# Congenital Lung Lesions (CPAM) — GCMD Library living collection Also covered as: CPAM · congenital pulmonary airway malformation · bronchial atresia · hydrops · CPAM (congenital pulmonary airway malformation) · bronchopulmonary sequestration · pleuropulmonary blastoma · bronchogenic cyst Experts: Dr. Todd Ponsky, Dr. Alan Flake, Dr. Jack Langer, Dr. Steven Rothenberg Updated: n/a · 32 episodes · 869 cited statements ## Episodes ### Foundations - [Neonatal Lung Lesions with Dr. Steven Rothenberg](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948) — podcast · 66:58 · [machine version](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948.md) - [Wilms Tumor: Audio Chapter](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487) — podcast · 64:03 · [machine version](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487.md) ### Diagnosis & Workup - [Prenatal Management of CPAMs: Lung Lesions](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089) — video · 18:16 · [machine version](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089.md) ### Acute Management - [Fetal Interventions Part II: Lung Lesions](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884) — video · 16:30 · [machine version](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884.md) - [Open Fetal Surgery Overview: Fetal Surgery 2012](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027) — video · 37:55 · [machine version](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027.md) - [Fetal Interventions Part I: Lung Lesions](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087) — video · 14:27 · [machine version](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087.md) - [Lung Lesions: Fetal Interventions Parts I+II](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088) — video · 30:56 · [machine version](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088.md) ### Surgical Management - [Postnatal Management of Lung Lesions Part III: Pediatric Thoracic Surgery...](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418) — video · 27:56 · [machine version](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418.md) - [Postnatal Management of Lung Lesions Part II: Pediatric Thoracic Surgery...](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419) — video · 25:07 · [machine version](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419.md) - [Postnatal Management of Lung Lesions Part I: Pediatric Thoracic Surgery Part...](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420) — video · 31:07 · [machine version](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420.md) - [Technique: Blinded Left Upper Lobectomy](https://library.globalcastmd.com/watch/technique-blinded-left-upper-lobectomy-1006) — video · 4:28 · [machine version](https://library.globalcastmd.com/watch/technique-blinded-left-upper-lobectomy-1006.md) - [Thoracoscopic Right Lower Lobe Cystic Lesion Excision: Update Course 2014](https://library.globalcastmd.com/watch/thoracoscopic-right-lower-lobe-cystic-lesion-excision-update-course-2014-1041) — video · 11:24 · [machine version](https://library.globalcastmd.com/watch/thoracoscopic-right-lower-lobe-cystic-lesion-excision-update-course-2014-1041.md) - [Thoracoscopic Upper Lobectomies for Symptomatic Congenital Pulmonary Airway...](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2226) — video · 5:58 · [machine version](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2226.md) - [Thoracoscopic Left Lower Lobectomy for Congenital Pulmonary Airway Malformation](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227) — video · 9:59 · [machine version](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227.md) - [Thoracoscopic Left Lower Lobectomy for Congenital Pulmonary Airway Malformation](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243) — video · 9:59 · [machine version](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243.md) - [Thoracoscopic Upper Lobectomies for Symptomatic Congenital Pulmonary Airway...](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2242) — video · 5:58 · [machine version](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2242.md) - [Neonatal Lung Lesions with Dr. Steven Rothenberg](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307) — podcast · 66:58 · [machine version](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307.md) ### Complications - [Complications and Beyond](https://library.globalcastmd.com/watch/complications-and-beyond-2993) — video · 66:36 · [machine version](https://library.globalcastmd.com/watch/complications-and-beyond-2993.md) ### Evidence & Research - [Management of Asymptomatic Lung Lesions: Pediatric Thoracic Surgery Part...](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883) — video · 20:11 · [machine version](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883.md) - [Should We Resect Asymptomatic CPAM Flake vs Langer](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391) — video · 14:03 · [machine version](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391.md) - [Journal of Pediatric Surgery Article Review: November 2021](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-november-2021-4911) — podcast · 11:48 · [machine version](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-november-2021-4911.md) - [Case Based Journal Review - CPAM in 2022](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319) — podcast · 12:23 · [machine version](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319.md) - [Update Course 2022 - APSA PDC UPDATES - Mary Edwards, Paul Jeziorczak, Craig Lillehei, and Charles Snyder,](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820) — video · 64:30 · [machine version](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820.md) - [Update Course Rewind: Congenital Lung Lesions 2022](https://library.globalcastmd.com/watch/update-course-rewind-congenital-lung-lesions-2022-6996) — video · 4:33 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-congenital-lung-lesions-2022-6996.md) - [Clinical Symptoms Affect Treatment and Prognosis in Pediatric Patients with Congenital Pulmonary Airway Malformation](https://library.globalcastmd.com/watch/clinical-symptoms-affect-treatment-and-prognosis-in-pediatric-patients-with-congenital-pulmonary-airway-malformation-7843) — video · 0:55 · [machine version](https://library.globalcastmd.com/watch/clinical-symptoms-affect-treatment-and-prognosis-in-pediatric-patients-with-congenital-pulmonary-airway-malformation-7843.md) - [Journal of Pediatric Surgery Article Review: October 2023](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504) — podcast · 12:59 · [machine version](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504.md) - [Quick Literature Updates Episode 18](https://library.globalcastmd.com/watch/quick-literature-updates-episode-18-10064) — video · 4:21 · [machine version](https://library.globalcastmd.com/watch/quick-literature-updates-episode-18-10064.md) ### Case-Based Learning - [Panel Discussion: Pediatric Thoracic Surgery Part 1-Lung Lesions 2012](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921) — video · 61:56 · [machine version](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921.md) - [Difficult Cases of Lung Lesions: Pediatric Thoracic Surgery Part 1-Lung...](https://library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085) — video · 21:56 · [machine version](https://library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085.md) - [Spontaneous Pneumothorax: Lung Lesions](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086) — video · 22:21 · [machine version](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086.md) ### In-Depth Reviews - [Congenital Cystic Lung Lesions: Update Course 2014](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643) — video · 24:39 · [machine version](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643.md) - [The Full Story on CPAMs](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463) — podcast · 56:08 · [machine version](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463.md) ## Chapters - [0:15](https://library.globalcastmd.com/watch/update-course-rewind-congenital-lung-lesions-2022-6996?t=15) Malignancy Risk Factors in Congenital Lung Lesions (Ep 29) - [1:46](https://library.globalcastmd.com/watch/update-course-rewind-congenital-lung-lesions-2022-6996?t=106) Prenatal Diagnosis and PPB Risk (Ep 29) - [2:37](https://library.globalcastmd.com/watch/update-course-rewind-congenital-lung-lesions-2022-6996?t=157) Indications for Resection and Timing Considerations (Ep 29) - [0:00](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=0) Introduction and Panel Assembly (Ep 7) - [6:18](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=378) Case 1: Segmentectomy vs Lobectomy for CPAM (Ep 7) - [12:39](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=759) Case 2: Primary Spontaneous Pneumothorax Management (Ep 7) - [31:01](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=1861) Pneumothorax: Surgical Technique and Pleurodesis (Ep 7) - [39:16](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=2356) Case 3: Bronchopulmonary Fistula After Hydatid Cyst (Ep 7) - [57:56](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=3476) Technical Discussion: Clips and Sealants (Ep 7) - [0:01](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2226?t=1) Introduction and Technical Context (Ep 18) - [0:16](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2226?t=16) Case 1: Left Upper Lobectomy (Ep 18) - [3:27](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2226?t=207) Case 2: Right Upper Lobectomy (Ep 18) - [5:46](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2226?t=346) Outcomes (Ep 18) - [0:01](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2242?t=1) Introduction and Technical Context (Ep 21) - [0:16](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2242?t=16) Case 1: Left Upper Lobectomy in 12-Year-Old (Ep 21) - [3:27](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2242?t=207) Case 2: Right Upper Lobectomy in 1-Year-Old (Ep 21) - [5:46](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2242?t=346) Outcomes (Ep 21) - [0:02](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=2) Case Introduction and Systemic Vessel Control (Ep 19) - [1:59](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=119) Fissure Dissection and Pulmonary Artery Control (Ep 19) - [6:02](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=362) Inferior Pulmonary Vein Division (Ep 19) - [9:19](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=559) Bronchus Division and Closure (Ep 19) - [0:02](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=2) Case Introduction and Systemic Vessel Control (Ep 20) - [1:59](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=119) Fissure Dissection and Pulmonary Artery Control (Ep 20) - [6:02](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=362) Inferior Pulmonary Vein Dissection (Ep 20) - [9:19](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=559) Bronchial Division and Case Outcome (Ep 20) - [0:11](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=11) Introduction and Journal Partnership (Ep 22) - [2:35](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=155) Case 1: Congenital Lung Lesion - Lobectomy Complication (Ep 22) - [20:20](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=1220) Case 2: Paraesophageal Hernia After Nissen (Ep 22) - [42:00](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=2520) Case 3: Esophageal Atresia with Esophageal-Lung Fistula (Ep 22) - [0:16](https://library.globalcastmd.com/watch/quick-literature-updates-episode-18-10064?t=16) ERAS Society Neonatal Perioperative Care Recommendations (Ep 32) - [1:56](https://library.globalcastmd.com/watch/quick-literature-updates-episode-18-10064?t=116) Transition of Care for Colorectal Conditions (Ep 32) - [2:50](https://library.globalcastmd.com/watch/quick-literature-updates-episode-18-10064?t=170) Timing of Surgery for CPAM (Ep 32) - [3:52](https://library.globalcastmd.com/watch/quick-literature-updates-episode-18-10064?t=232) Closing (Ep 32) - [0:00](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=0) Anatomic Variants of Pulmonary Sequestrations (Ep 2) - [3:50](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=230) Infra-diaphragmatic BPS Case Demonstration (Ep 2) - [7:20](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=440) Bronchogenic Cysts and Bronchial Atresia (Ep 2) - [11:00](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=660) Q&A: Clips, Ligatures, and Referral Centers (Ep 2) - [15:00](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=900) Timing