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Dohna M, Hirsch WF, Dingemann J, Gräfe D. [Congenital pulmonary malformations : Diagnosis and treatment]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:357-365. [PMID: 38546875 DOI: 10.1007/s00117-024-01291-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 05/02/2024]
Abstract
PERFORMANCE Congenital pulmonary malformations (CPM) are rare and can be associated with high morbidity. Clinical presentation, diagnostic procedures, imaging, and therapy of CPM are discussed. ACHIEVEMENTS Today, most CPM can be diagnosed prenatally by ultrasound. Postnatally, respiratory symptoms up to respiratory failure and recurrent lower respiratory tract infection are typical findings. Due to low diagnostic accuracy of chest x‑ray in CPM, all children with prenatal diagnosis of CPM or postnatally suspected CPM should undergo cross-sectional imaging. PRACTICAL RECOMMENDATIONS Based on imaging alone, the various subtypes of CPM cannot be definitively differentiated, which is why histological confirmation remains the gold standard. Surgical resection is the standard of care with minimally invasive procedures increasingly being employed. In certain situations, a watch-and-wait approach is possible.
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Affiliation(s)
- M Dohna
- Institut für diagnostische und interventionelle Radiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
- Klinik für diagnostische und interventionelle Radiologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
| | - W F Hirsch
- Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - J Dingemann
- Institut für diagnostische und interventionelle Radiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
- Klinik für Kinderchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - D Gräfe
- Universitätsklinikum Leipzig, Leipzig, Deutschland
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2
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Pederiva F, Rothenberg SS, Hall N, Ijsselstijn H, Wong KKY, von der Thüsen J, Ciet P, Achiron R, Pio d'Adamo A, Schnater JM. Congenital lung malformations. Nat Rev Dis Primers 2023; 9:60. [PMID: 37919294 DOI: 10.1038/s41572-023-00470-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 11/04/2023]
Abstract
Congenital lung malformations (CLMs) are rare developmental anomalies of the lung, including congenital pulmonary airway malformations (CPAM), bronchopulmonary sequestration, congenital lobar overinflation, bronchogenic cyst and isolated congenital bronchial atresia. CLMs occur in 4 out of 10,000 live births. Postnatal presentation ranges from an asymptomatic infant to respiratory failure. CLMs are typically diagnosed with antenatal ultrasonography and confirmed by chest CT angiography in the first few months of life. Although surgical treatment is the gold standard for symptomatic CLMs, a consensus on asymptomatic cases has not been reached. Resection, either thoracoscopically or through thoracotomy, minimizes the risk of local morbidity, including recurrent infections and pneumothorax, and avoids the risk of malignancies that have been associated with CPAM, bronchopulmonary sequestration and bronchogenic cyst. However, some surgeons suggest expectant management as the incidence of adverse outcomes, including malignancy, remains unknown. In either case, a planned follow-up and a proper transition to adult care are needed. The biological mechanisms through which some CLMs may trigger malignant transformation are under investigation. KRAS has already been confirmed to be somatically mutated in CPAM and other genetic susceptibilities linked to tumour development have been explored. By summarizing current progress in CLM diagnosis, management and molecular understanding we hope to highlight open questions that require urgent attention.
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Affiliation(s)
- Federica Pederiva
- Paediatric Surgery, "F. Del Ponte" Hospital, ASST Settelaghi, Varese, Italy.
| | - Steven S Rothenberg
- Department of Paediatric Surgery, Rocky Mountain Hospital for Children, Denver, CO, USA
| | - Nigel Hall
- University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Hanneke Ijsselstijn
- Department of Paediatric Surgery and Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Kenneth K Y Wong
- Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Jan von der Thüsen
- Department of Pathology and Clinical Bioinformatics, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Pierluigi Ciet
- Departments of Radiology and Nuclear Medicine and Respiratory Medicine and Allergology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Radiology, University of Cagliari, Cagliari, Italy
| | - Reuven Achiron
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, The Chaim Sheba Medical Center Tel-Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adamo Pio d'Adamo
- Laboratory of Medical Genetics, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - J Marco Schnater
- Department of Paediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
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3
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Elders BBLJ, Kersten CM, Hermelijn SM, Wielopolski PA, Tiddens HAWM, Schnater JM, Ciet P. Congenital lung abnormalities on magnetic resonance imaging: the CLAM study. Eur Radiol 2023; 33:4767-4779. [PMID: 36826502 PMCID: PMC10290040 DOI: 10.1007/s00330-023-09458-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/26/2023] [Accepted: 02/03/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVES Follow-up of congenital lung abnormalities (CLA) is currently done with chest computer tomography (CT). Major disadvantages of CT are exposure to ionizing radiation and need for contrast enhancement to visualise vascularisation. Chest magnetic resonance imaging (MRI) could be a safe alternative to image CLA without using contrast agents. The objective of this cohort study was to develop a non-contrast MRI protocol for the follow-up of paediatric CLA patients, and to compare findings on MRI to postnatal CT in school age CLA patients. METHODS Twenty-one CLA patients, 4 after surgical resection and 17 unoperated (mean age 12.8 (range 9.4-15.9) years), underwent spirometry and chest MRI. MRI was compared to postnatal CT on appearance and size of the lesion, and lesion associated abnormalities, such as hyperinflation and atelectasis. RESULTS By comparing school-age chest MRI to postnatal CT, radiological appearance and diagnostic interpretation of the type of lesion changed in 7 (41%) of the 17 unoperated patients. In unoperated patients, the relative size of the lesion in relation to the total lung volume remained stable (0.9% (range - 6.2 to + 6.7%), p = 0.3) and the relative size of lesion-associated parenchymal abnormalities decreased (- 2.2% (range - 0.8 to + 2.8%), p = 0.005). CONCLUSION Non-contrast-enhanced chest MRI was able to identify all CLA-related lung abnormalities. Changes in radiological appearance between MRI and CT were related to CLA changes, patients' growth, and differences between imaging modalities. Further validation is needed for MRI to be introduced as a safe imaging method for the follow-up of paediatric CLA patients. KEY POINTS • Non-contrast-enhanced chest MRI is able to identify anatomical lung changes related to congenital lung abnormalities, including vascularisation. • At long-term follow-up, the average size of congenital lung abnormalities in relation to normal lung volume remains stable. • At long-term follow-up, the average size of congenital lung abnormalities associated parenchymal abnormalities such as atelectasis in relation to normal lung volume decreases.
