Congenital Lung Lesions

Abstract

Congenital lung lesions vary in their histological patterns but often have a similar clinical presentation, namely, respiratory difficulties and recurrent infections. Routine prenatal imaging has led to an increase in diagnosis in the fetal period. The fetal lung lesions grow rapidly between 20 and 26 weeks’ gestation after which most will regress. Some of these lesions exhibit a mass effect that compresses normal lung tissue, leading to pulmonary hypoplasia, or compression of the heart and mediastinal structures, leading to hydrops and fetal demise. Options for fetal intervention include decompression of large cystic masses, open fetal surgery, and ex utero intrapartum treatment. More recently administration of maternal corticosteroids has been employed to decrease the growth of the fetal lung mass, but blinded randomized controlled trials are needed to prove efficacy. Symptomatic neonates require surgical resection. Asymptomatic neonates can be followed with chest CT, no earlier than 6 weeks of life, to further characterize the lesions. Small asymptomatic lesions may be observed if there is no concern for pleuropulmonary blastoma, a malignancy sometimes seen even in newborns. Resection is indicated to avoid infection or future symptoms and is frequently done thoracoscopically. Outcomes are generally excellent.