of CPAM Resection (Ep 2) - [18:10](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=1090) Technical Considerations for Small Infants (Ep 2) - [22:00](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=1320) Management of Complex Anatomy (Ep 2) ## Statements Every statement is attributed, typed, and timestamped; the link is the citation. - "The incidence of congenital lung lesions has increased over the past decades because more prenatal screening has been occurring worldwide" (epidemiological) [Ep 29 · 0:15](https://library.globalcastmd.com/watch/update-course-rewind-congenital-lung-lesions-2022-6996?t=15) - "Congenital lung lesions can often lead to malignancy or recurrent infections, both of which may require surgical workup and management" (clinical) [Ep 29 · 0:23](https://library.globalcastmd.com/watch/update-course-rewind-congenital-lung-lesions-2022-6996?t=23) - "In 2021, the Midwest Pediatric Surgery Consortium reviewed 521 primary lung lesions from 11 children's hospitals to identify specific risk factors associated with malignancy" (epidemiological) [Ep 29 · 1:07](https://library.globalcastmd.com/watch/update-course-rewind-congenital-lung-lesions-2022-6996?t=67) - "In the Midwest Pediatric Surgery Consortium series, no prenatally diagnosed lesions were malignant" (epidemiological) [Ep 29 · 1:20](https://library.globalcastmd.com/watch/update-course-rewind-congenital-lung-lesions-2022-6996?t=80) - "Roughly 10% of postnatally diagnosed congenital lung lesions were malignant" — Chuck Snyder (epidemiological) [Ep 29 · 1:24](https://library.globalcastmd.com/watch/update-course-rewind-congenital-lung-lesions-2022-6996?t=84) - "About half of the malignant lesions were associated with the DICER1 mutation" — Chuck Snyder (clinical) [Ep 29 · 1:24](https://library.globalcastmd.com/watch/update-course-rewind-congenital-lung-lesions-2022-6996?t=84) - "There was no malignant lesion that had a systemic feeding vessel" — Chuck Snyder (clinical) [Ep 29 · 1:32](https://library.globalcastmd.com/watch/update-course-rewind-congenital-lung-lesions-2022-6996?t=92) - "CT scan had poor sensitivity and specificity for malignancy" (clinical) [Ep 29 · 1:36](https://library.globalcastmd.com/watch/update-course-rewind-congenital-lung-lesions-2022-6996?t=96) - "Suspicion for malignancy by a CT scan and bilateral disease were predictive of malignancy" (clinical) [Ep 29 · 1:40](https://library.globalcastmd.com/watch/update-course-rewind-congenital-lung-lesions-2022-6996?t=100) - "In a series of approximately 400 cystic lesions, there was not a single patient who had antenatal diagnosis who was found to have a pleuropulmonary blastoma (PPB)" (epidemiological) [Ep 29 · 1:48](https://library.globalcastmd.com/watch/update-course-rewind-congenital-lung-lesions-2022-6996?t=108) - "If you have prenatal diagnosis, the chances of being PPB are close to 0" (epidemiological) [Ep 29 · 1:59](https://library.globalcastmd.com/watch/update-course-rewind-congenital-lung-lesions-2022-6996?t=119) - "For asymptomatic prenatally diagnosed lesions, the malignancy risk is not zero" (clinical) [Ep 29 · 2:21](https://library.globalcastmd.com/watch/update-course-rewind-congenital-lung-lesions-2022-6996?t=141) - "Many prenatally suspected lesions turn out to be nothing after birth, either not present or representing a mucus plug that has resolved" (clinical) [Ep 29 · 2:37](https://library.globalcastmd.com/watch/update-course-rewind-congenital-lung-lesions-2022-6996?t=157) - "CPAM becomes a general bucket for these lesions in the fetal world" (clinical) [Ep 29 · 2:52](https://library.globalcastmd.com/watch/update-course-rewind-congenital-lung-lesions-2022-6996?t=172) - "As the ability to identify specific lesions gets better with technological advances, management needs to change" (opinion) [Ep 29 · 2:56](https://library.globalcastmd.com/watch/update-course-rewind-congenital-lung-lesions-2022-6996?t=176) - "Children aged 4-9 years old with recurrent pneumonias from congenital lung lesions present a surgical challenge" (clinical) [Ep 29 · 3:04](https://library.globalcastmd.com/watch/update-course-rewind-congenital-lung-lesions-2022-6996?t=184) - "The chances of successful thoracoscopic resection are much lower in children aged 4-9 years with recurrent pneumonias than in the perinatal period or first year of life" (clinical) [Ep 29 · 3:13](https://library.globalcastmd.com/watch/update-course-rewind-congenital-lung-lesions-2022-6996?t=193) - "The primary concern for resection is preventing recurrent pneumonias and bronchiectasis rather than cancer" (opinion) [Ep 29 · 3:28](https://library.globalcastmd.com/watch/update-course-rewind-congenital-lung-lesions-2022-6996?t=208) - "The range of congenital lung anomalies varies from trivial little cysts to multilobar lesions that would require pneumonectomy" (clinical) [Ep 29 · 3:35](https://library.globalcastmd.com/watch/update-course-rewind-congenital-lung-lesions-2022-6996?t=215) - "Management must be tailored to the actual pathology of each individual lesion" (opinion) [Ep 29 · 3:50](https://library.globalcastmd.com/watch/update-course-rewind-congenital-lung-lesions-2022-6996?t=230) - "Reasons to resect congenital lung lesions include infection and risk of malignancy, with malignancy risk being a more minor reason for most surgeons" (opinion) [Ep 29 · 4:12](https://library.globalcastmd.com/watch/update-course-rewind-congenital-lung-lesions-2022-6996?t=252) - "Taking a lobectomy from an infant gives normal pulmonary functions when older" — Alan (clinical) [Ep 7 · 9:04](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=544) - "The risk of leaving CPAM disease behind by segmentectomy is relatively high" — Alan (clinical) [Ep 7 · 9:21](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=561) - "Segmentectomy of segment 6 and segment 10 is very difficult to perform thoracoscopically" — Yama (clinical) [Ep 7 · 9:51](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=591) - "If you do 100 segmentectomy cases, the likelihood of missing disease is significantly higher and complications are higher than lobectomy" — Alan (clinical) [Ep 7 · 11:49](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=709) - "Patients that undergo simple chest tube placement for symptomatic pneumothorax have upwards of 50% recurrence rate" — Alan (epidemiological) [Ep 7 · 22:56](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=1376) - "Second recurrence of pneumothorax occurs in about 75% of cases" — Alan (epidemiological) [Ep 7 · 23:36](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=1416) - "A recent study from Saint Peter in Kansas City found CT scan was very poor at defining bleb disease compared to subsequent thoracoscopy" — Alan (clinical) [Ep 7 · 28:46](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=1726) - "Almost all kids with spontaneous pneumothorax have some degree of bleb disease whether defined early or not" — Alan (clinical) [Ep 7 · 28:55](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=1735) - "Bleb disease doesn't necessarily mean recurrence" — Alan (clinical) [Ep 7 · 29:01](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=1741) - "Talc pleurodesis creates solid adhesions throughout the entire pleural space that complicate future thoracotomy" — Alan (clinical) [Ep 7 · 37:07](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=2227) - "Apical pleurectomy for pneumothorax typically extends down to the third intercostal space when apical blebs are present" — Steven Rothenberg (clinical) [Ep 7 · 37:22](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=2242) - "Hydrostatic pleurectomy can dissect the entire pleura by irrigating through a small pleural incision with a sealed suction irrigator" — Alan (clinical) [Ep 7 · 36:20](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=2180) - "In hydatid cyst surgery, there is usually a good plane between the lung and the cyst membrane" — Marcello (clinical) [Ep 7 · 52:24](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=3144) - "After removing the hydatid cyst membrane, you will always see some bubbling from bronchi in the lung" — Marcello (clinical) [Ep 7 · 52:34](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=3154) - "Once the parasite membrane is removed in hydatid cyst surgery, the patient is cured; closing fistulas is secondary" — Marcello (clinical) [Ep 7 · 53:13](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=3193) - "Persistent air leak hasn't been a problem in infant lobectomies with incomplete fissures, lasting maximum a few days" — Alan (clinical) [Ep 7 · 61:28](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=3688) - "Hem-o-lok clips are reliable for bronchi even in large diameter airways, with three sizes available including a 10mm plier version" — Marcello (clinical) [Ep 7 · 59:13](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=3553) - "For large vessels when ligature alone seems insufficient, placing one proximal Hem-o-lok clip before ligature is very safe" — Marcello (clinical) [Ep 7 · 59:52](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=3592) - "Pulmonary upper lobectomies are more technically challenging than lower lobectomies, especially following infection" (clinical) [Ep 18 · 0:01](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2226?t=1) - "A dual lumen endotracheal tube and low flow chest insufflation were used to collapse the left lung" (clinical) [Ep 18 · 0:39](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2226?t=39) - "Inflammatory adhesions can be seen between the left upper lobe and the chest wall" (clinical) [Ep 18 · 0:45](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2226?t=45) - "The fissure is completed by dividing the pulmonary tissue starting anteriorly and proceeding posteriorly" (clinical) [Ep 18 · 1:04](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2226?t=64) - "The superior pulmonary vein is identified but not divided initially to allow further cephalad retraction of the upper lobe" (clinical) [Ep 18 · 1:37](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2226?t=97) - "A combination of clips and ligature is used to divide the segmental arteries" (clinical) [Ep 18 · 1:51](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2226?t=111) - "Enlarged lymph nodes can be seen in the fissure" (clinical) [Ep 18 · 2:02](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2226?t=122) - "Where distance allows, the segmental vessels are clipped proximally prior to division with the ligature" (clinical) [Ep 18 · 2:06](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2226?t=126) - "10 millimeter clips are used to control each venous tributary separately" (clinical) [Ep 18 · 2:34](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2226?t=154) - "The segmental bronchus to the lingular segments is divided with an endo GIA" (clinical) [Ep 18 · 3:00](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2226?t=180) - "The inferior pulmonary ligament is divided to allow the lower lobe to rise in the chest" (clinical) [Ep 18 · 3:20](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2226?t=200) - "Resection was performed 3 months after resolution of the pneumonia" (clinical) [Ep 18 · 3:32](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2226?t=212) - "Left main stem intubation was used to isolate the right lung" (clinical) [Ep 18 · 3:37](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2226?t=217) - "Segmental inflammatory adhesions are present and have to be taken down and freed before dissection of the upper lobe" (clinical) [Ep 18 · 3:42](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2226?t=222) - "Persistent inflammation of the upper lobe and adhesions to the middle lobe are visible" (clinical) [Ep 18 · 3:51](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2226?t=231) - "The arteries are much smaller in this younger child and can be taken with a ligature after deliberate dissection" (clinical) [Ep 18 · 4:16](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2226?t=256) - "The most superior and largest of the segmental arteries is clipped proximally prior to application of the ligature" (clinical) [Ep 18 · 4:30](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2226?t=270) - "The superior pulmonary vein is in a slightly more superficial plane than the arteries" (clinical) [Ep 18 · 4:43](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2226?t=283) - "The recurrent segmental artery to the upper lobe arising from the main pulmonary trunk is found in the fissure" (clinical) [Ep 18 · 5:30](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2226?t=330) - "Both patients had excellent outcomes with complete expansion of the operated lung" (clinical) [Ep 