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Affiliation(s)
- Bernadette B L J Elders
- Department of Paediatric Pulmonology and Allergology, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Casper M Kersten
- Department of Paediatric Surgery, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Sergei M Hermelijn
- Department of Paediatric Surgery, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Piotr A Wielopolski
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Harm A W M Tiddens
- Department of Paediatric Pulmonology and Allergology, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - J Marco Schnater
- Department of Paediatric Surgery, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Pierluigi Ciet
- Department of Paediatric Pulmonology and Allergology, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
- Radiology Department, University of Cagliari, Cagliari, Italy.
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4
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King A, Olutoye OO, Lee TC, Keswani SG. Surgical Management of Congenital Lung Malformations. Neoreviews 2023; 24:e84-e96. [PMID: 36720690 DOI: 10.1542/neo.24-2-e84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Congenital lung malformations (CLMs) are commonly diagnosed prenatal lesions with varied natural history. Prenatal diagnosis and monitoring help to guide fetal interventions, delivery planning, and need for urgent perinatal surgical interventions. All prenatally diagnosed CLMs should be evaluated postnatally, typically with cross-sectional imaging, because many lesions persist despite the appearance of complete 'regression' in utero. Management of CLMs in asymptomatic infants weighs the surgical and anesthetic risk of prophylactic resection against the risk of expectant management, including the possibility of infection, malignant degeneration, and more complicated surgical resection later with loss of compensatory lung growth.
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Affiliation(s)
- Alice King
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.,Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX.,Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX
| | - Oluyinka O Olutoye
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Timothy C Lee
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.,Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX.,Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX
| | - Sundeep G Keswani
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.,Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX.,Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX
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5
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Lopyan NM, Perrone EE, VanHulle R, Bloom DA, Mychaliska GB, Speck KE. A single institution's experience with the management of peripheral bronchial atresia. Pediatr Surg Int 2022; 38:853-860. [PMID: 35229175 DOI: 10.1007/s00383-022-05089-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Peripheral bronchial atresia is a pulmonary abnormality diagnosed on postnatal computed tomography after prenatal imaging reveals a congenital lung lesion. Debate regarding management of this abnormality prompted us to review our institution's practice patterns and outcomes. METHODS All patients diagnosed with bronchial atresia were assessed from 6/2014 to 7/2020. Pediatric radiologists were surveyed to delineate computed tomography criteria used to diagnose peripheral bronchial atresia. Criteria were applied in an independent blinded review of postnatal imaging. Data for patients determined to have peripheral bronchial atresia and at least an initial pediatric surgical evaluation were analyzed. RESULTS Twenty-eight patients with bronchial atresia received at least an initial pediatric surgical evaluation. Expectant management was planned for 22/28 (79%) patients. Two patients transitioned from an expectant management strategy to an operative strategy for recurrent respiratory infections; final pathology revealed bronchial atresia in both. Six patients were initially managed operatively; final pathology revealed bronchial atresia (n = 3) or congenital lobar overinflation (n = 3). CONCLUSIONS Peripheral bronchial atresia can be safely managed expectantly. A change in symptoms is suspicious for alternate lung pathology, warranting further workup and consideration for resection. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Natalie M Lopyan
- Division of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, University of Michigan, 1540 E. Hospital Dr., Ann Arbor, MI, USA.
