EP17.13: Prenatal sonographic presentation, diagnosis and outcome of fetal echogenic lung lesion

Abstract

To describe fetal echogenic lung lesion in terms of presenting features on prenatal ultrasound, establishing diagnosis, predicting prognosis and outcome. This is a 5yr retrospective study from Jan' 13 to Dec'17. Total 40 fetuses were diagnosed with echogenic lung lesion. The GA was from 16 to 29 wks. This included 6 cases of CHAOS, 28 cases of CPAM and 6 cases of PulSequestration (PS) The US presentation of CHAOS was unmistakenly similar and classical in all cases with bilateral enlarged, echogenic lung with dilated trachea and anteriorly pushed heart. All the 3 cases of extrathoracic PS, delivered with normal postnatal USG abdomen and x-ray chest. 2 of 3 fetuses with intrathoracic PS regressed. In one fetus the lesion regressed but persisted. Postnatal x-ray confimrd the lesion. but as the child is asymptomati no intervention done. Out of 28 CPAM cases, 4 macrocystic, type II lesion in 3 and microcystic lesion in remaining 21 cases. Only 1 fetus had hydrops at diagnosis. Three fetuses had CVR > 1.6. Out of four macrocystic CPAM cases two terminated, one had IUFD due to hydrops and in one fetus the lesion increased in size, baby underwent thoracoscopic excision of the cyst at 2 yrs of life and doing well now. Out of 3 type II CPAM, two fetuses delivered and postnatal MRI is normal. In one fetus, the lesion became macrocystic during follow up, but regressed at 30 weeks with normal postnatal x-ray. 21 fetuses of microcystic CPAM, one with other systemic malformation terminated. In all 20 cases the postnatal x-ray was normal and babies are doing well. Fetal lung lesions are easily diagnosed during level II USG. Among fetal echogenic lung lesions the most common are CPAM. CHAOS are mostly fatal. CPAM and BPS are relatively benign lesions. Tracing the blood supply is the key to diagnosis. CPAM and BPS though look deceptive generally regress with increasing gestation. Diagnosing the lesion with accuracy, hydrops and the CVR are useful in predicting the outcomes.