Malformations pulmonaires congénitales : diagnostic et prise en charge anténataux

Prenatal diagnosis of fetal unilateral lung agenesis complicated with cardiac malposition

BACKGROUND

Fetal unilateral lung agenesis, complicated with cardiac shifting, is a rare anomaly, the diagnosis of which remains a challenge for many sonographers in routine screening programs. The present study describes a systematic approach for the diagnosis of fetal unilateral lung agenesis and cardiac malpositions in routine prenatal screening.

METHODS

A total of 18 cases of fetal unilateral lung agenesis complicated with cardiac malposition were reviewed. A systematic method was proposed to identify the fetal left side and right side according to the fetal head position and posture by acquiring a long axis and transverse view of the fetus. Fetal unilateral lung agenesis was diagnosed by evaluation of the ipsilateral pulmonary artery. The diagnosis was confirmed by postnatal echocardiography, digital radiology, and computed tomography after birth or by autopsy findings.

RESULTS

The left-sided fetal heart with the cardiac apex rotating to the left and posterior were confirmed in all 7 left lung agenesis cases, while the rightward shifting of the fetal heart together with the cardiac axis deviating to the right were confirmed in all 11 cases of right lung agenesis. The disappearance of the ipsilateral pulmonary artery was confirmed in all 18 cases of unilateral lung agenesis. Cardiac anomalies were present in a total of 7 of the 18 cases of lung agenesis with 4 of 7 in cases of left lung agenesis and 3 of 11 in cases of right agenesis.

CONCLUSIONS

The systematic approach introduced in the current report is helpful in the diagnosis of fetal unilateral lung agenesis complicated with cardiac malposition. The information provided by this study may be helpful to better understand unilateral lung agenesis anatomically and to facilitate its potential examination.

Recurrent febrile respiratory distress in infant: which diagnosis?

Congenital cystic adenomatoid malformation (CCAM) of the lung is a rare congenital anomaly. CCAM diagnosis can be made by prenatal ultrasound or in postnatal cases with regard to respiratory distress or recurrent respiratory infections. We present, for diagnostic purposes, a case of a patient, aged 4 months who had suffered since birth from recurrent bronchopulmonary infections. He was hospitalised several times for febrile respiratory distress. Chest x-rays previously performed were interpreted as normal. A final radiograph indicated the diagnosis and it was confirmed by CT. Surgical resection was performed with a positive result. CCAM responds to the prenatal diagnosis and requires frequent ultrasound checks during pregnancy and allowing for optimal management. The radiological assessment leads to the diagnosis and addresses the treatment which is based on a surgical cure.