18 · 5:46](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2226?t=346) - "Pulmonary upper lobectomies are more technically challenging than lower lobectomies, especially following infection" (clinical) [Ep 21 · 0:01](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2242?t=1) - "A dual lumen endotracheal tube and low flow chest insufflation were used to collapse the left lung" (clinical) [Ep 21 · 0:39](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2242?t=39) - "Inflammatory adhesions can be seen between the left upper lobe and the chest wall" (clinical) [Ep 21 · 0:45](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2242?t=45) - "The fissure is completed by dividing the pulmonary tissue starting anteriorly and proceeding posteriorly" (clinical) [Ep 21 · 1:04](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2242?t=64) - "The superior pulmonary vein is identified but not divided initially to allow further cephalad retraction of the upper lobe" (clinical) [Ep 21 · 1:37](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2242?t=97) - "A combination of clips and ligature is used to divide the segmental arteries" (clinical) [Ep 21 · 1:51](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2242?t=111) - "Enlarged lymph nodes can be seen in the fissure" (clinical) [Ep 21 · 2:02](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2242?t=122) - "Where distance allows, the segmental vessels are clipped proximally prior to division with the ligature" (clinical) [Ep 21 · 2:06](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2242?t=126) - "10 millimeter clips are used to control each venous tributary separately" (clinical) [Ep 21 · 2:34](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2242?t=154) - "The segmental bronchus to the lingular segments is divided with an endo GIA" (clinical) [Ep 21 · 3:00](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2242?t=180) - "The inferior pulmonary ligament is divided to allow the lower lobe to rise in the chest" (clinical) [Ep 21 · 3:20](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2242?t=200) - "Resection was performed 3 months after resolution of the pneumonia" (clinical) [Ep 21 · 3:32](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2242?t=212) - "Left main stem intubation was used to isolate the right lung" (clinical) [Ep 21 · 3:37](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2242?t=217) - "Persistent inflammation of the upper lobe and adhesions to the middle lobe were present" (clinical) [Ep 21 · 3:51](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2242?t=231) - "The arteries are much smaller in this younger child and can be taken with a ligature after deliberate dissection" (clinical) [Ep 21 · 4:16](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2242?t=256) - "The superior pulmonary vein is in a slightly more superficial plane than the arteries" (clinical) [Ep 21 · 4:43](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2242?t=283) - "The recurrent segmental artery to the upper lobe arising from the main pulmonary trunk is found in the fissure" (clinical) [Ep 21 · 5:30](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2242?t=330) - "Both patients had excellent outcomes with complete expansion of the operated lung" (clinical) [Ep 21 · 5:46](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2242?t=346) - "The malformation was diagnosed prenatally" (clinical) [Ep 19 · 0:11](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=11) - "The patient was asymptomatic at birth" (clinical) [Ep 19 · 0:11](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=11) - "CT scan at 4 months showed left lower lobe CPAM with systemic blood supply from sub-diaphragmatic aorta" (clinical) [Ep 19 · 0:17](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=17) - "The patient remained asymptomatic and operation was performed at 9 months of age" (clinical) [Ep 19 · 0:29](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=29) - "Left lung is isolated by right main stem intubation" (clinical) [Ep 19 · 0:36](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=36) - "Patient is placed in right lateral decubitus position with surgeon and assistant facing the patient" (clinical) [Ep 19 · 0:41](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=41) - "Large arterial vessel coming through diaphragm medial to inferior pulmonary ligament and entering left lower lobe confirms hybrid lesion" (clinical) [Ep 19 · 0:48](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=48) - "Inferior pulmonary ligament is divided to border of inferior pulmonary vein to mobilize left lower lobe" (clinical) [Ep 19 · 0:59](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=59) - "Systemic arterial vessel is skeletonized with hook cautery then double clipped proximally" (clinical) [Ep 19 · 1:11](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=71) - "Ligature device applied distally to coagulate and divide systemic vessel" (clinical) [Ep 19 · 1:31](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=91) - "Fissure is completed using ligature and sharp dissection" (clinical) [Ep 19 · 2:02](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=122) - "Division of pulmonary parenchyma in fissure allows visualization of pulmonary artery branches to lower lobe" (clinical) [Ep 19 · 2:24](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=144) - "Dissection should be kept as bloodless as possible" (opinion) [Ep 19 · 2:50](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=170) - "Any bleeding from divided parenchyma should be controlled early with ligature" (opinion) [Ep 19 · 2:53](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=173) - "Excellent visualization is essential for adequate vascular control" (opinion) [Ep 19 · 3:13](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=193) - "Right angle dissector is extremely useful in skeletonizing vessels" (opinion) [Ep 19 · 3:41](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=221) - "Precise dissection allows gaining adequate distance on vessels for safe ligation" (opinion) [Ep 19 · 3:46](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=226) - "Dissection in fissure always proceeds from medial to lateral" (opinion) [Ep 19 · 4:09](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=249) - "Clips are preferred proximally if adequate vessel length achieved, though ligature can be used as sole method" (opinion) [Ep 19 · 4:39](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=279) - "Once pulmonary artery and fissure parenchyma divided, bronchus comes into view" (clinical) [Ep 19 · 6:21](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=381) - "It is quite common for inferior pulmonary vein to consist of two major tributaries that join as they approach left atrium" (clinical) [Ep 19 · 8:15](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=495) - "When inferior pulmonary vein has two tributaries, it is best to dissect each separately" (opinion) [Ep 19 · 8:31](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=511) - "Veins are controlled by clipping on cardiac side and applying ligature on pulmonary side" (clinical) [Ep 19 · 8:36](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=516) - "Endo GIA device is introduced through chest wall to staple and divide bronchus" (clinical) [Ep 19 · 9:26](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=566) - "Specimen is extracted by slightly enlarging posteriormost port site" (clinical) [Ep 19 · 9:36](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=576) - "Patient was extubated at end of procedure" (clinical) [Ep 19 · 9:46](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=586) - "Patient discharged on 2nd postoperative day" (clinical) [Ep 19 · 9:46](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=586) - "Patient had excellent recovery with normal chest X-ray 2 years after procedure" (clinical) [Ep 19 · 9:53](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=593) - "The malformation was diagnosed prenatally" (clinical) [Ep 20 · 0:11](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=11) - "The patient was asymptomatic at birth" (clinical) [Ep 20 · 0:11](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=11) - "CT scan at 4 months showed left lower lobe CPAM with systemic blood supply from sub-diaphragmatic aorta" (clinical) [Ep 20 · 0:17](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=17) - "The operation was performed at 9 months of age" (clinical) [Ep 20 · 0:29](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=29) - "Left lung isolation is achieved by right main stem intubation" (clinical) [Ep 20 · 0:36](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=36) - "Patient is placed in right lateral decubitus position with surgeon and assistant facing the patient" (clinical) [Ep 20 · 0:41](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=41) - "Large arterial vessel coming through diaphragm medial to inferior pulmonary ligament confirms hybrid lesion" (clinical) [Ep 20 · 0:48](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=48) - "Inferior pulmonary ligament is divided to the border of inferior pulmonary vein to mobilize left lower lobe" (clinical) [Ep 20 · 0:59](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=59) - "Systemic arterial vessel is double clipped proximally and divided distally with ligature device" (clinical) [Ep 20 · 1:20](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=80) - "Fissure is completed using ligature and sharp dissection" (clinical) [Ep 20 · 2:10](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=130) - "Division of pulmonary parenchyma in fissure allows visualization of pulmonary artery branches to lower lobe" (clinical) [Ep 20 · 2:24](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=144) - "Dissection should be kept as bloodless as possible" (opinion) [Ep 20 · 2:50](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=170) - "Bleeding from divided parenchyma should be controlled early with ligature" (opinion) [Ep 20 · 2:53](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=173) - "Excellent visualization is essential for adequate vascular control" (opinion) [Ep 20 · 3:13](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=193) - "Right angle dissector is useful in skeletonizing vessels and gaining adequate distance for safe ligation" (opinion) [Ep 20 · 3:41](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=221) - "Dissection in fissure always proceeds from medial to lateral" (opinion) [Ep 20 · 4:09](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=249) - "Clips are preferred proximally if adequate vessel length achieved, though ligature alone can be used" (opinion) [Ep 20 · 4:54](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=294) - "After pulmonary artery and fissure division, the bronchus comes into view" (clinical) [Ep 20 · 6:21](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=381) - "It is common for inferior pulmonary vein to consist of two major tributaries joining near left atrium" (clinical) [Ep 20 · 8:15](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=495) - "When dual tributary anatomy present, best to dissect each tributary separately" (opinion) [Ep 20 · 8:31](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=511) - "Veins are controlled by clipping on cardiac side and ligature on pulmonary side" (clinical) [Ep 20 · 8:36](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=516) - "Endo-GIA device is used to staple and divide the bronchus" (clinical) [Ep 20 · 9:26](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=566) - "Specimen is extracted by enlarging posteriormost port site" (clinical) [Ep 20 · 9:36](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=576) - "Patient was extubated at end of procedure" (clinical) [Ep 20 · 9:46](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=586) - "Patient was discharged on 2nd postoperative day" (clinical) [Ep 20 · 9:46](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=586) - "Patient had excellent recovery with normal chest X-ray 2 years post-procedure" (clinical) [Ep 20 · 9:53](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=593) - "Chest X-ray is standard initial imaging for asymptomatic newborns with prenatally diagnosed lung lesions in US practice" — Todd (clinical) [Ep 22 · 3:17](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=197) - "CT scan with angiography is typically performed at 3-6 months in clinic for asymptomatic congenital lung lesions, not routinely in the NICU" — Jason Frischer (clinical) [Ep 22 · 4:32](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=272) - "Operating at 3 months is