Achiron R, Strauss S, Seidman D S, Lipitz S, Mashiach S, Goldman B
Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Ultrasound Obstet Gynecol. 1995 Jul;6(1):40-2. doi: 10.1046/j.1469-0705.1995.06010040.x.
The ultrasonographic appearance of fetal lung hyperechogenicity is most commonly associated with congenital bronchopulmonary abnormalities, such as cystic adenomatoid malformation or pulmonary lobar sequestration. Spontaneous disappearance of echogenic lung lesions has rarely been reported, mainly due to in utero resolution of cystic adenomatoid malformation. We describe four fetuses with echogenic lungs detected prenatally, none of them having been proved to have adenomatoid malformation or pulmonary sequestration of the lungs. Color Doppler sonography was used prenatally in all cases to rule out pulmonary sequestration. Three of the four fetuses showed complete resolution of the lung lesions during gestation, with normal neonatal outcome, but in one where the lesion decreased in size, intrauterine demise occurred at 28 weeks' gestation before complete resolution, and pneumonia was found at autopsy. We suggest that fetal lung hyperechogenicity may result from in utero bronchial tree obstruction with retention of mucoid fluid distal to the obstruction. With advancing gestation, in some cases the relative obstruction may be relieved, and the sonographic appearance of the lungs may return to normal. A retention of mucus in the bronchial tree should be added to the differential diagnosis of hyperechogenic lung lesions detected by antenatal ultrasound examination.
胎儿肺高回声的超声表现最常与先天性支气管肺异常相关，如囊性腺瘤样畸形或肺叶隔离症。回声性肺病变的自发消失鲜有报道，主要是由于囊性腺瘤样畸形在宫内自行消退。我们描述了4例产前检测到肺高回声的胎儿，均未证实患有腺瘤样畸形或肺叶隔离症。所有病例产前均使用彩色多普勒超声排除肺叶隔离症。4例胎儿中有3例在孕期肺病变完全消退，新生儿结局正常，但其中1例病变体积缩小，在妊娠28周时发生宫内死亡，尸检发现肺炎。我们认为胎儿肺高回声可能是由于宫内支气管树梗阻，梗阻远端黏液样液体潴留所致。随着孕周增加，在某些情况下相对梗阻可能会缓解，肺部的超声表现可能恢复正常。支气管树黏液潴留应纳入产前超声检查发现的高回声肺病变的鉴别诊断。
