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Fetal lung lesions: management and outcome
N S Adzick1, M R Harrison, T M Crombleholme
1The Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia, Pennsylvania 19104, USA.
American Journal of Obstetrics and Gynecology
|October 28, 1998
Summary
Prenatal diagnosis of fetal lung masses like congenital cystic adenomatoid malformation and extralobar pulmonary sequestration shows variable outcomes. Fetal therapy offers hope for hydrops cases, while many lesions resolve spontaneously or require postnatal intervention.
Area of Science:
- Medical research
- Fetal medicine
- Pediatric surgery
Background:
- Congenital cystic adenomatoid malformation (CCAM) and extralobar pulmonary sequestration (EPS) are common fetal lung anomalies.
- These conditions can lead to significant morbidity and mortality if not managed appropriately.
- Understanding their natural history and treatment outcomes is crucial for optimal patient care.
Purpose of the Study:
- To review the experience with CCAM and EPS in fetuses.
- To emphasize the natural history, management strategies, and outcomes of these conditions.
- To evaluate the effectiveness of fetal interventions for severe cases.
Main Methods:
- Retrospective review of 175 fetal lung lesions diagnosed via antenatal ultrasonography.
- Data collected from two specialized fetal treatment centers.
- Analysis of management approaches including expectant management, fetal surgery, and thoracoamniotic shunting.
Main Results:
- CCAM: 134 cases; expectant management successful for non-hydropic lesions. Fetal surgery and shunting improved survival in hydropic cases.
- EPS: 41 cases; 28 regressed spontaneously prenatally. Symptomatic cases required postnatal resection.
- Fetal therapy (surgery/shunting) demonstrated positive outcomes in selected hydropic CCAM and EPS cases.
Conclusions:
- Prenatally diagnosed lung masses have a variable natural history.
- Most CCAM can be managed expectantly with postnatal resection; fetal therapy is viable for hydrops.
- Many EPS lesions resolve in utero, potentially avoiding postnatal intervention.