considered the 'sweet spot' for congenital lung lesion resection; waiting longer results in more inflammation and increased difficulty" — Witt (clinical) [Ep 22 · 8:26](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=506) - "Thoracoscopic approach provides better visibility than open thoracotomy for lobectomy in 3-month-old infants" — Miguel Gilfan (clinical) [Ep 22 · 12:08](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=728) - "Energy devices work well for vessel control in small babies during thoracoscopic lobectomy" — Witt (clinical) [Ep 22 · 13:22](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=802) - "Staplers can fail during thoracoscopic lobectomy and surgeons must be prepared with backup plans before firing any device" — Witt (clinical) [Ep 22 · 18:30](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=1110) - "When using energy devices for vessel control, leave enough remnant tissue so the vessel doesn't retract if the seal fails" — Jason Frischer (clinical) [Ep 22 · 17:23](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=1043) - "Dissecting vessels too cleanly (removing all adventitia) can make them unsuitable for stapling" — Sean (clinical) [Ep 22 · 19:52](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=1192) - "Placing a silk suture on the pulmonary vein before using energy devices or staplers provides safety if the primary method fails" — Sean (clinical) [Ep 22 · 18:40](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=1120) - "The real risk of malignancy in congenital lung lesions remains unknown, limiting evidence-based decisions on observation versus resection" — Todd (epidemiological) [Ep 22 · 20:24](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=1224) - "Medical therapy alone is unlikely to resolve symptomatic paraesophageal hernias; they will continue to progress and require surgical repair" — Sean (clinical) [Ep 22 · 24:09](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=1449) - "Primary crural repair without mesh is preferred if the crura come together easily without tension" — Dan (clinical) [Ep 22 · 25:54](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=1554) - "Biologic mesh is safer than non-absorbable mesh in children for hiatal hernia repair due to risk of erosion into esophageal lumen with permanent mesh" — Witt (clinical) [Ep 22 · 26:52](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=1612) - "Adult data suggests mesh reinforcement reduces recurrence rates in paraesophageal hernia repair" — Sean (epidemiological) [Ep 22 · 27:19](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=1639) - "Dysphagia within 2 weeks of Nissen fundoplication is too early for dilation; waiting 4-6 weeks allows swelling to resolve" — Witt (clinical) [Ep 22 · 32:49](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=1969) - "In one surgeon's personal experience, swallowing normalized on day 18 after Nissen fundoplication" — Witt (opinion) [Ep 22 · 33:54](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=2034) - "Post-fundoplication obstruction can result from posterior crural sutures placed too anteriorly, creating a pinch point as the esophagus courses anterior-to-posterior across the diaphragm" — Sean (clinical) [Ep 22 · 36:46](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=2206) - "Intraoperative contrast or endoscopy can identify which structure (crura vs fundoplication) is causing obstruction during revision surgery" — Sean (clinical) [Ep 22 · 38:20](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=2300) - "Using a bougie during fundoplication and observing for hang-up at the GE junction can identify overly tight posterior crural sutures intraoperatively" — Witt (clinical) [Ep 22 · 41:07](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=2467) - "Minimal dissection technique with no posterior crural sutures eliminates the risk of posterior crural obstruction after fundoplication" — Sean (clinical) [Ep 22 · 41:54](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=2514) - "Patients requiring multiple fundoplication revisions may ultimately need gastric disconnection as definitive management" — Todd (opinion) [Ep 22 · 44:27](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=2667) - "Gastric disconnection is a good operation in cognitively impaired patients who don't take much by mouth and have failed multiple fundoplications" — Dan (clinical) [Ep 22 · 45:22](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=2722) - "Nissen fundoplication is a mechanical fix to a physiologic problem, making it inherently challenging" — Dan (opinion) [Ep 22 · 44:09](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=2649) - "In unstable neonates with esophageal atresia and gastric distention, open gastrostomy with esophageal control at the GE junction is faster and safer than laparoscopic approach" — Todd (clinical) [Ep 22 · 52:35](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=3155) - "Bronchoscopy should be performed in all esophageal atresia cases to identify additional fistulas or airway anomalies" — Dan (guideline) [Ep 22 · 54:34](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=3274) - "Esophageal-lung fistula is extremely rare with approximately 30 reported cases" — Jason Frischer (epidemiological) [Ep 22 · 64:12](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=3852) - "Tracheal reconstruction with reimplantation of stenotic bronchus is possible in select cases of complex tracheoesophageal anomalies" — Dan (clinical) [Ep 22 · 61:10](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=3670) - "When decompressing a neonate with gastric distention from tracheoesophageal fistula, the patient may decompensate further after decompression" — Todd (clinical) [Ep 22 · 52:48](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=3168) - "The ERAS Society used a modified Delphi technique with a multidisciplinary group of experts to reach more than 70% consensus" — Lizzie Lee (guideline) [Ep 32 · 1:10](https://library.globalcastmd.com/watch/quick-literature-updates-episode-18-10064?t=70) - "The ERAS Society agreed on 16 recommendations covering 11 topics including team communication, pre-surgery fasting, temperature control, and antibiotic use" — Lizzie Lee (guideline) [Ep 32 · 1:34](https://library.globalcastmd.com/watch/quick-literature-updates-episode-18-10064?t=94) - "The ERAS Society did not have enough data to make recommendations about nasogastric tubes and central lines" — Lizzie Lee (guideline) [Ep 32 · 1:43](https://library.globalcastmd.com/watch/quick-literature-updates-episode-18-10064?t=103) - "Eight studies were found examining transition from pediatric to adult healthcare for colorectal conditions" — Alex Halpern (epidemiological) [Ep 32 · 2:21](https://library.globalcastmd.com/watch/quick-literature-updates-episode-18-10064?t=141) - "Studies agreed that transitional care should start early in adolescence" — Alex Halpern (guideline) [Ep 32 · 2:24](https://library.globalcastmd.com/watch/quick-literature-updates-episode-18-10064?t=144) - "Little evidence exists that transfer from pediatric to adult care is happening in a coordinated or timely fashion" — Alex Halpern (epidemiological) [Ep 32 · 2:24](https://library.globalcastmd.com/watch/quick-literature-updates-episode-18-10064?t=144) - "No models of transition care were identified for patients with anorectal malformations and Hirschsprung's disease" — Alex Halpern (epidemiological) [Ep 32 · 2:33](https://library.globalcastmd.com/watch/quick-literature-updates-episode-18-10064?t=153) - "The CPAM study included 110 patients" — Cecilia Gigena (epidemiological) [Ep 32 · 3:21](https://library.globalcastmd.com/watch/quick-literature-updates-episode-18-10064?t=201) - "Patients who underwent surgery before becoming symptomatic had shorter length of stay" — Cecilia Gigena (clinical) [Ep 32 · 3:21](https://library.globalcastmd.com/watch/quick-literature-updates-episode-18-10064?t=201) - "Patients who underwent surgery before becoming symptomatic had shorter mechanical ventilation after surgery" — Cecilia Gigena (clinical) [Ep 32 · 3:21](https://library.globalcastmd.com/watch/quick-literature-updates-episode-18-10064?t=201) - "Patients who underwent surgery before becoming symptomatic had shorter operating times" — Cecilia Gigena (clinical) [Ep 32 · 3:21](https://library.globalcastmd.com/watch/quick-literature-updates-episode-18-10064?t=201) - "There was no significant difference in conversion or post-operative complications between symptomatic and asymptomatic CPAM patients undergoing surgery" — Cecilia Gigena (clinical) [Ep 32 · 3:31](https://library.globalcastmd.com/watch/quick-literature-updates-episode-18-10064?t=211) - "It appears safer to operate on CPAM patients before they become symptomatic" — Cecilia Gigena (opinion) [Ep 32 · 3:44](https://library.globalcastmd.com/watch/quick-literature-updates-episode-18-10064?t=224) - "Sequestrations can have abnormal pulmonary venous drainage patterns visible on CT" — Alan (clinical) [Ep 2 · 0:00](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=0) - "Lung lesions are frequently misdiagnosed as intra-diaphragmatic or sub-diaphragmatic when they are actually in the chest" — Steve (clinical) [Ep 2 · 0:19](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=19) - "Some infra-diaphragmatic lesions are approached laparoscopically" — Steve (clinical) [Ep 2 · 0:30](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=30) - "A new class of lesions exists within the leaves of the diaphragm muscle requiring opening of the diaphragm for access" — Steve (clinical) [Ep 2 · 0:39](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=39) - "Infra-diaphragmatic sequestrations are often located at the GE junction or esophageal hiatus" — Alan (clinical) [Ep 2 · 0:51](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=51) - "Infra-diaphragmatic sequestrations can cause esophageal obstructive symptomatology" — Alan (clinical) [Ep 2 · 0:56](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=56) - "Extra-lobar sequestrations can have systemic arterial inflow and distal azygous outflow" — Alan (clinical) [Ep 2 · 1:18](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=78) - "Extra-lobar sequestrations are completely separately invested by pleura with no parenchymal connection" — Alan (clinical) [Ep 2 · 1:52](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=112) - "The majority of infra-diaphragmatic lesions approached through the abdomen extend up through the esophageal hiatus" — Steve (clinical) [Ep 2 · 4:45](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=285) - "Bronchogenic cysts can be alone or associated with bronchial obstruction" — Alan (clinical) [Ep 2 · 7:20](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=440) - "Hyperplastic growth of the distal lobe is often seen when bronchogenic cysts are associated with bronchial atresia" — Alan (clinical) [Ep 2 · 7:29](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=449) - "Alveolarization phase of lung development continues until 4 to 6 years of age" — Alan (clinical) [Ep 2 · 16:27](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=987) - "Recent study showed increased risk of complications like infection with delayed resection but no difference in long-term pulmonary function" — Alan (clinical) [Ep 2 · 15:33](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=933) - "Resection timing probably doesn't matter from a lung growth perspective if done in the first 3 months" — Alan (opinion) [Ep 2 · 16:43](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=1003) - "Most CPAM lesions are removed before 3 months of age at Steve's center" — Steve (clinical) [Ep 2 · 17:38](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=1058) - "Thoracoscopic resection is technically easier in younger infants, though requires comfort working in small spaces" — Steve (opinion) [Ep 2 · 17:44](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=1064) - "Children recover quicker from thoracoscopic resection at younger ages with shorter hospitalization" — Steve (clinical) [Ep 2 · 17:51](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=1071) - "Setup and trocar positioning is critical for thoracoscopic surgery in small neonates" — Steve (clinical) [Ep 2 · 18:15](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=1095) - "CO2 pressure of 7 centimeters of water is typically used for thoracoscopic lung resection" — Alan (clinical) [Ep 2 · 19:12](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=1152) - "Starting CO2 pressure of 4 is adequate if good single lung ventilation is achieved" — Steve (clinical) [Ep 2 · 19:27](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=1167) - "Mild