Short Abstract
All lung malformations can appear prenatally as hyperechogenic images.
Prenatal features cannot predict postnatal symptoms.INTRODUCTION
Congenital lung malformations encompass a wide spectrum of diseases that
include pulmonary cystic malformations (PCM), bronchopulmonary
sequestrations (BPS), bronchogenic cysts (BC) and congenital lobar
emphysema (CLE) 1, 2, 3. Associations can also be
observed, mainly cystic images with systemic arterial vascularization
that are recognized as hybrid malformations 4-6, but
also more diverse associations, pleading for a continuous spectrum
rather than for independent lung diseases7. The
majority of affected fetuses remain asymptomatic prenatally as well as
after birth 1,8,9, but rare cases with prenatal
hydrops can be observed, that are associated with a very poor prognosis10,11.
Prenatal diagnosis is based on ultrasound features including size,
location, echogenicity and presence or absence of a systemic arterial
supply. However, the agreement between pre and postnatal imaging and/or
histopathological analysis has been shown to be limited10-12. The classical prenatal ultrasound aspect varies
from hyperechoic to hypoechoic images, with single or multiple
locations. Several classifications have been proposed for congenital
lung images, since the Stocker’s original classification in 1970s, which
was based on postmortem pathological data 13-16. The
prenatal evaluation is now classically based on the Adzick
classification, which divides these images in macrocystic (cysts
diameter > 5 mm) and microcystic (cysts diameter
< 5 mm) 13. Macrocystic images are defined
after birth as congenital cystic malformations with a large agreement
among fetal medicine professionals 13,14,17,18.
Microcystic malformations appear as solid hyperechoic structures in the
prenatal images and are not that clearly identified after birth, leading
to inaccuracies in the prenatal counseling and also difficulties for
postnatal management 17,18.
The aim of the study was to determine the concordance between pre and
postnatal diagnosis of prenatal hyperechoic lung images, in view of
providing accurate information to parents during pregnancy and to
organize perinatal management.