Pulmonary and Intestinal Congenital Anomalies Masquerading as Cystic Suprarenal Masses
12 March 2012
04 June 2012
17 August 2012 (online)
Objectives The prenatal finding of a cystic suprarenal mass (CSM) presents a wide differential diagnosis. The aim of this study was to present the natural course and outcome of antenatally diagnosed CSMs.
Methods We reviewed the medical records of patients with prenatally detected CSMs that were assessed between January 1998 and December 2011. Retrospective data collection included the age at the time of diagnosis, the size of the mass, and the sonographic evolution of the mass. Surgical treatment was indicated in cases of malignant tumors and symptoms or when size increased.
Results The observation period ranged from 1 month to 10 years. The data of 21 patients were analyzed. The median length of follow-up was 32 months (ranging from 2 to 131 months). A total of 13 masses were detected on the left side and 8 on the right side. In 13 patients, the lesions disappeared after a median of 7 months (ranging from 0 to 37 months). Surgery was performed in two neonates: one for a teratoma at 10 days postpartum, and one for a neuroblastoma at 17 days postpartum. Six patients had an extralobar pulmonary sequestration (ELPS), and in four patients, surgical resection was performed at an average of 9.2 months (ranging from 1 to 20 months) postpartum, because of an infection or increase in ELPS size. Histological examination confirmed the pulmonary sequestration. An association with congenital cystic adenomatoid malformation (CCAM) was found in one patient, and ectopic pancreatic tissue was discovered in another patient. Two patients conservatively managed remain under observation.
Conclusions During the neonatal period, the accurate assessment of CSMs is necessary to exclude the presence of malignant tumors. Most patients can be conservatively managed, with close follow-up, including radiological assessment. If the mass persists after 1 year of age, ELPS should be considered as a probable diagnosis, and minimally invasive laparoscopic surgery can be performed, as it provides both definitive diagnosis and treatment.
- 1 de Luca JL, Rousseau T, Durand C, Sagot P, Sapin E. Diagnostic and therapeutic dilemma with large prenatally detected cystic adrenal masses. Fetal Diagn Ther 2002; 17 (1) 11-16
- 2 Baunin C, Puget C, Guitard J , et al. Antenatal detection of subdiaphragmatic pulmonary sequestration: a case report. Eur J Pediatr Surg 1994; 4 (3) 173-175
- 3 Curtis MR, Mooney DP, Vaccaro TJ , et al. Prenatal ultrasound characterization of the suprarenal mass: distinction between neuroblastoma and subdiaphragmatic extralobar pulmonary sequestration. J Ultrasound Med 1997; 16 (2) 75-83
- 4 Ballouhey Q, Abbo O, Rouquette I, Rittié JL, Viale J, Galinier P. Complex communicating bronchopulmonary foregut malformation with pancreatic heterotopy depicted with fetal magnetic resonance imaging: a case report. J Pediatr Surg 2012; 47 (5) e7-e9
- 5 Abbey P, Das CJ, Pangtey GS, Seith A, Dutta R, Kumar A. Imaging in bronchopulmonary sequestration. J Med Imaging Radiat Oncol 2009; 53 (1) 22-31
- 6 Agayev A, Yilmaz S, Cekrezi B, Yekeler E. Extralobar pulmonary sequestration mimicking neuroblastoma. J Pediatr Surg 2007; 42 (9) 1627-1629
- 7 Laje P, Martinez-Ferro M, Grisoni E, Dudgeon D. Intraabdominal pulmonary sequestration. A case series and review of the literature. J Pediatr Surg 2006; 41 (7) 1309-1312
- 8 Zeidan S, Gorincour G, Potier A , et al. Congenital lung malformation: evaluation of prenatal and postnatal radiological findings. Respirology 2009; 14 (7) 1005-1011
- 9 Daneman A, Baunin C, Lobo E , et al. Disappearing suprarenal masses in fetuses and infants. Pediatr Radiol 1997; 27 (8) 675-681
- 10 Bush A. Congenital lung disease: a plea for clear thinking and clear nomenclature. Pediatr Pulmonol 2001; 32 (4) 328-337
- 11 Bush A. Prenatal presentation and postnatal management of congenital thoracic malformations. Early Hum Dev 2009; 85 (11) 679-684
- 12 Boubnova J, Peycelon M, Garbi O, David M, Bonnard A, De Lagausie P. Thoracoscopy in the management of congenital lung diseases in infancy. Surg Endosc 2011; 25 (2) 593-596
- 13 Curros F, Chigot V, Emond S , et al. Role of embolisation in the treatment of bronchopulmonary sequestration. Pediatr Radiol 2000; 30 (11) 769-773
- 14 Laje P, Liechty KW. Postnatal management and outcome of prenatally diagnosed lung lesions. Prenat Diagn 2008; 28 (7) 612-618
- 15 Riebel T, Scheer I, David S, Kitzig F. [Infradiaphragmatic extralobar pulmonary sequestration]. Rofo 2006; 178 (11) 1115-1120
- 16 Marwede D, Tillig ER, Hirsch W. Imaging findings and differential diagnosis of infradiaphragmatic pulmonary sequestration. Pediatr Int 2008; 50 (6) 821-823
- 17 Kim HK, Choi YH, Ryu SM , et al. Infected infradiaphragmatic retroperitoneal extralobar pulmonary sequestration: a case report. J Korean Med Sci 2005; 20 (6) 1070-1072
- 18 Laberge JM, Puligandla P, Flageole H. Asymptomatic congenital lung malformations. Semin Pediatr Surg 2005; 14 (1) 16-33
- 19 Joyeux L, Mejean N, Rousseau T, Couaillier JF, Piard F, Sapin E. Ectopic extralobar pulmonary sequestrations in children: interest of the laparoscopic approach. J Pediatr Surg 2010; 45 (11) 2269-2273