METHODS
This is a retrospective study of all consecutive patients diagnosed
prenatally with hyperechoic lung images examined at our institution
between 2009 and 2018. The study was approved by the institutional
review board and no written consent was required from the families.
Information on pre- and post-natal periods and imaging were retrieved
from the medical charts. Prenatal evaluation was performed by a fetal
medicine specialist and monthly serial ultrasound examination was
performed from referral and up until delivery using a Voluson 730,
Expert E8 or E10 (General Electric, Zipf, Austria). Each ultrasound
examination included description of the mass and its evolution since the
last exam: laterality, echogenicity, detection or absence of a feeding
systemic arterial supply, and size in the three plans. Fetal
hemodynamics was also serially assessed. Presence or absence of
complications defined as mediastinal shift, compression of neighboring
organs, signs of heart failure, polyhydramnios and hydrops were
evaluated.
Gestational age at birth and birth weight were recorded; neonatal and
postnatal respiratory signs and symptoms were assessed in all cases. The
correlation between prenatal ultrasound features and neonatal symptoms
was examined. Postnatal management included confirmation of the prenatal
findings by chest x-ray in the first days of life and thoracic CT-scan
without contrast injection or MRI within the first 6 months of birth.
The need for surgery was assessed by a pediatric surgeon based both on
clinical symptoms and CT-scan features. When surgery was required, the
histology of the malformation was studied. When conservative management
was decided, imaging follow-up was based on CT-scan with low radiation
dose. Patients with macrocystic malformation (BC, PCM or hybrid masses)
were always referred for surgery, even when asymptomatic. This decision
was taken considering the risk of over infection of the cysts, the
surgical difficulties after infectious complications and the potential
for malignancy. Patients with CLE were operated only when showing
respiratory symptoms or signs of compression on follow-up CT-scan. In
case of BPS, the surgical indication was based on the presence of
secondary clinical symptoms, increase in size of the lesion on follow-up
imaging or large systemic arteries.