Lung Ultrasound: A New Tool in the Management of Congenital Lung MalformationFunding A.D.M. and R.P. won a PhD fellowship funded by Mellin S.p.A. (Milan, Italy) to attend the Doctorate (PhD) course in Biomolecular Pharmaceutical and Medical Sciences of University of Bari “Aldo Moro.”
25 June 2019 (online)
Objective This study was aimed to evaluate effectiveness of lung ultrasound (LUS) in the management of congenital pulmonary airway malformation and pulmonary sequestration in NICUs.
Study Design This is a nonconsecutive case series of neonates admitted to the academic NICU of Policlinico of Bari, Italy, from 2010 to 2018, for suspected lung malformations and examined by LUS.
Results Seven neonates were admitted for suspected pulmonary malformations, four neonates were diagnosed with pulmonary sequestration and three with congenital pulmonary airway malformation either type I (two cases) or type II (one case) according to Adzick classification. Prenatal scans had described lung malformations in six patients. Two underwent surgical intervention during the 1st month of life. All were successfully discharged home and their follow-up has been uneventful thereafter. In all the seven neonates, LUS easily detected the lesion showing a significantly high correspondence with computed tomography (CT) scan findings.
Conclusion We described the first case series of neonates affected by complex pulmonary malformations, assessed by LUS. In our experience, LUS was safe and effective for the diagnosis with high degree of consistency with CT scan findings. We suggest that LUS might be an important diagnostic method for lung malformations in newborns and a useful technique for their follow-up and late management, avoiding multiple exposures to radiations.
Keywordslung ultrasound - congenital pulmonary airway malformation - pulmonary sequestration - congenital diaphragmatic hernia
What is Known about the Topic?
Congenital Pulmonary Airway Malformation and PS are rare malformations, usually diagnosed on prenatal scans. CT scan and CT angiography scan are the preferred imaging techniques for the postnatal management of CPAM and PS, respectively. Surgical repair is necessary in selected cases only.
What Does this Study Add?
LUS is useful in addition to traditional imaging techniques for the diagnosis and follow-up of pulmonary malformations. LUS and CT scan findings present a high degree of consistency. Single or multiple hypoechoic cysts of various dimensions and lung consolidation on LUS might be suggestive of pulmonary malformations.
Parental informed consent was obtained from all patients.
- 1 Pramanik AK, Rosenkrantz T, Clark DA. Respiratory distress syndrome. Available at: https://emedicine.medscape.com/article/976034-overview#a6 . Accessed June 26, 2018
- 2 Lakhoo K. Management of congenital cystic adenomatous malformations of the lung. Arch Dis Child Fetal Neonatal Ed 2009; 94 (01) F73-F76
- 3 Sahu S, Muthuvel S, Naware SS, Dhavala SS. Congenital cystic adenomatoid malformation of lung. Med J Armed Forces India 2008; 64 (03) 268-269
- 4 Gallacher DJ, Hart K, Kotecha S. Common respiratory conditions of the newborn. Breathe (Sheff) 2016; 12 (01) 30-42
- 5 Stocker JT, Madewell JE, Drake RM. Congenital cystic adenomatoid malformation of the lung. Classification and morphologic spectrum. Hum Pathol 1977; 8 (02) 155-171
- 6 Adzick NS, Harrison MR, Glick PL. , et al. Fetal cystic adenomatoid malformation: prenatal diagnosis and natural history. J Pediatr Surg 1985; 20 (05) 483-488
- 7 Durell J, Lakhoo K. Congenital cystic lesions of the lung. Early Hum Dev 2014; 90 (12) 935-939
- 8 Biyyam DR, Chapman T, Ferguson MR, Deutsch G, Dighe MK. Congenital lung abnormalities: embryologic features, prenatal diagnosis, and postnatal radiologic-pathologic correlation. Radiographics 2010; 30 (06) 1721-1738
- 9 Hall NJ, Stanton MP. Long-term outcomes of congenital lung malformations. Semin Pediatr Surg 2017; 26 (05) 311-316
- 10 Bhat SK, Nambiar R, Nayak D, Shah KH. Prenatal diagnosis and postnatal management of congenital pulmonary airway malformation. Int J Infertil Fetal Med 2017; 8 (02) 89-92
- 11 Gargani L, Volpicelli G. How I do it: lung ultrasound. Cardiovasc Ultrasound 2014; 12 (01) 25
- 12 Cattarossi L. Lung ultrasound: its role in neonatology and pediatrics. Early Hum Dev 2013; 89 (Suppl. 01) S17-S19
- 13 Copetti R, Cattarossi L, Macagno F, Violino M, Furlan R. Lung ultrasound in respiratory distress syndrome: a useful tool for early diagnosis. Neonatology 2008; 94 (01) 52-59
- 14 Vergine M, Copetti R, Brusa G, Cattarossi L. Lung ultrasound accuracy in respiratory distress syndrome and transient tachypnea of the newborn. Neonatology 2014; 106 (02) 87-93
- 15 Balk DS, Lee C, Schafer J. , et al. Lung ultrasound compared to chest X-ray for diagnosis of pediatric pneumonia: a meta-analysis. Pediatr Pulmonol 2018; 53 (08) 1130-1139
- 16 Liu J, Ren X-L, Li J-J. POC-LUS guiding pleural puncture drainage to treat neonatal pulmonary atelectasis caused by congenital massive effusion. J Matern Fetal Neonatal Med 2018; 1-3
- 17 Basile V, Di Mauro A, Scalini E. , et al. Lung ultrasound: a useful tool in diagnosis and management of bronchiolitis. BMC Pediatr 2015; 15 (01) 63
- 18 Cattarossi L, Copetti R, Brusa G, Pintaldi S. Lung ultrasound diagnostic accuracy in neonatal pneumothorax. Can Respir J 2016; 2016: 6515069
- 19 Piastra M, Yousef N, Brat R, Manzoni P, Mokhtari M, De Luca D. Lung ultrasound findings in meconium aspiration syndrome. Early Hum Dev 2014; 90 (Suppl. 02) S41-S43
- 20 Soldati G, Copetti R. Ecografia Toracica: seconda edizione. Available at: https://www.cgems.it/Cgems-Prodotti-Dettaglio/443/Ecografia-toracica—2seconda-edizione . Accessed November 3, 2018
- 21 Yousef N, Mokhtari M, Durand P. , et al. Lung ultrasound findings in congenital pulmonary airway malformation. Am J Perinatol 2018; 35 (12) 1222-1227
- 22 David M, Lamas-Pinheiro R, Henriques-Coelho T. Prenatal and postnatal management of congenital pulmonary airway malformation. Neonatology 2016; 110 (02) 101-115