| | - Erin E Perrone
- Division of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, University of Michigan, 1540 E. Hospital Dr., Ann Arbor, MI, USA
- Fetal Diagnosis and Treatment Center, University of Michigan, Michigan Medicine, Ann Arbor, MI, USA
| | - Rachel VanHulle
- Division of Pediatric Radiology, Department of Radiology, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - David A Bloom
- Division of Pediatric Radiology, Department of Radiology, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - George B Mychaliska
- Division of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, University of Michigan, 1540 E. Hospital Dr., Ann Arbor, MI, USA
- Fetal Diagnosis and Treatment Center, University of Michigan, Michigan Medicine, Ann Arbor, MI, USA
| | - K Elizabeth Speck
- Division of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, University of Michigan, 1540 E. Hospital Dr., Ann Arbor, MI, USA
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Sumiya R, Nagasaka S, Ikeda T, Suyama Y, Miyazaki H. Complete thoracoscopic surgery for extensive emphysema in the right upper and middle lobes caused by right B5 bronchial atresia. J Surg Case Rep 2021; 2021:rjab484. [PMID: 34729173 PMCID: PMC8557331 DOI: 10.1093/jscr/rjab484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/05/2021] [Indexed: 11/27/2022] Open
Abstract
Bronchial atresia is a rare congenital condition that may lead to infectious complications. Almost all patients with this condition are diagnosed early in life with normal lungs, making them particularly suitable candidates for thoracoscopic surgery. A 30-year-old man was referred to our hospital due to an abnormal shadow on chest radiography taken 7 years prior. Despite being diagnosed with B5 bronchial atresia, he refused to undergo surgical resection. Seven years later, he developed right chest pain. Computed tomography showed B5 bronchial occlusion, mucoid impaction and emphysematous changes. Treatment with thoracoscopic right middle lobectomy and S3 partial resection using four ports resulted in good lung expansion after discharge. This study highlights that thoracoscopic surgical resection should be considered in patients with bronchial atresia.
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Affiliation(s)
- Ryusuke Sumiya
- Department of General Thoracic Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Satoshi Nagasaka
- Department of General Thoracic Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takeshi Ikeda
- Department of General Thoracic Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yuto Suyama
- Department of General Thoracic Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hideki Miyazaki
- Pathology Division of Clinical Laboratory, National Center for Global Health and Medicine, Tokyo, Japan
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7
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Zarfati A, Voglino V, Tomà P, Cutrera R, Frediani S, Inserra A. Conservative management of congenital bronchial atresia: The Bambino Gesù children's hospital experience. Pediatr Pulmonol 2021; 56:2164-2168. [PMID: 33760393 DOI: 10.1002/ppul.25385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 03/01/2021] [Accepted: 03/10/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Congenital bronchial atresia (CBA) is a rare airway malformation. No management guidelines exist because of limited evidence: treatment, surgical or conservative, is based on consensus and opinion. OBJECTIVE To review the experience of a pediatric tertiary center and provide additional data about nonsurgical management of CBA and its outcomes after a structured follow-up, and to help formulate appropriate evidence-based guidelines. METHODS A retrospective analysis of clinical, radiological, surgical, and pathological data of all pediatric patients with suspicion of CBA referred to the surgical department of the Bambino Gesù children's hospital of Rome between December 2013 and 2019, along with a review of the literature. RESULTS Among the 18 children initially included in the study, 2 were lost to follow-up after radiological diagnosis, 4 underwent surgery for radiological suspicion of other pulmonary malformations. The final population is composed of 12 conservatively managed patients. At the end of the follow-up (median: 29 months, range 3-61), 1 patient (8%) was symptomatic. CONCLUSION Conservative management for CBA appears to be safe. Surgery should be reserved for patients with symptomatic or complicated cases.
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Affiliation(s)
- Angelo Zarfati
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù' Children Hospital, Rome, Italy
| | - Valerio Voglino
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù' Children Hospital, Rome, Italy
| | - Paolo Tomà
- Pediatric Radiology Unit, Bambino Gesù' Children Hospital, Rome, Italy
| | - Renato Cutrera
- Pediatric Broncopneumology, Bambino Gesù' Children Hospital, Rome, Italy
| | - Simone Frediani
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù' Children Hospital, Rome, Italy
| | - Alessandro Inserra
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù' Children Hospital, Rome, Italy
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8
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de Melo ASA. Diagnostic imaging in bronchial atresia. Radiol Bras 2021; 54:V. [PMID: 33854270 PMCID: PMC8029932 DOI: 10.1590/0100-3984.2021.54.2e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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9
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Puglia EBMD, Rodrigues RS, Daltro PA, Souza AS, Paschoal MM, Labrunie EM, Irion KL, Hochhegger B, Zanetti G, Marchiori E. Tomographic findings in bronchial atresia. Radiol Bras 2021; 54:9-14. [PMID: 33574627 PMCID: PMC7863713 DOI: 10.1590/0100-3984.2019.0136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective To evaluate computed tomography (CT) findings in 23 patients with bronchial atresia. Materials and Methods The CT images were reviewed by two radiologists who reached decisions by consensus. We included only patients who presented with abnormalities on CT and in whom the diagnosis had been confirmed by pathological examination of the surgical specimen (if the lesion was resected). The CT scans were assessed in order to identify the main findings and to map the distribution of the lesions (i.e., to determine whether the pulmonary involvement was unilateral or bilateral). Results The main CT finding was the combination of bronchocele and hyperinflation of the distal lung. That combination was observed in all of the patients. The lesions were unilateral in all 23 cases, being seen predominantly in the left upper lobe, followed by the right lower lobe, right upper lobe, middle lobe, and left lower lobe. Conclusion The diagnosis of bronchial atresia can be reliably made on the basis of a finding of bronchocele accompanied by hyperinflation of the adjacent lung parenchyma.
