention was necessary despite prenatal treatment.
- Rapid postnatal deterioration underscores the unpredictable nature of BC.
- Complete resolution of symptoms was achieved post-surgery.
Implications:
- Early diagnosis and surgical management of BC are crucial for optimal outcomes.
- Prenatal diagnosis and intervention may not always prevent the need for postnatal surgery.
- This case emphasizes the importance of vigilant postnatal monitoring for infants with congenital lung malformations.
Abstract:
Approximately 50% of all congenital lung malformations are pulmonary and mediastinal bronchogenic cysts (BC). Therefore, their diagnosis and management is of clinical importance. Usually asymptomatic in the first months of life, bronchogenic cysts are frequently clinically inapparent even adulthood. Early diagnosis and elective surgery can prevent late complications such as pneumothorax, pulmonary hypertension, and recurrent infections; prognosis after surgery is excellent. If mediastinal shifting is present, fetal thoracocentesis is indicated to prevent cardiovascular insufficiency. We report a case of a prenatally diagnosed intrapulmonary BC of the right lung. Following in utero thoracocentesis of the cyst and transient spontaneous regression postnatal onset of severe clinical symptoms due to rapidly developing hyperinflation and mediastinal shifting within the first days of life required early surgical intervention.