E2381. Prenatal Ultrasound With Post Natal Correlation of Echogenic Lung Lesions
  1. Bhanupriya Singh; Lohia Institute of Medical Sciences
A variety of congenital lung malformations arise from aberrations in different stages of lung development occurring in around 1 in 10-20,000 pregnancies. Occasionally these present in the neonatal period with symptoms, in which case treatment is invariably surgical resection. The aim of this study is to describe the spectrum of echogenic lung lesions on prenatal ultrasound with postnatal correlation and emphasis on diagnostic approach.

Materials and Methods:
Background The more common prenatally diagnosed fetal lung lesions include Congenital cystic adenomatoid malformations (CCAMs) , Bronchopulmonary sequestration(BPS), Congenital high airway obstruction syndrome, Pulmonary hypoplasia, Congenital diaphragmatic hernia (CDH). They usually manifest cystic, echogenic, or mixed cystic-echogenic lung lesions revealed by prenatal ultrasonography, and often have overlapping sonographic features that pose a diagnostic challenge.

Pulmonary hypoplasia can be primary or secondary and can be unilateral or bilateral depending on the etiology and time of insult to the lungs. Primary -very rare and is caused by a primary process in which the lung does not form normally. Secondary causes of pulmonary hypoplasia include masses that compress the lungs (e.g., CDH), skeletal malformations that do not allow the lungs to grow (e.g., thanatophoric dysplasia), and severe prolonged oligohydramnios (e.g., bilateral renal agenesis). Bilateral pulmonary agenesis is incompatible with postnatal life. Prognosis and management are variable and depend on the severity and nature of the associated conditions. In CDH, the pleuroperitoneal canal fails to close completely, resulting in herniation of abdominal viscera into the thoracic cavity. It is associated with high rates of morbidity and mortality. Prognosis can be poor from lung hypoplasia and a high frequency of associated anomalies. Herniated bowel may mimic a cystic lung lesion such as CCAM. Real-time scanning for bowel peristalsis within the thoracic cavity and sliding movements through the defect would aid diagnosis. In cases where differentiating between CDH and CCAM seem difficult, fetal magnetic resonance imaging has proven to be useful.

Prenatal sonography remains the primary modality for fetal structural assessment. Through appreciating the spectrum of imaging appearances of fetal lung lesions, which can be very similar, and acknowledging diagnostic pitfalls, could facilitate optimal prenatal counselling and postnatal management planning. Fetal echogenic lung lesions have an overall good prognosis. Serial ultrasound scanning is recommended to monitor the size of the lesion and to detect possible development of fetal hydrops, which is especially associated with a poor outcome. Postnatal follow-up is warranted in all cases.