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Affiliation(s)
- Elazir Barbosa Mota Di Puglia
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.,Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, RJ, Brazil
| | - Rosana Souza Rodrigues
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.,Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, RJ, Brazil
| | | | - Arthur Soares Souza
- Faculdade de Medicina de São José do Rio Preto (Famerp), São José do Rio Preto, SP, Brazil
| | | | | | | | - Bruno Hochhegger
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Gláucia Zanetti
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Edson Marchiori
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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10
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Watanabe T, Ohno M, Tahara K, Tomonaga K, Fuchimoto Y, Fujino A, Hishiki T, Tsukamoto K, Ito Y, Sugibayashi R, Wada S, Sago H, Higuchi M, Kawasaki K, Yoshioka T, Kanamori Y. An investigation on clinical differences between congenital pulmonary airway malformation and bronchial atresia. J Pediatr Surg 2018; 53:2390-2393. [PMID: 30227995 DOI: 10.1016/j.jpedsurg.2018.08.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 08/25/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND/PURPOSE Differences in clinical features between congenital pulmonary airway malformation (CPAM) and bronchial atresia (BA) have not yet been clearly described. METHODS We retrospectively reviewed 112 patients with a pathological diagnosis of CPAM or BA. The clinical parameters were statistically analyzed between these diseases. RESULTS Seventy-one patients received prenatal diagnosis and 41 received postnatal diagnosis. The percentage of prenatal diagnosis was significantly higher in CPAM patients (84% vs 50%, p < 0.001). Among patients with prenatal diagnosis, the backgrounds were not different between the two diseases except for the number of Caesarean sections (81% vs 9%, p < 0.0001). The numbers of patients that underwent fetal interventions and emergent neonatal surgery were higher in CPAM (51% vs 15%, p < 0.01 and 76% vs 12%, p < 0.0001), although there was no statistical difference in survival rate (86% vs 97%, p = 0.2). In patients receiving postnatal diagnosis, pneumonia was the primary symptom in most BA patients, whereas respiratory distress was the major symptom in patients with CPAM. Age at presentation of the primary symptom was significantly older in BA patients (4.2 years vs 1.2 years, p < 0.005). CONCLUSION CPAM and BA have distinct clinical features in terms of therapeutic and natural history. Careful imaging evaluation and pathological analysis can lead to an accurate diagnosis of BA. TYPE OF STUDY Prognostic study. LEVEL OF EVIDENCE Level II. This study is categorized as a "Prognostic Study" with LEVEL III of Evidence.
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Affiliation(s)
- Toshihiko Watanabe
- Division of Surgery, National Center for Child Health and Development, Tokyo, Japan; Department of Pediatric Surgery, Tokai University School of Medicine, Kanagawa, Japan.
| | - Michinobu Ohno
- Division of Surgery, National Center for Child Health and Development, Tokyo, Japan
| | - Kazunori Tahara
- Division of Surgery, National Center for Child Health and Development, Tokyo, Japan
| | - Kotaro Tomonaga
- Division of Surgery, National Center for Child Health and Development, Tokyo, Japan
| | - Yasushi Fuchimoto
- Division of Surgery, National Center for Child Health and Development, Tokyo, Japan
| | - Akihiro Fujino
- Division of Surgery, National Center for Child Health and Development, Tokyo, Japan
| | - Tomoro Hishiki
- Division of Surgery, National Center for Child Health and Development, Tokyo, Japan
| | - Keiko Tsukamoto
- Division of Neonatology, National Center for Child Health and Development
| | - Yushi Ito
- Division of Neonatology, National Center for Child Health and Development
| | - Rika Sugibayashi
- Division of Fetal Medicine, National Center for Child Health and Development
| | - Seiji Wada
- Division of Fetal Medicine, National Center for Child Health and Development
| | - Haruhiko Sago
- Division of Fetal Medicine, National Center for Child Health and Development
| | - Masataka Higuchi
- Division of Pulmonology, National Center for Child Health and Development
| | - Kazuteru Kawasaki
- Division of Pulmonology, National Center for Child Health and Development
| | - Takako Yoshioka
- Department of Pathology, National Center for Child Health and Development
| | - Yutaka Kanamori
- Division of Surgery, National Center for Child Health and Development, Tokyo, Japan
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11
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Garcia-Reina S, Fernández E, Martinez-Barenys C, López de Castro P. Incidental diagnosis of bronchial atresia after chest trauma. Arch Bronconeumol 2018; 55:53-54. [PMID: 29803522 DOI: 10.1016/j.arbres.2018.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/14/2018] [Accepted: 03/15/2018] [Indexed: 10/16/2022]
Affiliation(s)
- Samuel Garcia-Reina
- Departamento de Cirugía Torácica, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España.