tension pneumothorax from CO2 insufflation is well tolerated in infants" — Steve (clinical) [Ep 2 · 19:55](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=1195) - "Current technology limits thoracoscopic lobectomy to infants over approximately 2 kg" — Steve (clinical) [Ep 2 · 20:49](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=1249) - "PDA ligations are now routinely done thoracoscopically down to 800g" — Steve (clinical) [Ep 2 · 20:49](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=1249) - "5mm clip applicators take up 2/3 of the chest in very small infants limiting maneuverability" — Steve (clinical) [Ep 2 · 21:32](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=1292) - "Thoracoscopic lobectomy requires a healthy stable baby with adequate contralateral lung for single lung ventilation" — Alan (clinical) [Ep 2 · 22:08](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=1328) - "Stable babies with small lesions can be sent home to grow for 1-2 months before returning for resection" — Steve (clinical) [Ep 2 · 22:44](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=1364) - "True bilobar involvement of CPAM is relatively rare" — Alan (clinical) [Ep 2 · 24:13](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=1453) - "Most apparent bilobar involvement is actually abnormalities of lobulation or fissure formation" — Alan (clinical) [Ep 2 · 24:18](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=1458) - "Clips on vessels can be dislodged during subsequent dissection" — Steve (clinical) [Ep 2 · 11:50](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=710) - "Sealed vessels cannot be dislodged during dissection unlike clips" — Steve (opinion) [Ep 2 · 12:02](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=722) - "Good histologic diagnoses can be obtained from thoracoscopic resections despite pathologist concerns about specimen quality" — Alan (clinical) [Ep 2 · 14:15](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=855) - "When bronchogenic cyst obstructs upper lobe bronchus, the bronchus is destroyed enough that lobectomy is required, not just cyst resection" — Alan (clinical) [Ep 2 · 8:32](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=512) - "32-week ultrasound used to prognosticate whether fetus will be asymptomatic or symptomatic at birth based on mediastinal shift" (clinical) [Ep 3 · 0:05](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=5) - "Absence of mediastinal shift and relatively small lesion predicts asymptomatic status at birth" (clinical) [Ep 3 · 0:18](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=18) - "CPAMs are prone to infection and routinely show mucoid stasis at resection" (clinical) [Ep 3 · 2:05](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=125) - "CPAMs show evidence of inflammation and infection when resected at 2-3 months of age" (clinical) [Ep 3 · 2:15](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=135) - "CPAMs have established malignant potential including pleuropulmonary blastoma, bronchoalveolar carcinoma, and rhabdomyosarcoma" (clinical) [Ep 3 · 2:27](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=147) - "Pleuropulmonary blastoma cannot be differentiated radiologically from CPAM" (clinical) [Ep 3 · 2:43](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=163) - "Speaker personally resected three CPAMs that were stage 1 pleuropulmonary blastomas" (clinical) [Ep 3 · 2:51](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=171) - "Pleuropulmonary blastomas are highly malignant and lethal if allowed to progress beyond stage 1" (clinical) [Ep 3 · 2:59](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=179) - "Intralobar BPS can have CPAM histology" (clinical) [Ep 3 · 3:11](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=191) - "There is anatomical and histological overlap between congenital lung lesion types" (clinical) [Ep 3 · 3:15](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=195) - "Cannot be absolutely certain that a sequestration with small cysts lacks CPAM histology" (clinical) [Ep 3 · 3:30](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=210) - "Intralobar BPS has communications via pores of Kohn which can lead to infection" (clinical) [Ep 3 · 3:40](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=220) - "Waiting until 4-5 months of age can result in significant inflammation within fissures that changes the dissection" — Steve (clinical) [Ep 3 · 4:20](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=260) - "Earlier resection is surgically easier and less traumatic for the infant" (opinion) [Ep 3 · 6:38](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=398) - "Thoracoscopic resection has shorter hospital stay, less pain, no thoracotomy morbidity, and better cosmesis" (clinical) [Ep 3 · 7:09](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=429) - "Segmental bronchial stenoses have a very confluent appearance, almost like emphysematous pulmonary parenchyma" (clinical) [Ep 3 · 7:46](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=466) - "Presence of any cysts in bronchial stenosis lesions usually indicates CPAM histology" (clinical) [Ep 3 · 7:58](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=478) - "Middle lobe is the hardest lobe to resect thoracoscopically" (opinion) [Ep 3 · 9:49](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=589) - "CPAMs often have abnormally globulated appearance and abnormal fissures related to developmental effects" (clinical) [Ep 3 · 10:32](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=632) - "Cannot depend on normal anatomy when doing lobectomies for CPAMs" (clinical) [Ep 3 · 10:42](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=642) - "Hybrid lesions can have large feeding vessels approximately half the size of the aorta" (clinical) [Ep 3 · 13:51](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=831) - "Systemic feeding vessels in sequestrations have abnormal integrity similar to PDAs" (clinical) [Ep 3 · 13:57](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=837) - "Sequestrations can draw blood supply from essentially any systemic source" (clinical) [Ep 3 · 15:55](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=955) - "Intralobar sequestrations with pulmonary venous drainage represent high output potential shunts that can cause cardiac failure by 3-4 years of age" (clinical) [Ep 3 · 20:39](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=1239) - "Arterialization of vasculature occurs in sequestrations, with even pulmonary veins becoming thickened like arteries" (clinical) [Ep 3 · 21:23](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=1283) - "Multiple feeding vessels are common in sequestrations despite CT appearance of single vessel" — Steve (clinical) [Ep 3 · 22:01](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=1321) - "Extralobar BPS have separate pleural investment, no bronchial connection, and systemic arterial supply" (clinical) [Ep 3 · 23:09](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=1389) - "Extralobar BPS can have systemic or pulmonary venous drainage" (clinical) [Ep 3 · 23:09](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=1389) - "Extralobar BPS have mucostasis but no airway communication, so no infection risk" (clinical) [Ep 3 · 23:34](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=1414) - "Extralobar sequestrations can get infected, likely via hematogenous route" — Steve (clinical) [Ep 3 · 24:28](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=1468) - "Once any congenital lung lesion gets infected, it becomes much more difficult to resect" — Steve (clinical) [Ep 3 · 24:36](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=1476) - "Purely extralobar sequestrations that are prenatally diagnosed are relatively straightforward to resect" — Steve (opinion) [Ep 3 · 24:41](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=1481) - "Edematous extralobar BPS typically have small pedicles" (clinical) [Ep 3 · 19:33](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=1173) - "Edematous sequestrations often have pleural effusions due to lymphatic congestion" (clinical) [Ep 3 · 25:28](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=1528) - "Esophageal bronchus may be present when sequestration is against the esophagus and difficult to separate" (clinical) [Ep 3 · 30:53](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=1853) - "Most people believe now that CCAMs do not become PPB, but PPB is a de novo tumor that is cystic and cannot be differentiated on imaging" — Jean Martin (clinical) [Ep 6 · 0:31](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=31) - "There are several cases of prenatally diagnosed lesions that turned out to be PPB after birth" — Jean Martin (clinical) [Ep 6 · 0:51](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=51) - "A Toronto series estimates that cystic lesions that look like CCAM, about 4% will actually turn out to be PPB" — Jean Martin (epidemiological) [Ep 6 · 1:24](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=84) - "There is about a 1% risk of bronchioalveolar carcinoma in CCAM, occurring in teenage years or early adulthood" — Jean Martin (epidemiological) [Ep 6 · 1:34](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=94) - "If resecting by thoracoscopy, the specimen should be placed in a bag before extraction to avoid tumor spillage if it turns out to be PPB" — Jean Martin (clinical) [Ep 6 · 2:11](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=131) - "Extralobar sequestrations by definition have no communication and no air on CT scan, and their infection rate is not very high" — Jean Martin (clinical) [Ep 6 · 2:39](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=159) - "Malignant transformation of extralobar sequestration is extremely rare, with maybe one or two cases of squamous cell carcinoma in world literature" — Jean Martin (epidemiological) [Ep 6 · 3:00](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=180) - "Infection and cancer are not good arguments to resect a non-communicating extralobar sequestration" — Jean Martin (opinion) [Ep 6 · 3:11](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=191) - "The COG study showed it was safe to observe adrenal masses in neonates" — Jean Martin (guideline) [Ep 6 · 5:52](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=352) - "CT scan is the best method to follow pulmonary lesions, but it induces a certain incidence of malignancy itself" — Alan (clinical) [Ep 6 · 6:20](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=380) - "You cannot differentiate CCAM from PPB on CT scan until you have a stage two or three occurrence" — Alan (clinical) [Ep 6 · 6:32](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=392) - "There are children who die from pulmonary lobectomy, particularly done thoracoscopically" — Jack (clinical) [Ep 6 · 7:29](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=449) - "Thoracoscopic lobectomy should have no more morbidity than open in experienced hands" — Steve (opinion) [Ep 6 · 8:13](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=493) - "The mortality for thoracoscopic lobectomy should be zero if performed by surgeons with advanced thoracic and minimally invasive skills" — Steve (opinion) [Ep 6 · 8:26](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=506) - "If massive bleeding occurs during thoracoscopic lobectomy, the chance of salvaging the situation is probably better if already open" — Jack (opinion) [Ep 6 · 9:04](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=544) - "PPB remains extremely rare, occurring approximately once every 3-4 years in a high-volume center that sees 20-25 new CCAM cases per year" — Jack (epidemiological) [Ep 6 · 10:28](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=628) - "The estimated lifelong risk of infection for CCAM is somewhere around 20-30%" — Jack (epidemiological) [Ep 6 · 10:54](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=654) - "Most CCAM infections can be treated and lobectomy can be done afterwards" — Jack (clinical) [Ep 6 · 11:06](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=666) - "A prospective study showed 18 of 21 asymptomatic patients developed symptomatology during follow-up averaging 2 years up to 13 years" — Alan (epidemiological) [Ep 6 · 11:29](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=689) - "The infection rate data was 10% with a mean follow-up of 4 years, which was tripled to estimate lifetime risk" — Jack (epidemiological) [Ep 6 · 12:08](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=728) - "Before prenatal diagnosis, it was not common