THE PROGNOSTIC FACTORS IN THE PRENATAL-DIAGNOSIS OF THE ECHOGENIC FETAL LUNG

The prenatal diagnosis of an echogenic fetal lung (EFL) is now often m ade in the early second trimester using high-resolution ultrasound. Th is ultrasound appearance is usually caused by a congenital cystic aden omatoid lung malformation (CCAM), an intrapulmonary lung sequestration or obstruction of a major airway. In order to provide prognostic guid elines to parents who may be considering termination of a fetus with t hese findings, we have analysed a series of 11 cases diagnosed in our centre over the past 2 years in conjunction with 60 cases from major p ublished series. The data suggest that in the absence of non-immune hy drops fetalis (NIHF) or other anomalies, the outcome for the fetuses i s excellent, with over 90 per cent survival. Neither early diagnosis ( 24 weeks) nor the presence of mediastinal shift is a poor prognostic i ndicator. In addition, it appears that if NIHF is absent at diagnosis, the chance that it will develop as the pregnancy continues is small ( 6 per cent). Furthermore, there is a significant (up to 30 per cent) c hance that this ultrasound finding will resolve in utero. The developm ent of in utero fetal surgical techniques may be the only hope for tho se hydropic fetuses who appear to have a dismal prognosis.