| | - Esther Fernández
- Departamento de Cirugía Torácica, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - Carlos Martinez-Barenys
- Departamento de Cirugía Torácica, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - Pedro López de Castro
- Departamento de Cirugía Torácica, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
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12
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Qi S, Zhang B, Yue Y, Shen J, Teng Y, Qian W, Wu J. Airflow in Tracheobronchial Tree of Subjects with Tracheal Bronchus Simulated Using CT Image Based Models and CFD Method. J Med Syst 2018; 42:65. [PMID: 29497841 DOI: 10.1007/s10916-017-0879-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 12/13/2017] [Indexed: 12/13/2022]
Abstract
Tracheal Bronchus (TB) is a rare congenital anomaly characterized by the presence of an abnormal bronchus originating from the trachea or main bronchi and directed toward the upper lobe. The airflow pattern in tracheobronchial trees of TB subjects is critical, but has not been systemically studied. This study proposes to simulate the airflow using CT image based models and the computational fluid dynamics (CFD) method. Six TB subjects and three health controls (HC) are included. After the geometric model of tracheobronchial tree is extracted from CT images, the spatial distribution of velocity, wall pressure, wall shear stress (WSS) is obtained through CFD simulation, and the lobar distribution of air, flow pattern and global pressure drop are investigated. Compared with HC subjects, the main bronchus angle of TB subjects and the variation of volume are large, while the cross-sectional growth rate is small. High airflow velocity, wall pressure, and WSS are observed locally at the tracheal bronchus, but the global patterns of these measures are still similar to those of HC. The ratio of airflow into the tracheal bronchus accounts for 6.6-15.6% of the inhaled airflow, decreasing the ratio to the right upper lobe from 15.7-21.4% (HC) to 4.9-13.6%. The air into tracheal bronchus originates from the right dorsal near-wall region of the trachea. Tracheal bronchus does not change the global pressure drop which is dependent on multiple variables. Though the tracheobronchial trees of TB subjects present individualized features, several commonalities on the structural and airflow characteristics can be revealed. The observed local alternations might provide new insight into the reason of recurrent local infections, cough and acute respiratory distress related to TB.
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Affiliation(s)
- Shouliang Qi
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, China. .,Key Laboratory of Medical Image Computing of Northeastern University (Ministry of Education), Shenyang, China.
| | - Baihua Zhang
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, China.,Key Laboratory of Medical Image Computing of Northeastern University (Ministry of Education), Shenyang, China
| | - Yong Yue
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jing Shen
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Yueyang Teng
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, China.,Key Laboratory of Medical Image Computing of Northeastern University (Ministry of Education), Shenyang, China
| | - Wei Qian
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, China.,College of Engineering, University of Texas at El Paso, El Paso, TX, USA
| | - Jianlin Wu
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
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13
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Traibi A, Seguin-Givelet A, Grigoroiu M, Brian E, Gossot D. Congenital bronchial atresia in adults: thoracoscopic resection. J Vis Surg 2017; 3:174. [PMID: 29302450 DOI: 10.21037/jovs.2017.10.15] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/17/2017] [Indexed: 11/06/2022]
Abstract
Congenital bronchial atresia (CBA) is a rare congenital malformation consisting in an interruption of a lobar or-more frequently-of a segmental bronchus. It leads to mucus impaction and hyperinflation of the obstructed lung segment. It causes infectious complications and, in the long term, destruction of the adjacent lung parenchyma. Thus, a surgical resection is usually indicated, even in asymptomatic patients.
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Affiliation(s)
- Akram Traibi
- Thoracic Department, Curie-Montsouris Thorax Institute, Institut Mutualiste Montsouris, Paris, France
| | - Agathe Seguin-Givelet
- Thoracic Department, Curie-Montsouris Thorax Institute, Institut Mutualiste Montsouris, Paris, France.,Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
| | - Madalina Grigoroiu
- Thoracic Department, Curie-Montsouris Thorax Institute, Institut Mutualiste Montsouris, Paris, France
| | - Emmanuel Brian
- Thoracic Department, Curie-Montsouris Thorax Institute, Institut Mutualiste Montsouris, Paris, France
| | - Dominique Gossot
- Thoracic Department, Curie-Montsouris Thorax Institute, Institut Mutualiste Montsouris, Paris, France
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14
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Droukas DD, Machnicki SC. A 28-Year-Old Woman With Branching Opacity and Chest Pain. Chest 2017; 151:e85-e89. [PMID: 28390642 DOI: 10.1016/j.chest.2016.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 12/08/2016] [Accepted: 12/29/2016] [Indexed: 11/24/2022] Open
Abstract
A 28-year-old female patient presented through her primary care physician with symptoms of atypical chest pain and chronic cough. Her pain was described as pleuritic and intermittently radiating to the right arm. Her medical history was significant for recurrent respiratory infections, gastritis, and a left ovarian cyst treated with ipsilateral salpingo-oophorectomy. She denied any history of smoking, known lung disease, or extrapulmonary infections.
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Affiliation(s)
- Daniel D Droukas
- Department of Diagnostic Radiology, Lenox Hill Hospital, New York, NY.
