Fetal Lung Adenomatosis: Risks and Management Options

Q: Fetal Lung Adenomatosis: Risks and Management Options

Hello： Some fetal lung deformities may be detected during prenatal examinations, and pulmonary sequestration is one of these deformities. <br>If abnormalities are found during the prenatal check-up, it is advisable to cooperate with the obstetrician for further monitoring and dif

Possible fetal pulmonary adenoma?

Hello, doctor.
My sister-in-law is from mainland China, 36 years old, and currently with my brother in Shanghai, China.
She is 24 weeks pregnant.
During a recent prenatal check-up, it was found that "mid-pregnancy screening can detect some fetal abnormalities, but not all.
The left lung of the fetus shows increased echogenicity with a size of approximately 20*30*40mm, and there are blood flow signals present, pushing the heart to the right side of the thoracic cavity." In summary, the conclusion states: "Increased echogenicity of the fetal left lung" (possible pulmonary adenoma).
I would like to ask: 1.
The fetus is already 24 weeks along; can this fetus still be carried to term? Is this condition serious? Can the baby be born healthy? 2.
Based on your expertise, what would be the best course of action for us at this point? Thank you very much for your assistance.

Jiang Xiaojie, 30~39 year old female. Ask Date: 2011/03/31

Dr. Dong Yuhong reply Obstetrics and Gynecology

Hello: Some fetal lung deformities may be detected during prenatal examinations, and pulmonary sequestration is one of these deformities.
If abnormalities are found during the prenatal check-up, it is advisable to cooperate with the obstetrician for further monitoring and differential diagnosis of the deformities.
Attention should be paid to the presence of other deformities, as well as whether the deformities affect the fetal circulation or lead to fetal edema.
The impact on the fetus will depend on the subsequent changes in the deformity and the occurrence of any fetal complications.
It is recommended to consult with obstetricians, neonatologists, or pediatric surgeons for further examination and advice.
Thank you.

Reply Date: 2011/03/31

More Info

Fetal lung adenomatosis, often referred to as congenital pulmonary airway malformation (CPAM), is a condition characterized by abnormal lung development in the fetus. It can manifest in various forms, with the most common being cystic lesions in the lung tissue. The findings from your sister-in-law's prenatal ultrasound indicate a significant area of increased echogenicity in the left lung, which raises concerns for potential lung malformations such as CPAM or other lung lesions.

1. Can the pregnancy continue?
At 24 weeks of gestation, the pregnancy can certainly continue, but the decision to proceed should be made with careful consideration of the potential outcomes. Many cases of CPAM are detected prenatally, and while some may lead to complications, others can be managed effectively. The presence of blood flow signals within the lesion suggests that it is vascularized, which is a positive sign, as it may indicate that the lung tissue is functioning to some extent. However, the degree of lung development and the potential for respiratory issues at birth will depend on the size and nature of the lesion.

2. What are the best management options?
The management of fetal lung adenomatosis typically involves a multidisciplinary approach, including obstetricians, pediatricians, and pediatric surgeons. Here are some options and considerations:
- Monitoring: Regular ultrasounds should be performed to monitor the growth of the lesion and the overall development of the fetus. This includes assessing the size of the lesion, the presence of any associated complications (such as hydrops), and the development of the other lung.

- Delivery Planning: If the lesion is significant, planning for delivery in a specialized center with a neonatal intensive care unit (NICU) is crucial. This ensures that immediate care can be provided to the newborn if respiratory distress occurs.

- Postnatal Evaluation: After birth, a thorough evaluation of the newborn will be necessary. This may include imaging studies such as chest X-rays or CT scans to assess the lung structure and function.

- Surgical Intervention: If the lesion is causing significant respiratory distress or if there are concerns about malignancy, surgical intervention may be required. This could involve resection of the affected lung tissue.

- Genetic Counseling: Given that some lung malformations can be associated with genetic syndromes, genetic counseling may be beneficial for the family to understand any potential risks.

In conclusion, while the diagnosis of fetal lung adenomatosis can be concerning, many cases can be managed successfully with appropriate prenatal care and planning. It is essential to maintain open communication with the healthcare team to ensure that all potential risks are addressed and that the best possible outcomes for both the mother and the baby are achieved. Regular follow-ups and a well-coordinated delivery plan will be key in managing this condition effectively.

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