Perinatal Imaging in Bronchopulmonary Sequestration

Abstract

Received September 2, 2008, from the Fetal Medicine Center, Department of Obstetrics and Gynecology, Clinica Las Condes, Santiago, Chile. Revision requested September 8, 2008. Revised manuscript accepted for publication October 7, 2008. I thank Ximena Ortega, MD, for evaluating the prenatal magnetic resonance imaging; Jose M. Cortes, MT, and Juan A. Escaffi, MD, for performing and evaluating the angiographic computed tomography; and Angel Blanco, MD, Jose L. Martinez, MD, and Hernan Villalon, MD, for their substantial contribution to the postnatal care of the infant reported here. This work was supported by the Sociedad Profesional de Medicina Fetal “Fetalmed” Limitada, Chile. Address correspondence to Waldo Sepulveda, MD, Fetal Medicine Center, Clinica Las Condes, Casilla 208, Santiago 20, Chile. E-mail fetalmed@yahoo.com Abbreviations CCAM, cystic congenital adenomatoid malformation; CT, computed tomography; MRI, magnetic resonance imaging 30-year-old woman, gravida 2, para 1, was referred to our center at 21 weeks’ gestation after the prenatal detection of an echogenic mass in the right lung during a second-trimester anatomy scan. Her medical and obstetric histories were unremarkable; the current pregnancy had been otherwise uncomplicated; and the first-trimester scan at 11 weeks confirmed the dates and a normal nuchal translucency thickness measurement. Sonographic examination at referral showed adequate fetal growth and a normal amniotic fluid volume. Detailed examination of the fetal anatomy revealed a predominantly solid echogenic lesion with several small cysts, the largest measuring 3 mm, occupying the lower two-thirds of the right lung (Figure 1, A and B). There were no signs of a mediastinal shift, cardiac compression, abnormal venous return, or additional fetal structural anomalies. Color Doppler sonography depicted a large arterial vessel feeding the mass, which originated from the abdominal aorta (Figure 1C). The diagnosis of pulmonary sequestration was entertained, but the presence of small cysts within the mass also suggested a hybrid lesion associated with cystic congenital adenomatoid malformation (CCAM) of the lung. The pregnancy was followed with serial scans, which showed a slight reduction of the size of the mass, a normal amniotic fluid volume, and no signs of fetal hydrops. Fetal magnetic resonance imaging (MRI), performed at 31 weeks, confirmed the presence of a predominantly solid mass with small cysts in the fetal right lung and a feeding vessel arising from the abdominal aorta and crossing the diaphragm (Figure 2). At 38 weeks, a male neonate was delivered vaginally, weighing 3200 g and with Apgar scores of 9 and 10 at 1 and 5 minutes, respectively. There were no neonatal respiratory complications and the infant remained asymptomatic. Angiographic computed tomography (CT) was per-