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15
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Yu G, Xia B, Wang Z, Huang B, Zhang Y, Hong C, Shang N, Tang J. Prenatal and postnatal management of congenital bronchial atresia (CBA): single tertiary center report. J Matern Fetal Neonatal Med 2016; 30:2006-2010. [PMID: 27628315 DOI: 10.1080/14767058.2016.1236083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To summarize our diagnosis and management experience of congenital bronchial atresia (CBA). METHODS A retrospective review was conducted, clinical data were collected of all patients with CBA. RESULTS Among the nine patients (5 males and 4 females), six cases with right side and three cases with left cases, including one patient with mainstem bronchial atresia (MBA), two cases with lobar bronchial atresia (LBA), six cases with segmental bronchial atresia (SBA). Eight were diagnosed as congenital cystic adenomatoid malformation (CCAM) type III by ultrasound (US) in prenatal. The MBA patient was diagnosed by computed tomography (CT) and bronchofibroscopy, only two patients by pathological findings and the other six patients by CT. Five cases were accompanied by CCAM, one case with bronchopulmonary sequestration (BPS), two cases with emphysema. Eight cases except MBA were underwent thoracoscopic surgery treatment and had favorable prognosis. Two cases with LBA merged with complication of pectus excavatum after surgery. One case with MBA had no surgery and died in the 13 days old. CONCLUSIONS CBA is an easily misdiagnosed disease from pathologic conditions, definitive diagnosis of this condition depends on combination CT or clinical pathologic diagnosis. Thoracoscopic resection is a safe and feasible treatment of CBA in experienced hands.
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Affiliation(s)
- Gang Yu
- a Department of Maternal-Fetal Medicine , Guangdong Women and Children Hospital , Guangzhou , China
| | - Bo Xia
- a Department of Maternal-Fetal Medicine , Guangdong Women and Children Hospital , Guangzhou , China
| | - Zhu Wang
- a Department of Maternal-Fetal Medicine , Guangdong Women and Children Hospital , Guangzhou , China
| | - Baisha Huang
- a Department of Maternal-Fetal Medicine , Guangdong Women and Children Hospital , Guangzhou , China
| | - Ying Zhang
- a Department of Maternal-Fetal Medicine , Guangdong Women and Children Hospital , Guangzhou , China
| | - Chun Hong
- a Department of Maternal-Fetal Medicine , Guangdong Women and Children Hospital , Guangzhou , China
| | - Ning Shang
- a Department of Maternal-Fetal Medicine , Guangdong Women and Children Hospital , Guangzhou , China
| | - Jing Tang
- a Department of Maternal-Fetal Medicine , Guangdong Women and Children Hospital , Guangzhou , China
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16
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Kuroda T, Nishijima E, Maeda K, Fuchimoto Y, Hirobe S, Tazuke Y, Watanabe T, Usui N. Perinatal features of congenital cystic lung diseases: results of a nationwide multicentric study in Japan. Pediatr Surg Int 2016; 32:827-31. [PMID: 27461429 DOI: 10.1007/s00383-016-3930-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/21/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The current study aimed to assess the perinatal risk and clinical features of congenital cystic lung diseases (CCLD). MATERIALS AND METHODS Of the 874 CCLD patients identified in a nationwide survey, 428 patients born between 1992 and 2012 and treated at 10 high-volume centers, were retrospectively reviewed. RESULTS Fetal hydrops was visualized using MRI in 9.2 % of the patients. Prenatal interventions were described for 221 of the 428 patients, including the maternal administration of steroid and pleuro-amniotic shunting. Postnatally, a right-to-left shunt flow through a persistent ductus arteriosus was observed in 7.8 % of the patients. The fetal lung lesion volume ratio (LVR) was significantly higher among these symptomatic patients (2.04 ± 1.71 vs. 0.98 ± 0.50, P < 0.00071), and decreased to a greater degree in non-CCAM patients compared with CCAM patients during the late gestational period (from 1.37 ± 1.28 to 1.14 ± 0.84 in CCAM and from 1.08 ± 0.47 to 0.46 ± 0.64 in non-CCAM). CONCLUSIONS An estimated 8-9 % of prenatally diagnosed patients carry the highest risk of perinatal respiratory distress. Fetal LVR remaining at a high level during the late gestational period seems to predict a high risk.
