Prenatal presentation and postnatal management of congenital thoracic malformations

Area of Science:

• Pediatric Surgery
• Fetal Medicine
• Thoracic Surgery

Background:

• Congenital thoracic malformations (CTMs) are diagnosed antenatally, causing parental anxiety and management uncertainty.
• The spectrum of CTMs includes cystic adenomatoid malformation, sequestration, and congenital lobar emphysema.
• While most CTMs do not require antenatal intervention, fetal hydrops may necessitate medical or surgical treatment due to high mortality.

Purpose of the Study:

• To review the management strategies for congenital thoracic malformations (CTMs) diagnosed antenatally.
• To discuss the therapeutic dilemma posed by asymptomatic CTMs in newborns.
• To highlight the importance of individualized family counseling based on current evidence.

Main Methods:

• Review of existing literature on antenatal diagnosis and management of CTMs.
• Discussion of surgical versus conservative approaches for asymptomatic CTMs.
• Analysis of potential complications and long-term risks associated with CTMs.

Main Results:

• Most CTMs shrink in the third trimester and may not require intervention.
• Symptomatic newborns clearly require surgical intervention.
• Asymptomatic CTMs present a dilemma, with potential for spontaneous resolution versus risks of infection, pneumothorax, bleeding, or malignancy.

Conclusions:

• Individualized counseling is crucial for families facing CTM diagnosis, both antenatally and postnatally.
• The limitations of current evidence regarding CTM management should be emphasized.
• Video-assisted thoracoscopic surgery (VATS) offers low morbidity for CTM excision when surgery is indicated.