48E / 194 – ABNORMAL LUNG FEATURES ON PRENATAL ULTRASOUND AND POSTNATAL
OUTCOME.
AE Dereymaeker1, A Debeer2, L De Catte3, R Devlieger3, L Breysem4, J Breckpot5, E Verbeken6,
P Moerman6, A Lerut7, D Van Raemdonck7, K De Boeck1.
1University Hospitals Leuven Department of Pediatric Pulmonology – Leuven, Belgium
2University Hospitals Leuven Neonatal Intensive Care Unit - Leuven, Belgium
3University Hospitals Leuven Department of Obstetrics and Gynaecology - Leuven, Belgium
4University Hospitals Leuven Department of Radiology - Leuven, Belgium
5University Hospitals Leuven Centre for Human Genetics - Leuven, Belgium
6University Hospitals Leuven Department of Pathology - Leuven, Belgium
7University Hospitals Leuven Department of Thoracic Surgery and Esophageal Surgery - Leuven,
Belgium
Background:
With widespread use of prenatal ultrasound many major congenital lung malformations are detected
antenatally. Congenital pulmonary adenomatoid malformations (CPAM), bronchopulmonary
sequestration (BPS) and congenital lobar emphysema (CLE) are the most common prenatal
diagnoses. However, the correlation between antenatal findings and postnatal diagnosis, management
and outcome is still unclear.
Aim of the study:
To describe the correlation between prenatal sonographic findings, postnatal imaging and
histopathological features of congenital lung malformations and to determine the significance of these
findings in postnatal outcome.
Patients and methods:
In this retrospective study from 1998 to 2008 we identified 36 fetuses with abnormal prenatal lung
sonographic features, diagnosed at 17 to 34 weeks of gestation. In all cases we gathered prenatal
sonographic findings, postnatal imaging and/or histopathological features if available. Subjects with a
clear-cut diagnosis of isolated congenital diaphragmatic hernia were not included.
Results:
CPAM was suspected on prenatal ultrasonography in 25 out of 36 cases. The presence of CPAM was
confirmed by postnatal Computed Tomography (CT) in 19 of them, but could not be differentiated from
BPS in the remaining 6 cases. Histopathologic information was available on 20 resected lesions and
confirmed the CPAM diagnosis in 17 cases, including 3 cases with an unclear diagnosis on postnatal
CT. In the 3 remaining cases the histopathologic diagnosis of congenital bronchiectasis was retained.
In 9 out of 36 cases the type of lung malformation could not be distinguished on prenatal ultrasound.
One case presented with a combination of congenital diaphragmatic hernia (CDH) and BPS requiring
urgent surgical intervention at birth due to respiratory distress. Postnatal CT was performed in all other
cases and suggested the diagnosis of CPAM in one case, BPS in one case, CLE in 3 cases and
remained unclear in 3 cases (BPS and/or CPAM). Histopathologic data were available in 5 of these 8
cases, confirming the tomographic diagnosis in all of them (1 CPAM, 1 BPS 2 CLE and 1 combination
of BPS and CPAM). The 3 remaining cases (1 CLE and 2 cases with BPS and/or CPAM on postnatal
CT) are still in clinical follow-up and did not undergo surgical resection yet.
In 2 out of 36 cases the prenatal diagnosis was a congenital high airway obstruction syndrome
(CHAOS). Histopathologic data of the first case revealed a combination of CPAM and BPS, which was
not suspected on prenatal ultrasound. No histopathologic data on the other case were available.
Ten out of 25 patients prenatally diagnosed as CPAM presented with respiratory problems, either
acute respiratory distress at birth (6 cases) or recurrent infections (4 cases). In the non-CPAM group
there was 1 mors in utero and 7 symptomatic cases with acute respiratory distress.
Conclusion:
Concordance between postnatal lung CT and postnatal histopathology was superior to concordance
between prenatal lung ultrasound and postnatal histopathology. In this study the type of lesion (CPAM
versus non-CPAM) was suggestive to predict postnatal outcome, however patient cohorts were too
small and divers to be statistically significant. Therefore the ability of perinatal imaging to predict
outcome still needs to be refined.