Two's Company: Multiple Thoracic Lesions on Prenatal US and MRI

Fetal Diagn Ther. 2020;47(8):642-652. doi: 10.1159/000507783. Epub 2020 Jun 29.


Background: Congenital pulmonary airway malformations (CPAM), bronchopulmonary sequestrations (BPS), and CPAM-BPS hybrid lesions are most commonly solitary; however, >1 lung congenital lung lesion may occur.

Objectives: To assess the frequency of multiple congenital thoracic anomalies at a high-volume referral center; determine prenatal ultrasound (US) and magnetic resonance imaging (MRI) features of these multifocal congenital lung lesions that may allow prenatal detection; and determine the most common distribution or site of origin.

Methods: Database searches were performed from August 2008 to May 2019 for prenatally evaluated cases that had a final postnatal surgical diagnosis of >1 congenital lung lesion or a lung lesion associated with foregut duplication cyst (FDC). Lesion location, size, echotexture, and signal characteristics were assessed on prenatal imaging and correlated with postnatal computed tomographic angiography and surgical pathology. -Results: Of 539 neonates that underwent surgery for a thoracic lesion, 35 (6.5%) had >1 thoracic abnormality. Multiple discrete lung lesions were present in 19 cases, and a lung lesion associated with an FDC was present in 16. Multifocal lung lesions were bilateral in 3 cases; unilateral, multilobar in 12; and, unilobar multisegmental in 4. Median total CPAM volume/head circumference ratio for multifocal lung lesions on US was 0.66 (range, 0.16-1.80). Prenatal recognition of multifocal lung lesions occurred in 7/19 cases (36.8%). Lesion combinations were CPAM-CPAM in 10 cases, CPAM-BPS in 5, CPAM-hybrid in 2, hybrid-hybrid in 1, and hybrid-BPS in 1. Of 5 unilateral, multifocal lung lesions, multifocality was prenatally established through identification of a band of normal intervening lung or intrinsic differences in lesion imaging features.

Conclusions: Although less common, multiple thoracic abnormalities can be detected prenatally. Of multifocal lung lesions, the most common combination was CPAM-CPAM, with a unilateral, multilobar distribution. Prenatal recognition is important for pregnancy counseling and postnatal surgical management.

Keywords: Bronchopulmonary sequestration; Congenital cystic adenomatoid malformation; Congenital pulmonary airway malformation; Foregut duplication cyst; Hybrid lesion; Obstetric ultrasound; Prenatal MRI.

MeSH terms

  • Bronchopulmonary Sequestration / diagnostic imaging*
  • Cystic Adenomatoid Malformation of Lung, Congenital / diagnostic imaging*
  • Databases, Factual
  • Female
  • Humans
  • Infant, Newborn
  • Lung / diagnostic imaging*
  • Magnetic Resonance Imaging
  • Male
  • Pregnancy
  • Prenatal Diagnosis
  • Retrospective Studies
  • Ultrasonography, Prenatal