Surgical management of congenital lung anomalies

Prenatal diagnosis allows for insight into the evaluation of fetal lung anomalies. Serial ultrasonographic studies of fetuses helped in evaluation and definition of the natural course of these lesions as well as necessity for fetal therapy. It has been found that the overall prognosis depends on the size of the lung mass and the secondary derangement of normal lung tissue and cardiovascular system. Although much is known about the prenatal course of these anomalies, little is known about the postnatal course of asymptomatic patients. Infants who are symptomatic at birth require early surgical treatment. During the period from 1984-2003, 23 patients with congenital lung anomalies were treated, out of whom 19 were diagnosed postnatally and 4 prenatally. All postnatally diagnosed patients (9 congenital lobar emphysema, 5 congenital cystic adenomatoid malformations, 3 pulmonal cysts, 1 bronchopulmonary sequestration and 1 arteriovenous malformation) underwent surgical excision (lobectomy or sequestrectomy) after becoming symptomatic (main symptoms were infection or respiratory distress). Prenatally diagnosed patients (2 bronchopulmonary sequestrations and one enteric mediastinal cyst) underwent elective surgical interventions (sequestrectomy and excision of the cyst) in infancy. Postoperative course was uneventful in all patients. One patient probably had spontaneous involution of the mass. We believe that elective resection is indicated in asymptomatic neonates with congenital lung anomalies, because of the potential risk of infection and occult malignant transformation. Early resection also maximizes compensatory lung growth. This approach eliminates any risk of pulmonary infection, lung abscess formation or malignant transformation. In addition, subsequent exposure to radiation will be avoided. nema