FETAL LUNG LESIONS - MANAGEMENT AND OUTCOME

OBJECTIVE: Our purpose was to review our experience with fetal congeni tal cystic adenomatoid malformation and extralobar pulmonary sequestra tion emphasizing natural history, management, and outcome. STUDY DESIG N: We conducted a retrospective review of 175 fetal lung lesions diagn osed by antenatal ultrasonography at 2 fetal treatment centers. RESULT S: There were 134 congenital cystic adenomatoid malformationcases. Fou rteen women underwent elective abortion, 101 women were managed expect antly 13 women had fetal surgery, and 6 women had placement of a thora coamniotic shunt. For the congenital cystic adenomatoid malformation l esions that were not associated with nonimmune hydrops, all babies sur vived. Of 25 large congenital cystic adenomatoid malformations that ha d associated hydrops that were followed expectantly, all fetuses died before or shortly after birth. Fetal surgical resection of the tumor ( fetal lobectomy) was performed at 21 to 29 weeks' gestation in 13 hydr opic fetuses with 8 fetuses continuing gestation with subsequent hydro ps resolution, impressive in utero lung growth, and neonatal survival. Six fetuses with a very large solitary cyst underwent thoracoamniotic shunting and 5 survived. There were 41 extralobar pulmonary sequestra tion cases. Twenty-eight extralobar pulmonary sequestrations dramatica lly regressed on serial prenatal sonography, were asymptomatic after b irth, and were only detectable by imaging studies postnatally (no rese ction required). Of the remaining 13 extralobar pulmonary sequestratio n cases, 2 underwent elective abortion, 7 symptomatic lesions were res ected after birth with survival, 1 hydropic fetus died, and 3 fetuses had an associated tension hydrothorax with secondary hydrops that was successfully treated by either fetal thoracenteses or thoracoamniotic shunting followed by postnatal resection. CONCLUSIONS: The natural his tory of prenatally diagnosed lung masses is variable, and associated a nomalies are rare. Most congenital cystic adenomatoid malformation les ions can be managed with maternal transport, planned term delivery, an d postnatal resection. Many extralobar pulmonary sequestrations dramat ically decrease in size before birth and may not need treatment after birth. Fetal therapy is now an option for lung lesions associated with nonimmune hydrops.