for people to present during teenage years or in adult thoracic surgery units with symptomatic infected CCAMs" — Jack (epidemiological) [Ep 6 · 12:40](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=760) - "Small asymptomatic extralobar sequestration is a relatively known finding at autopsy, but asymptomatic CCAM on autopsy series is nonexistent" — Jean Martin (epidemiological) [Ep 6 · 15:44](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=944) - "The majority of CCAMs do become symptomatic; it is not a normal variant" — Jean Martin (opinion) [Ep 6 · 16:04](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=964) - "Many families choose operative management as soon as they hear the word cancer or infection" — Jack (clinical) [Ep 6 · 16:47](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=1007) - "Approximately 25% of respondents in a poll do not advocate routine resection of asymptomatic CCAM" — Jack (epidemiological) [Ep 6 · 18:02](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=1082) - "There is a hidden mortality in pediatric surgery because people do not report bad results, only known through lawsuits" (opinion) [Ep 6 · 18:25](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=1105) - "Centers that routinely perform thoracoscopic lobectomy for CCAM can treat them with extremely low morbidity and no mortality" — Alan (opinion) [Ep 6 · 19:29](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=1169) - "In a review of 100 thoracoscopic lobectomies, there were two transfusions and two latent pneumothoraces as the only complications" — Alan (clinical) [Ep 6 · 19:49](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=1189) - "Shunts for macrocystic CCAMs have been performed with pretty good success, with similar test numbers to published series" — Jack (clinical) [Ep 5 · 0:29](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=29) - "Vessel occlusion in bronchopulmonary sequestrations or hybrid lesions using various techniques has had mixed success" — Jack (clinical) [Ep 5 · 0:49](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=49) - "Radiofrequency ablation for vessel occlusion was a disaster and is not recommended" — Jack (clinical) [Ep 5 · 1:27](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=87) - "Coil embolization was initially successful but the fetus died about a week later for unclear reasons" — Jack (clinical) [Ep 5 · 1:33](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=93) - "Alcohol injection for vessel occlusion carries risk of systemic circulation through shunts, potentially causing thrombosis in cardiac chambers and other sites" — Alan (clinical) [Ep 5 · 1:52](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=112) - "The effects of alcohol injection on fetal neural development and organ development have not been studied experimentally, even in sheep models" — Alan (opinion) [Ep 5 · 2:29](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=149) - "Radiofrequency ablation cannot be controlled in the fetus due to 90% water content, with energy dispersing unpredictably and causing collateral damage" — Alan (clinical) [Ep 5 · 3:00](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=180) - "Probably 95% of CCAMs are now prenatally diagnosed" (epidemiological) [Ep 5 · 3:46](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=226) - "Almost none of prenatally diagnosed CCAMs require prenatal intervention and very few require intervention the day the child is born" (clinical) [Ep 5 · 3:52](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=232) - "Only one or two centers in the world should be thinking about extreme fetal interventions for lung lesions due to the small number of cases requiring such treatment" (opinion) [Ep 5 · 4:09](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=249) - "The majority of children with prenatally diagnosed lung lesions can be delivered without fetal distress" (clinical) [Ep 5 · 4:33](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=273) - "Some cases with hydrops have regressed spontaneously, with the CCAM not even detectable on CT scan a year after birth" (clinical) [Ep 5 · 4:57](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=297) - "Many lung lesions have been referred after recommendation for termination by practitioners who don't understand the natural history" — Alan (clinical) [Ep 5 · 5:20](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=320) - "Even very large prenatal lung lesions can regress and be asymptomatic at birth, or have very good survival rates with appropriate interventions" — Alan (clinical) [Ep 5 · 5:31](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=331) - "Garden variety postnatal CCAM is very different than some prenatal CCAMs" — Alan (clinical) [Ep 5 · 5:44](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=344) - "True cystic CCAMs do not disappear, though they often regress and become isoechogenic in third trimester" — Alan (clinical) [Ep 5 · 6:05](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=365) - "All cystic CCAMs seen prenatally and followed with postnatal CT scan at one month remain present and prominent" — Alan (clinical) [Ep 5 · 6:30](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=390) - "Some lesions that look like CCAMs in utero are actually bronchial stenosis or atresia, which can be minimally apparent or non-apparent after birth" — Alan (clinical) [Ep 5 · 6:13](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=373) - "Congenital lung lesions should be called 'congenital lung lesions' (macrocystic, hyperechoic, or mixed) rather than CCAMs, since CCAM is a pathological diagnosis requiring specimen examination" — Jean Martin (opinion) [Ep 5 · 7:45](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=465) - "Many tertiary centers have the capacity to perform EXIT procedures with appropriate team approach and leadership" — Jean Martin (clinical) [Ep 5 · 8:17](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=497) - "Indications for EXIT procedure are more important than technical capability, as inappropriate use can lead to unnecessary intervention" — Jean Martin (opinion) [Ep 5 · 8:28](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=508) - "Good prenatal diagnosis is essential and not equivalent across all centers or practitioners" — Alan (opinion) [Ep 5 · 9:19](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=559) - "Lung agenesis is frequently misdiagnosed as microcystic CCAM at other centers" — Alan (clinical) [Ep 5 · 9:33](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=573) - "EXIT procedure is more invasive than regular cesarean section" — Jean Martin (clinical) [Ep 5 · 9:56](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=596) - "Pleuro-amniotic shunts are used specifically for macrocystic CCAMs with evidence of hydrops" — Alan (clinical) [Ep 5 · 11:08](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=668) - "Hydrops is defined as requiring more than just ascites: must include pleural effusion, pericardial effusion, and skin or scalp edema" — Alan (clinical) [Ep 5 · 11:18](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=678) - "Pure ascites is not necessarily hydrops and can be related to mediastinal shift and hepatic venous return" — Alan (clinical) [Ep 5 · 11:27](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=687) - "Pleuro-amniotic shunts are avoided prophylactically" — Alan (clinical) [Ep 5 · 11:48](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=708) - "Large macrocystic lesions may be tapped just prior to delivery to improve ventilation, but shunts are not placed unless there is hydrops" — Alan (clinical) [Ep 5 · 11:52](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=712) - "CVR cutoff of 1.6 is used for prediction of adverse physiology" — Alan (clinical) [Ep 5 · 13:33](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=813) - "CVR less than 1.6 on presentation of a CCAM predicts likelihood of hydrops evolution at about 3% or less than 5%" — Alan (clinical) [Ep 5 · 13:36](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=816) - "It is very unusual for a CVR less than 1.6 with microcystic lesion to evolve into hydrops" — Alan (clinical) [Ep 5 · 14:04](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=844) - "CVR greater than 1.6 requires close watching with much higher likelihood of hydrops evolution" — Alan (clinical) [Ep 5 · 14:11](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=851) - "Macrocystic lesions are a wild card because cystic component can grow very rapidly and can be worrisome even if CVR is less than 1.6" — Alan (clinical) [Ep 5 · 14:18](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=858) - "MRI is often helpful in defining anatomy and general size of lesions" — Alan (clinical) [Ep 5 · 14:40](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=880) - "MRI can clarify abnormalities when there is ambiguity on ultrasound or confusion about diagnosis" — Alan (clinical) [Ep 5 · 15:07](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=907) - "In centers not geared toward fetal aspects, most patients are followed with fetal ultrasound alone and evaluated after birth, with MRI reserved for unusual cases" (clinical) [Ep 5 · 15:25](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=925) - "A 4-month-old, 5 kg infant with prenatally diagnosed CAM underwent thoracoscopic left upper lobectomy." (clinical) [Ep 9 · 0:01](https://library.globalcastmd.com/watch/technique-blinded-left-upper-lobectomy-1006?t=1) - "An anterior approach was used with three ports: 4 mm in the posterior axillary line for the telescope, and two 3 mm ports in the anterior axillary line." (clinical) [Ep 9 · 0:08](https://library.globalcastmd.com/watch/technique-blinded-left-upper-lobectomy-1006?t=8) - "The lower 3 mm port was later changed to 5 mm for access of the endoscopic clip applier." (clinical) [Ep 9 · 0:16](https://library.globalcastmd.com/watch/technique-blinded-left-upper-lobectomy-1006?t=16) - "A new 3 mm sealer-dissector was used for the case." (clinical) [Ep 9 · 0:28](https://library.globalcastmd.com/watch/technique-blinded-left-upper-lobectomy-1006?t=28) - "The sealer was used to compress cysts in the left upper lobe to allow easier access to the pulmonary vessels." (clinical) [Ep 9 · 0:32](https://library.globalcastmd.com/watch/technique-blinded-left-upper-lobectomy-1006?t=32) - "The upper lobe was retracted inferiorly to expose the superior branches of the pulmonary artery (apical posterior and anterior branches)." (clinical) [Ep 9 · 0:46](https://library.globalcastmd.com/watch/technique-blinded-left-upper-lobectomy-1006?t=46) - "The main trunk of the artery to the upper lobe was dissected out and sealed proximally and distally, then divided between the seals." (clinical) [Ep 9 · 0:58](https://library.globalcastmd.com/watch/technique-blinded-left-upper-lobectomy-1006?t=58) - "This technique allows for a safe, effective, and reproducible method for sealing pulmonary vessels without risk of bleeding." (opinion) [Ep 9 · 1:10](https://library.globalcastmd.com/watch/technique-blinded-left-upper-lobectomy-1006?t=70) - "Each of the main branches of the superior pulmonary vein were individually isolated, dissected out, and then sealed proximally and distally with division of the vessel between the seals." (clinical) [Ep 9 · 1:36](https://library.globalcastmd.com/watch/technique-blinded-left-upper-lobectomy-1006?t=96) - "The major fissure was incomplete anteriorly." (clinical) [Ep 9 · 2:11](https://library.globalcastmd.com/watch/technique-blinded-left-upper-lobectomy-1006?t=131) - "The sealer was used to help define the plane of the incomplete major fissure, and the lung between the upper and lower lobes was sealed and then divided." (clinical) [Ep 9 · 2:11](https://library.globalcastmd.com/watch/technique-blinded-left-upper-lobectomy-1006?t=131) - "As dissection continued posteriorly towards the main pulmonary arteries through the major fissure, an almost finger-fracture technique was used to divide the lung parenchyma and expose the artery." (clinical) [Ep 9 · 2:24](https://library.globalcastmd.com/watch/technique-blinded-left-upper-lobectomy-1006?t=144) - "A small posterior branch of the artery going to the upper lobe was identified." (clinical) [Ep 9 · 2:40](https://library.globalcastmd.com/watch/technique-blinded-left-upper-lobectomy-1006?t=160) - "The superior and inferior branches of the pulmonary artery going to the lingula were individually isolated, sealed, and divided using the 3 mm sealer." (clinical) [Ep 9 · 2:54](https://library.globalcastmd.com/watch/technique-blinded-left-upper-lobectomy-1006?t=174) - "The bronchus to the lingula was sealed with a 5 mm