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.