Prenatal/postnatal imaging of the chest and kidney

Abstract

The clinical significance of some frequent fetal anomalies is assessed very differently in the literature, resulting in confusing postnatal protocols. Our presentation will aim at 2 controversial issues: fetal hydronephrosis and congenital pulmonary malformations. How to efficiently balance a good sensitivity in detecting fetal hydronephrosis with a reasonable false-positive rate postnatally? Should asymptomatic patients with prenatally recognized pulmonary malformations be managed surgically or conservatively? 1) Fetal hydronephrosis and postnatal investigation: The lack of consensus arises from the cases of mild pyelectasis (4–10 mm), which may be either normal or indicator of reflux and/or obstruction. Some authors have proposed highly sensitive cutoff values that are associated with an unacceptable false-positive rate postnatally. At the opposite, others determine the need for voiding cystourethrography only on a positive postnatal ultrasound. In our institution, a postnatal investigation is indicated when, after 24 wks G.A., there is evidence of calicectasis, ureterectasis, or bladder dilatation, or when the a.p. pelvis diameter exceeds 10 mm. 2) Postnatal management of adenomatoid malformations and pulmonary sequestrations: The sharp increase in the number of cases recognized in utero and the knowledge of the natural history of these malformations raise nowadays the question of their systematic early removal in asymptomatic newborns. The effectiveness of prophylactic resection of congenital pulmonary lesions recognized in utero is questionable at the present time because there is no prospective study on asymptomatic patients, which would determine the true percentage of patients who will develop infections or malignancies.