Bromley B, Parad R, Estroff J A, Benacerraf B R
Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, USA.
J Ultrasound Med. 1995 Dec;14(12):927-36; quiz p1378. doi: 10.7863/jum.1995.14.12.927.
We describe 25 cases of echogenic or complex fetal lung masses seen sonographically and suspected of being cystic adenomatoid malformations or sequestrations of the lung. On the basis of prenatal sonographic appearance, 40% of fetuses were suspected of having type 1, 20% type 2, and 40% type 3 cystic adenomatoid malformations or sequestrations. Sixteen (64%) of the 25 fetuses with lung masses survived the perinatal period, and 80% of the nonaborted fetuses survived. Eleven infants (69% of liveborns) had no respiratory symptoms at birth. Nine of the survivors underwent surgical resections of their masses after birth, whereas the other seven children are being followed conservatively. The postnatal diagnoses revealed that four of the fetuses had sequestrations, one had a sequestration with elements consistent with cystic adenomatoid malformation, and two who were thought to have type 1 cystic adenomatoid malformation had an esophageal duplication cyst and a thoracic neuroblastoma, respectively. All the other infants who had a pathologic diagnosis or postnatal imaging had cystic adenomatoid malformations. Increasing mediastinal shift was associated with decreasing survival as 90% of fetuses with no mediastinal shift are alive, whereas 50% of the nonaborted fetuses with a severe mediastinal shift survived. Follow-up scans in utero were available in 15 cases. The size of the mass became smaller in 53% during gestation. Seventy-one percent of pregnancies had normal amniotic fluid volumes and 29% were complicated by polyhydramnios. Survival of nonaborted fetuses was 100% in pregnancies with normal amniotic fluid compared with 50% in those with polyhydramnios. Eight percent of the fetuses with chest masses had additional structural abnormalities and were karyotypically abnormal. In conclusion, many fetuses with lung masses show improvement of the sonographic findings in utero, and many infants may not be symptomatic at birth. Of the survivors in this series, only slightly greater than half underwent surgery.
我们描述了25例超声检查发现的胎儿肺内强回声或复杂肿块，怀疑为囊性腺瘤样畸形或肺隔离症。根据产前超声表现，40%的胎儿疑似患有1型囊性腺瘤样畸形，20%为2型，40%为3型囊性腺瘤样畸形或肺隔离症。25例有肺部肿块的胎儿中，16例（64%）度过围生期，未流产胎儿的存活率为80%。11例婴儿（占活产儿的69%）出生时无呼吸症状。9例幸存者出生后接受了肿块手术切除，另外7名儿童则进行保守随访。产后诊断显示，4例胎儿患有肺隔离症，1例既有肺隔离症又有符合囊性腺瘤样畸形的成分，2例原本被认为患有1型囊性腺瘤样畸形的胎儿分别患有食管重复囊肿和胸段神经母细胞瘤。所有其他经病理诊断或产后影像学检查的婴儿均患有囊性腺瘤样畸形。纵隔移位增加与存活率降低相关，无纵隔移位的胎儿90%存活，而有严重纵隔移位的未流产胎儿50%存活。15例可获得宫内随访扫描结果。53%的病例肿块大小在孕期变小。71%的妊娠羊水体积正常，29%合并羊水过多。羊水正常的妊娠中未流产胎儿的存活率为100%，而羊水过多的妊娠中这一比例为50%。8%的胸部肿块胎儿有其他结构异常且染色体核型异常。总之，许多有肺部肿块的胎儿在宫内超声表现有所改善，许多婴儿出生时可能无症状。在本系列的幸存者中，只有略超过一半接受了手术。