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Affiliation(s)
| | - Tatsuo Kuroda
- Department of Pediatric Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuyku-ku, Tokyo, 160-8582, Japan.
| | - Eiji Nishijima
- Department of Pediatric Surgery, Takatsuki Hospital, Osaka, Japan
| | - Kosaku Maeda
- Department of Pediatric Surgery, Jichi Medical College, Shimotsuke, Japan
| | - Yasusih Fuchimoto
- Department of Surgery, National Center for Child Health and Development, Tokyo, Japan
| | - Seiichi Hirobe
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Yuko Tazuke
- Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Toshihiko Watanabe
- Department of Surgery, National Center for Child Health and Development, Tokyo, Japan
| | - Noriaki Usui
- Department of Pediatric Surgery, Osaka University, Osaka, Japan
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17
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Alamo L, Vial Y, Gengler C, Meuli R. Imaging findings of bronchial atresia in fetuses, neonates and infants. Pediatr Radiol 2016; 46:383-90. [PMID: 26646151 DOI: 10.1007/s00247-015-3487-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 08/12/2015] [Accepted: 10/19/2015] [Indexed: 02/06/2023]
Abstract
Congenital lung malformations are increasingly detected before birth. However, bronchial atresia is rarely identified in utero and not always recognized in neonates. There are two types of atresia: 1) proximal, located at the level of the mainstem or the proximal lobar bronchi, which is extremely rare and usually lethal during pregnancy, causing a tremendous volume increase of the distal involved lung with secondary hypoplasia of the normal lung, and 2) peripheral, located at the segmental/subsegmental bronchial level, which may present as an isolated lesion or as part of a complex congenital malformation. Prenatal findings are mostly nonspecific. Postnatal exams show overinflated lung areas and focal bronchial dilations. The typical fluid-filled bronchoceles are not always observed in neonates but develop progressively in the first months of life. This pictorial essay describes the spectrum of imaging findings of bronchial atresia in fetuses, neonates and infants.
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Affiliation(s)
- Leonor Alamo
- Department of Diagnostic and Interventional Radiology, University Hospital of Lausanne (CHUV) and University of Lausanne (UNIL), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | - Yvan Vial
- Department of Obstetrics and Gynecology, University Hospital of Lausanne (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Carole Gengler
- Department of Pathology, University Hospital of Lausanne (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Reto Meuli
- Department of Diagnostic and Interventional Radiology, University Hospital of Lausanne (CHUV) and University of Lausanne (UNIL), Rue du Bugnon 46, 1011, Lausanne, Switzerland
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18
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Abstract
Antenatal detection of congenital pulmonary airway malformations (CPAM) has improved immeasurably from its initial application in the 1980s and probably encompasses >80% of all such lesions. Accurate diagnosis still remains less reliable and definitive diagnosis requires detailed anatomical imaging (typically with CT scan) in the post-natal period. About 10% of all lesions will present with symptoms during the neonatal period and the choice of surgical intervention is then easy. For those that remain asymptomatic then there is still a degree of controversy about elective surgical resection. This article presents the case for elective surgery within the first year of life and aims to quantify the risks of non-intervention such as abscess, empyema, recurrent pneumonia, air-leak, and pneumothorax and various types of malignancy in such cases. The current surgical approach now includes both open muscle-sparing thoracotomy and thoracoscopic resection.
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Affiliation(s)
- Rashmi Singh
- Department of Paediatric Surgery, King׳s College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Mark Davenport
- Department of Paediatric Surgery, King׳s College Hospital, Denmark Hill, London SE5 9RS, UK.
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19
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Wang A, D'Amico TA, Berry MF. Surgical Management of Congenital Pulmonary Malformations After the First Decade of Life. Ann Thorac Surg 2014; 97:1933-8. [DOI: 10.1016/j.athoracsur.2014.01.053] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 01/09/2014] [Accepted: 01/17/2014] [Indexed: 10/25/2022]
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20
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Peranteau WH, Moldenhauer JS, Khalek N, Martinez-Poyer JL, Howell LJ, Johnson MP, Flake AW, Adzick NS, Hedrick HL. Open Fetal Surgery for Central Bronchial Atresia. Fetal Diagn Ther 2014; 35:141-7. [DOI: 10.1159/000357497] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 11/19/2013] [Indexed: 11/19/2022]
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21
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Posada Ayala A, Del-Río Camacho G, Fernández-Cantalejo Padial J, Presa Abós T. Broncocele como imagen radiológica persistente. An Pediatr (Barc) 2013; 79:118-9. [DOI: 10.1016/j.anpedi.2012.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Revised: 04/27/2012] [Accepted: 05/30/2012] [Indexed: 10/28/2022] Open
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22
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Zribi H, Brian E, Lenoir S, Validire P, Gossot D. [Congenital bronchial atresia in adults]. Rev Mal Respir 2011; 28:672-6. [PMID: 21645840 DOI: 10.1016/j.rmr.2010.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Accepted: 12/18/2010] [Indexed: 11/19/2022]
Abstract
Congenital bronchial atresia is a rare congenital obliteration of a segmental or lobar bronchus resulting in distension of the corresponding parenchyma. It is seldom diagnosed in the adult. It may lead to infectious complications and, in the long term, to damage to the adjacent lung parenchyma. A surgical resection is necessary and it can be achieved by thoracoscopy. We report a recent series of six patients.