clip applier, both proximally and distally, and divided between these." (clinical) [Ep 9 · 3:12](https://library.globalcastmd.com/watch/technique-blinded-left-upper-lobectomy-1006?t=192) - "5 mm clips have proven to be an effective way to seal the bronchus in infants under 10 kg." (opinion) [Ep 9 · 3:25](https://library.globalcastmd.com/watch/technique-blinded-left-upper-lobectomy-1006?t=205) - "The main bronchus to the remainder of the upper lobe was visualized at its bifurcation between the apical posterior and anterior branches." (clinical) [Ep 9 · 3:38](https://library.globalcastmd.com/watch/technique-blinded-left-upper-lobectomy-1006?t=218) - "Each bronchial branch was individually sealed with a 5 mm clip and then divided proximal to this." (clinical) [Ep 9 · 3:54](https://library.globalcastmd.com/watch/technique-blinded-left-upper-lobectomy-1006?t=234) - "The upper lobe was brought out through the lower trocar site in a piecemeal fashion." (clinical) [Ep 9 · 4:05](https://library.globalcastmd.com/watch/technique-blinded-left-upper-lobectomy-1006?t=245) - "The child had a chest tube in for 24 hours and was discharged on the 2nd postoperative day." (clinical) [Ep 9 · 4:13](https://library.globalcastmd.com/watch/technique-blinded-left-upper-lobectomy-1006?t=253) - "Most congenital defects are still treated by waiting and treating the neonate, with fetal intervention reserved for a very few appropriately selected cases" — Alan Flake (clinical) [Ep 10 · 1:08](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=68) - "Accepted indications for fetal surgery include pulmonary airway malformations, bronchial atresia, CHAOS, sacrococcygeal teratoma, and myelomeningocele" — Alan Flake (clinical) [Ep 10 · 1:41](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=101) - "The majority of CPAM lesions regress late in gestation and do not require any fetal intervention" — Alan Flake (clinical) [Ep 10 · 2:53](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=173) - "Bronchial atresia can masquerade as microcystic CPAM but is distinguished by a dilated central bronchus or mucocele and requires documentation of contralateral lung presence" — Alan Flake (clinical) [Ep 10 · 3:31](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=211) - "Hydrops is the sole indication for consideration of open fetal surgery in CPAM" — Alan Flake (clinical) [Ep 10 · 5:13](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=313) - "CVR (CPAM volume ratio) greater than 1.6 indicates high risk for evolution to hydrops" — Alan Flake (clinical) [Ep 10 · 6:01](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=361) - "The majority of high-risk CPAMs respond to a trial of maternal steroids" — Alan Flake (clinical) [Ep 10 · 6:15](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=375) - "Open fetal surgery for CPAM is now extremely rare, with CHOP and UCSF reporting approximately one case in five years combined" (epidemiological) [Ep 10 · 28:44](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1724) - "Steroids have had a dramatic impact on reducing the number of open fetal surgeries for microcystic CPAM" — Alan Flake (clinical) [Ep 10 · 29:11](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1751) - "Macrocystic CPAMs and bronchial atresia do not respond as well to steroids as microcystic CPAMs" — Alan Flake (clinical) [Ep 10 · 29:23](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1763) - "Open fetal surgery for CPAM has approximately 60% survival" — Alan Flake (epidemiological) [Ep 10 · 10:34](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=634) - "Thoracoamniotic shunts for macrocystic CPAM have 70-75% survival" — Alan Flake (epidemiological) [Ep 10 · 10:34](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=634) - "CHOP has treated three bronchial atresia cases by fetal intervention with one intraoperative fetal death, one hepatic necrosis death, and one ongoing NICU case" — Alan Flake (epidemiological) [Ep 10 · 10:52](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=652) - "Bronchial atresia is a much more difficult lesion to treat than CPAMs" — Alan Flake (opinion) [Ep 10 · 11:46](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=706) - "SCT fetal pathophysiology includes tumor vascular steal leading to high output cardiac failure" — Alan Flake (clinical) [Ep 10 · 12:18](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=738) - "Fetal SCT resection aims to interrupt arteriovenous steal from the low resistance tumor to prevent progression of high output failure" — Alan Flake (clinical) [Ep 10 · 12:28](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=748) - "Fetal SCT surgery is a quick debulking procedure to remove arteriovenous steal without coccyxectomy" — Alan Flake (clinical) [Ep 10 · 13:16](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=796) - "Watchful waiting in SCT can be hazardous, with majority of deaths occurring between 27-32 weeks gestation" — Alan Flake (clinical) [Ep 10 · 15:51](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=951) - "CHOP now uses a preemptive approach for SCT, delivering patients after 27 weeks at the slightest hint of fetal or maternal decompensation" — Alan Flake (clinical) [Ep 10 · 16:33](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=993) - "Five recent SCT cases managed with early delivery protocol had good outcomes with surprisingly little prematurity morbidity" — Alan Flake (epidemiological) [Ep 10 · 16:59](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1019) - "No safe ablative technology has been identified for SCT that does not induce significant collateral injury" — Alan Flake (clinical) [Ep 10 · 17:36](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1056) - "Essential components of EXIT procedure include maintenance of uteroplacental blood flow, complete uterine relaxation, maintenance of intrauterine volume, maternal homeostasis and hemostasis, control of membranes, and avoiding placenta and cord" — Alan Flake (clinical) [Ep 10 · 18:41](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1121) - "EXIT procedure requires a multidisciplinary team with specific roles for each member" — Alan Flake (clinical) [Ep 10 · 19:10](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1150) - "CHAOS (congenital high airway obstruction syndrome) can result in marked diaphragm inversion, ascites, and thoracic abnormalities" — Alan Flake (clinical) [Ep 10 · 21:05](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1265) - "CHAOS patients have to grow into their ventilatory mechanics and can have significant morbidity when treated at birth" — Alan Flake (clinical) [Ep 10 · 21:33](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1293) - "CVR is calculated by measuring CPAM in 3 dimensions, applying ellipse formula, and dividing by head circumference to standardize for gestational age" — Alan Flake (clinical) [Ep 10 · 26:38](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1598) - "CVR has been reliable for predicting hydrops risk, determining surveillance frequency, and counseling families" — Alan Flake (clinical) [Ep 10 · 27:05](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1625) - "Failure of steroid therapy is defined as progression of hydrops" — Alan Flake (clinical) [Ep 10 · 27:48](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1668) - "Patients on steroids for CPAM should be monitored with ultrasound every other day or 2-3 times per week because changes can occur rapidly" — Alan Flake (clinical) [Ep 10 · 28:05](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1685) - "One theory is that steroids drive lung development and make microcystic CPAM tissue mature more completely" (opinion) [Ep 10 · 29:41](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1781) - "Steroids may ameliorate maternal immune response against the fetus in hydropic patients" (opinion) [Ep 10 · 30:19](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1819) - "The evolution of fetal intervention for CPAM is a very happy story, demonstrating that solving one problem is not a reason to stop investigation" — Farmer (opinion) [Ep 10 · 30:49](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1849) - "Some fetuses with massive ascites and mild pleural effusion can be observed if cardiac function remains intact, rather than immediately intervening" (clinical) [Ep 10 · 31:25](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1885) - "CVR has been useful for counseling families and determining follow-up tempo, with high CVR patients followed 2-3 times per week" — Adzik (clinical) [Ep 10 · 33:34](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=2014) - "CPAM growth rate can be quite abrupt between 18 and 26-28 weeks gestation, then tends to plateau" — Adzik (clinical) [Ep 10 · 34:11](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=2051) - "Steroids are most effective in microcystic/solid CPAM forms but are used even in type 1 and type 2 cases to arrest growth of solid components" (clinical) [Ep 10 · 35:52](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=2152) - "In Cincinnati experience with 56 CPAM cases, prophylactic treatment for CVR above 1.6 resulted in literally 100% survival" (epidemiological) [Ep 10 · 36:28](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=2188) - "Once hydrops is established in CPAM, steroids achieve 49% survival" (epidemiological) [Ep 10 · 36:42](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=2202) - "If first course of steroids fails in CPAM, second course salvages about 2 out of 6 patients, with others proceeding to fetal surgery" (epidemiological) [Ep 10 · 36:51](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=2211) - "Patient is an 11-year-old boy with right pulmonary hydatid cyst from a particular area of Chile" — Marco (clinical) [Ep 12 · 0:00](https://library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=0) - "The hydatid cyst occupied the entire right thorax" — Marco (clinical) [Ep 12 · 0:15](https://library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=15) - "Initial thoracoscopic approach was impossible due to cyst size" — Marco (clinical) [Ep 12 · 0:26](https://library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=26) - "Eight bronchial fistulas were treated through mini-thoracotomy in the first surgery" — Marco (clinical) [Ep 12 · 1:10](https://library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=70) - "Surgeon used single-port technique because tissue was highly inflamed and to avoid excessive parenchymal trauma" — Marco (clinical) [Ep 12 · 3:12](https://library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=192) - "Bleeding occurred during closure of the last fistula due to limited working space" — Marco (clinical) [Ep 12 · 3:26](https://library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=206) - "Surgicel was placed in the fistula and closed with PDS suture to control bleeding" — Marco (clinical) [Ep 12 · 3:55](https://library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=235) - "Two fistulas were sutured during the thoracoscopic procedure" — Todd (clinical) [Ep 12 · 4:31](https://library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=271) - "Compression with needle driver was used to control bleeding before placing suture" — Marco (clinical) [Ep 12 · 5:30](https://library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=330) - "Patient was discharged 5 days after surgery without complications or pneumothorax" — Marco (clinical) [Ep 12 · 7:21](https://library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=441) - "Surgery was performed approximately 3 months prior to this discussion" — Marco (clinical) [Ep 12 · 7:59](https://library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=479) - "Complete removal of the mucosa is necessary rather than suturing from inside the cavity" — Marco (opinion) [Ep 12 · 8:12](https://library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=492) - "Concern that the fistulas will recur with the intracavitary suturing approach" — Todd (opinion) [Ep 12 · 8:23](https://library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=503) - "Recommended approach is bronchoscopy to identify involved segment followed by thoracotomy" — Marco (opinion) [Ep 12 · 8:36](https://library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=516) - "Intracavitary approach may be useful for treating pneumatoceles which lack mucosal lining" — Alan (opinion) [Ep 12 · 9:47](https://library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=587) - "Hydatid cyst is a parasitosis very common in southern Argentina but less common in first-world countries" — Marcello (epidemiological) [Ep 12 · 