2000-06-30-07 Echogenic lung mass, disappearance © Cafici www.thefetus.net/
Echogenic lung mass, disappearance
Daniel Cafici, MD, Philippe Jeanty, MD, PhD
The prenatal recognition of an echogenic lung mass commonly is associated with problems of differential diagnosis. The following lesions may present with echogenic lung masses,2:
· Intrathoracic lung sequestration
· Cystic adenomatoid tumor of the microcystic form
· Tracheal obstruction (both lungs completely involved)
· Bronchial atresia
· Congenital lobar emphysema
Among 16 intrathoracic lung sequestrations in 14 fetuses with prenatally demonstrated feeding vessels arising from the aorta,
· 2 fetuses required placement of a thoracoamniotic shunt
· 4 fetuses completely lost evidence of a mass
Spontaneous involution has been demonstrated for:
· intrathoracic sequestration in fetuses,,1,2,,, and newborns,
· intraabdominal sequestrations
· bronchial plugs
· type II congenital cystic adenomatoid malformation6
Pulmonary sequestrations tend to have a favorable outcome; many regress prenatally, those who persist can be treated postnatally, and the only one that require intervention are those with hydrops or effusion. The presence of mediastinal shift or even diaphragmatic inversion does not necessarily predict poor outcome. Only those fetuses with hydrops have poor outcome.
This fetus was seen first at 20 weeks when a echogenic lung mass was seen with a vascular supply arising from the descending thoracic aorta. Note the mediastinal shift and subtle diaphragmatic inversion.
The lung mass displaces the heart and everts the diaphragm.
The mass surrounds the aorta and gets a feeding vessel from the descending aorta
A repeat scan at 24 week demonstrate some reduction of the mass
The feeding vessel.
At 28 weeks the mass had disappeared and the newborn was asymptomatic.
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