E2381. Prenatal Ultrasound With Post Natal Correlation of Echogenic Lung Lesions
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
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:
The more common prenatally diagnosed fetal lung lesions include
Congenital cystic adenomatoid malformations (CCAMs) ,
Congenital high airway obstruction syndrome,
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
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
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
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
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.