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Affiliation(s)
- H Zribi
- Département Thoracique, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014 Paris, France
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23
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Bonnefoy C, Blanc P, Coste K, Delabaere A, Dechelotte PJ, Laurichesse-Delmas H, Labbe A, Jacquetin B, Lemery D, Sapin V, Gallot D. Prenatal diagnosis of lobar bronchial atresia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 37:110-112. [PMID: 20878667 DOI: 10.1002/uog.8838] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
We report three cases of fetal lobar bronchial atresia referred to our Fetal Medicine Center during the mid-trimester of pregnancy over the last 15 years. Lobar bronchial atresia can mimic a main stem bronchial atresia on mid-trimester ultrasound examination as it induces extensive lobar enlargement, major mediastinal shift and eversion of the diaphragm. It was associated with severe pulmonary hypoplasia in all three cases, even though polyhydramnios and ascites were absent in two. Termination of pregnancy was performed at parental request after extensive counseling in each of the cases and necropsy confirmed one or two enlarged lung lobes leading to major compression of the remaining lobe(s) of the ipsilateral lung, the contralateral lung and the heart. No other anomalies were observed and the karyotype was normal in all cases.
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Affiliation(s)
- C Bonnefoy
- Maternal Fetal Medicine Unit, CHU Clermont-Ferrand, CHU Estaing, Clermont-Ferrand Cedex 1, France
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24
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Poupalou A, Varetti C, Lauron G, Steyaert H, Valla JS. Perinatal diagnosis and management of congenital bronchial stenosis or atresia: 4 cases. J Thorac Cardiovasc Surg 2011; 141:e11-4. [DOI: 10.1016/j.jtcvs.2010.09.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Revised: 08/18/2010] [Accepted: 09/09/2010] [Indexed: 10/18/2022]
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25
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Abstract
Multidetector CT has broadened the potential of imaging to demonstrate anomalies of the lung and the tracheobronchial tree with increasing frequency. Two-and three-dimensional reformatting improve the understanding of complex tracheobronchial anomalies. Most congenital tracheobronchial anomalies are rare and almost always nonsymptomatic; however, some may be confused with or even responsible for respiratory disease. Tracheal and accessory cardiac bronchi are among the most frequent anomalies, but other ectopic or supernumerary lung buds, developmental tracheobronchial interruption, obstruction, or compression, communicating bronchopulmonary foregut malformations, and bronchial malformations associated with anomalies of situs can be detected, even late after birth.
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Affiliation(s)
- Amandine Desir
- Department of Medical Imaging, University Hospital of Liège, B35 Sart Tilman, B-4000 Liège, Belgium
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26
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Abstract
Structural upper and lower airway disorders and parenchymal disorders are uncommon in pediatric practice, but many pediatricians will encounter them and be responsible for the ongoing care of these patients. Pediatricians need to be cognizant of these diagnoses because, even though management of these disorders generally lacks an evidence base, existing principles of good care surrounding accurate diagnosis, classifications of severity, judicious use of investigations, medication, and surgical approaches are essential to good outcomes.
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27
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Gabilondo A, Ugarte M, Legasa L, Galardi A. Caso 3. Atresia bronquial congénita. RADIOLOGIA 2009; 51:96; discussion 103-4. [DOI: 10.1016/s0033-8338(09)70414-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2006] [Accepted: 09/04/2006] [Indexed: 12/01/2022]
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28
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Mechoulan A, Podevin G, Paumier A, Philippe HJ, Le Mouel F, Le Vaillant C, Quéré MP, Joubert M, Winer N. Le diagnostic anténatal d’atrésie bronchique est-il possible ? ACTA ACUST UNITED AC 2008; 36:407-12. [DOI: 10.1016/j.gyobfe.2007.12.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2007] [Accepted: 12/06/2007] [Indexed: 11/25/2022]
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29
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Tsai AY, Liechty KW, Hedrick HL, Bebbington M, Wilson RD, Johnson MP, Howell LJ, Flake AW, Adzick NS. Outcomes after postnatal resection of prenatally diagnosed asymptomatic cystic lung lesions. J Pediatr Surg 2008; 43:513-7. [PMID: 18358291 DOI: 10.1016/j.jpedsurg.2007.10.032] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Symptomatic congenital lung lesions require surgical resection, but the management of asymptomatic lung lesions is controversial. Some surgeons advocate observation because of concerns about potential operative morbidity and mortality, as well as a lack of long-term follow-up information. On the other hand, malignant degeneration, pneumonia, and pneumothorax are known consequences of cystic lung lesions. This study aims to assess the safety of resection for asymptomatic lung lesions that were diagnosed before birth. METHODS A retrospective review of all patients with prenatally diagnosed lung lesions at Children's Hospital of Philadelphia (Philadelphia, Penn) was performed from 1996 to 2005. The perioperative course of patients who were asymptomatic was analyzed. RESULTS One hundred five complete records of children with asymptomatic lesions were reviewed. Overall mortality was 0% and morbidity was 6.7% including 2.9% significant postoperative air leak and 3.8% transfusion requirement. Nine patients had a pathologic diagnosis that differed from preoperative radiological findings, and 9 patients had additional pathologic findings. CONCLUSION This series demonstrates that surgery can be performed safely on patients who were asymptomatic with congenital cystic adenomatoid malformation of the lung and other types of lung lesions with no mortality and minimal morbidity. The frequency of disparate pathologic diagnoses and the potential for development of malignancy and other complications support the argument for early resection.
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Affiliation(s)
- Anthony Y Tsai
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
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