P18.10: Hyperechogenic solid masses of lungs: prenatal diagnosis and outcome

The purpose of the study was to describe the accuracy of prenatal diagnosis by US color Doppler imaging and MRI and to review outcome of fetal lung abnormal lesions. This is a prospective analysis of all fetuses diagnosed antenatally that were born in our department during last six years (2004–2009). The routine ultrasound diagnosis was confirmed by color Doppler flow imaging and by prenatal MRI scan. In a 6-years period, 35 cases of lung abnormal lesion were reffered for further management. 14 cases with cystic or cystic-solid mixture masses were excluded from the study (4 cases of CCAM type I, 9 cases of CCAM type II and 1 case of bronchogenic cyst). Expert ultrasound and fetal MRI identified twenty-one solid hyperechogenic lesions. All the lesions were described to be unilateral, all fetuses had normal karyotype from amniocentesis. The gestational age at diagnosis was 16–28 weeks. Lesions of 4 cases were demonstrated systemic arterial blood supply arising from the aorta on color Doppler flow image and the diagnosis of pulmonary sequestration were suggested. Other lesions were noted to be CCAM type III. In two cases diagnostic type of CCAM was different from US and MRI investigations. One fetus with lung sequestration had CCAM type III also. The lesions were sometimes complicated by varying degrees of mediastinal shift (7/21, 33%). Polyhydramnios was present in one patient only, no hydrops fetalis was detected. Termination of pregnancy was performed in two cases. Spontaneous regression of the sonographic appearances during pregnancy was observed in 59% (10/17) cases of CCAM. All cases of hyperechogenic lung lesion had good perinatal outcome and only seven of them required surgical treatment. A wide range of lung malformations can be recognized in the fetus. Blood supply of the lesion should be evaluated by color Doppler flow image and by MRI scan for better differentiating pathology and evaluating the prognosis. The postnatal outcome of fetal lung diseases is better than previously assumed. Supported by grant VZ FNM 64203/6202.