Fetal lung dysplasia: clinical outcome based on a new classification system

Authors: R. Achiron¹; Y. Zalel¹; S. Lipitz¹; J. Hegesh²; R. Mazkereth³; J. Kuint³; J. Jacobson⁴; S. Yagel⁵

Source: Ultrasound in Obstetrics and Gynecology, Volume 24, Number 2, August 2004 , pp. 127-133(7)

Publisher: John Wiley & Sons, Ltd.

Buy & download fulltext article:

The full text article is not available for purchase.

The publisher only permits individual articles to be downloaded by subscribers.

Abstract:

Objective

To evaluate the clinical application of a new classification system of fetal lung anomalies.

Methods

Forty fetal diagnoses of lung lesions were analyzed according to our proposed classification system in which each lung component is considered using two-dimensional ultrasound and color and power Doppler technology. Medical files, natural history and neonatal follow-up were recorded.

Results

Type I dysplasia: Four cases of agenesis of the lung were diagnosed, three with right lung agenesis and one with left lung agenesis. Three of the four patients elected to undergo termination of pregnancy (TOP). The surviving fetus was diagnosed with scimitar syndrome and postnatal embolization of the aberrant vessel was performed. Type II dysplasia: One case of normal lung with abnormal systemic feeding artery was diagnosed with normal neonatal outcome. Type III dysplasia: Abnormal lung with abnormal vascularity was found in 14 cases, presenting in most cases as echogenic lung masses. Seven were supradiaphragmatic, six subdiaphragmatic and one case was of undetermined position. All 14 fetuses showed an aberrant systemic artery emerging from the aorta. Abnormal venous drainage could be identified in only five (36%) of the fetuses: three had prominent azygos vein, one showed drainage to the inferior vena cava and one had multiple intrapulmonary veins forming a huge arteriovenous (A-V) shunt. Two cases in this group underwent TOP, the case with A-V shunt following development of hydrops, and one on maternal request. The remaining 12 fetuses (86%) survived and were alive and well at the time of writing; only one of them needed immediate postnatal embolization of the bilateral aberrant feeding arteries. Type IV dysplasia: Abnormal lung with no vascular abnormality was diagnosed in 20 fetuses. In this group there was one case of intrauterine fetal death, two patients underwent TOP, one complicated with hydrops and one on maternal request. The survival rate in this group was 85%. Only two cases needed immediate surgical repair. Type V miscellaneous dysplasia: One fetus demonstrated echogenic lung with split notochord syndrome and survived.

Conclusions

Congenital bronchopulmonary and related vascular anomalies can be categorized using the new classification system. This new approach enabled prenatal evaluation of each lung component and facilitated cogent management of the fetus with congenital lung dysplasia. Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd.

Keywords: classification system; fetal lung lesion; prenatal ultrasound

Document Type: Research article

DOI: http://dx.doi.org/10.1002/uog.1112

Affiliations: 1: Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel-Hashomer and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel 2: Department of Pediatric Cardiology, The Chaim Sheba Medical Center, Tel-Hashomer and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel 3: Neonatal Intensive Care Unit, The Chaim Sheba Medical Center, Tel-Hashomer and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel 4: Department of Pediatric Radiology, The Chaim Sheba Medical Center, Tel-Hashomer and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel 5: Department of Obstetrics and Gynecology, Hadassah University Hospital—Mount Scopus, Jerusalem, Israel

Publication date: 2004-08-01

More about this publication?

As of January 2010, this journal will no longer be available on IngentaConnect, please visit Wiley InterScience to arrange continued access to this content
Access this journal at Wiley InterScience
ingentaconnect is not responsible for the content or availability of external websites

Fetal lung dysplasia: clinical outcome based on a new classification system

Buy & download fulltext article:

Tools

Key

Text size:

Useful pages