10:23](https://library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=623) - "The key to treating hydatid cysts is removing the white parasitic membrane from inside the lung" — Marcello (clinical) [Ep 12 · 12:06](https://library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=726) - "There is usually a good tissue plane between the lung and the hydatid cyst" — Marcello (clinical) [Ep 12 · 12:23](https://library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=743) - "After membrane removal, bronchial openings that bubble are visible and should be sutured" — Marcello (clinical) [Ep 12 · 12:33](https://library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=753) - "First surgery is optimal timing because tissues are not yet friable or bleeding" — Marcello (clinical) [Ep 12 · 12:42](https://library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=762) - "Once the parasitic membrane is removed, the patient is cured; subsequent management is only about closing fistulas" — Marcello (clinical) [Ep 12 · 13:13](https://library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=793) - "In the first attempt, all lung tissue was fixed to the thoracic wall, preventing thoracoscopic approach" — Marco (clinical) [Ep 12 · 13:36](https://library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=816) - "Bronchopleural fistula after staphylococcal pneumonia and empyema presents a similar clinical situation" — Liam (clinical) [Ep 12 · 14:30](https://library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=870) - "Thoracoscopy to remove membrane and allow lung expansion is essential for fistula healing" — Liam (opinion) [Ep 12 · 14:45](https://library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=885) - "The technique works because the fistula size was appropriate; would not attempt with a huge fistula" — Marco (opinion) [Ep 12 · 15:11](https://library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=911) - "One recurrence case after segmentectomy was easier to operate than expected" — Alan (clinical) [Ep 12 · 16:59](https://library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=1019) - "Hemalock clips have been used for esophageal atresia for at least 10 years without problems" — Marcello (clinical) [Ep 12 · 19:05](https://library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=1145) - "Hemalock clips are used for bronchi in lung lobectomies, even large bronchi, using three available sizes" — Marcello (clinical) [Ep 12 · 19:12](https://library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=1152) - "Large-size Hemalock with plier is 10mm diameter and can handle very wide bronchi" — Marcello (clinical) [Ep 12 · 19:21](https://library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=1161) - "Hemalock clips are used in patients over 7 years old for lobectomy" — Marcello (clinical) [Ep 12 · 19:31](https://library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=1171) - "For large vessels, a proximal Hemalock clip is placed before ligature when ligature alone feels insufficient" — Marcello (clinical) [Ep 12 · 19:31](https://library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=1171) - "Hemalock is described as a mechanical suture alternative for resource-limited settings because it is inexpensive compared to staplers" — Marcello (opinion) [Ep 12 · 20:00](https://library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=1200) - "Persistent air leak has not been a problem in infant lobectomies with incomplete fissures, lasting maximum a few days" — Alan (clinical) [Ep 12 · 21:22](https://library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=1282) - "Concern exists about tissue sealant potentially occluding the chest tube" — Alan (opinion) [Ep 12 · 21:38](https://library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=1298) - "Tissue sealant has not been needed in infant lobectomies" — Alan (opinion) [Ep 12 · 21:45](https://library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=1305) - "EXIT procedures have been performed with lobectomy at time of delivery" — Jack (clinical) [Ep 15 · 0:00](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=0) - "Average CVR for EXIT cases has been over 2, representing large lesions" — Alan (clinical) [Ep 15 · 0:46](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=46) - "EXIT procedures are reserved for cases with evidence of compression including diaphragmatic aversion, marked mediastinal shift, often ascites" — Alan (clinical) [Ep 15 · 0:46](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=46) - "ECMO is very rare in CCAM patients" — Alan (clinical) [Ep 15 · 1:41](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=101) - "EXIT to ECMO has not been used; conventional ventilation is always tried first" — Alan (clinical) [Ep 15 · 1:39](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=99) - "Complex cases are referred to specialized centers while simple cases stay local, skewing reported percentages of EXIT and fetal surgery" — Jean-Martin (opinion) [Ep 15 · 2:04](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=124) - "No clear reduction in ability to have subsequent pregnancy after fetal surgery, studied and published approximately 4 times" — Alan (clinical) [Ep 15 · 2:46](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=166) - "Patients are not allowed to labor after fetal surgery incision, equivalent to classical cesarean section in upper uterus" — Alan (guideline) [Ep 15 · 2:59](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=179) - "Patients should never labor with future pregnancies after fetal surgery" — Alan (guideline) [Ep 15 · 3:08](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=188) - "No placenta accreta at hysterotomy site has been observed thus far" — Alan (clinical) [Ep 15 · 3:22](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=202) - "EXIT procedure is different from cesarean section and requires anesthetic team tuned into uterine relaxation and maternal issues" — Alan (clinical) [Ep 15 · 4:03](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=243) - "EXIT procedure requires expertise with hysterotomy and a whole team of people" — Alan (clinical) [Ep 15 · 4:15](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=255) - "EXIT can be more widely disseminated than fetal surgery programs" — Alan (opinion) [Ep 15 · 4:23](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=263) - "Close to 100 EXIT procedures performed at CHOP in past 10 years" — Alan (epidemiological) [Ep 15 · 4:49](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=289) - "Maternal expertise must be available at the hospital; bringing mother to freestanding children's hospital without maternal expertise is a bad idea" (guideline) [Ep 15 · 5:13](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=313) - "Approximately 4 or 5 centers in the US clearly have qualifications and background to do good EXIT procedures" — Alan (epidemiological) [Ep 15 · 6:04](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=364) - "EXIT procedure requires weeks of planning and discussions involving 15 to 20 people" (clinical) [Ep 15 · 6:44](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=404) - "One EXIT case per year is probably not enough to justify doing EXIT procedures; 3 to 5 per year is reasonable threshold" — Alan (opinion) [Ep 15 · 7:15](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=435) - "Very few if any cases of hydrops from sequestrations are due to high output failure mechanism" — Alan (clinical) [Ep 15 · 8:23](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=503) - "Most BPS causing hydrops have associated pleural effusions, mediastinal shift, or mass effect" — Alan (clinical) [Ep 15 · 8:34](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=514) - "Injecting alcohol or embolic substances into fetal vessels has potential hazard including neurologic effects, not adequately studied" — Alan (opinion) [Ep 15 · 9:13](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=553) - "Basic operation is the same for fetal lobectomy; difference is consistency of tissues and size" — Alan (clinical) [Ep 15 · 10:28](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=628) - "At 23 weeks and especially at 20 weeks, fetal tissues become very gelatinous and friable" — Alan (clinical) [Ep 15 · 10:49](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=649) - "Mishaps in fetal surgery usually related to traction causing tissue tears" — Alan (clinical) [Ep 15 · 11:04](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=664) - "Fetus is anesthetized from mother and receives additional anesthetic and paralytic shot" — Alan (clinical) [Ep 15 · 11:48](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=708) - "Fetus is positioned before opening uterus in amniotic fluid space" — Alan (clinical) [Ep 15 · 11:59](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=719) - "For thoracotomy, arm on operative side is brought out of hysterotomy to expose chest" — Alan (clinical) [Ep 15 · 12:09](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=729) - "Fetus is buoyed by amniotic infusion and comes up to almost seal the hysterotomy" — Alan (clinical) [Ep 15 · 12:23](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=743) - "No successful complete pneumonectomy has been performed" — Alan (clinical) [Ep 15 · 12:58](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=778) - "Bilobar lobectomies have been performed successfully" — Alan (clinical) [Ep 15 · 13:21](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=801) - "Many CCAM cases have abnormal fissure formation making anatomic separation difficult" — Alan (clinical) [Ep 15 · 13:24](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=804) - "Small fragments of lung left behind grow dramatically if airway and vasculature preserved" — Alan (clinical) [Ep 15 · 13:37](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=817) - "Fetal surgery can still be performed after prior cesarean sections" — Alan (clinical) [Ep 15 · 14:07](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=847) - "Most C-sections are done through lower uterine segment and do not interfere with fetal surgery incision" — Alan (clinical) [Ep 15 · 14:12](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=852) - "If prior classical cesarean section, fetal surgery incision is placed elsewhere" — Alan (clinical) [Ep 15 · 14:20](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=860) - "50% of patients who undergo simple chest tube placement for symptomatic pneumothorax will have recurrence" — Mark (epidemiological) [Ep 14 · 7:27](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=447) - "Second recurrence rate is approximately 75%" — Mark (epidemiological) [Ep 14 · 7:55](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=475) - "Most spontaneous pneumothorax patients are adolescents around 18 years old" — Marcello (epidemiological) [Ep 14 · 5:12](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=312) - "A recent study from Saint Peter in Kansas City found CT scan was very poor at defining bleb disease compared to subsequent thoracoscopy" — Mark (clinical) [Ep 14 · 13:00](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=780) - "Almost all spontaneous pneumothorax patients have some degree of bleb disease whether defined early or not" — Mark (clinical) [Ep 14 · 13:17](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=797) - "Bleb disease doesn't necessarily mean recurrence" — Mark (clinical) [Ep 14 · 13:28](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=808) - "Patients with spontaneous pneumothorax usually don't present in extremis, they usually come in with pain" — Mark (clinical) [Ep 14 · 14:44](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=884) - "More people are using chemical pleurodesis instead of mechanical pleurodesis and finding better results, shorter OR times, and decreased recurrence rates" — Mark (clinical) [Ep 14 · 19:08](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=1148) - "There is still a pretty high recurrence rate even after VATS with blebectomy and mechanical and/or chemical pleurodesis" — Mark (clinical) [Ep 14 · 19:17](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=1157) - "Apical pleurectomy causes more postoperative pain than talc pleurodesis" — Todd (clinical) [Ep 14 · 19:49](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=1189) - "Talc creates random massive chemical pleurodesis throughout the chest, which may complicate future chest access" — Todd (clinical) [Ep 14 · 20:21](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=1221) - "Apical pleurectomy is limited to the apex of the lung, typically down to the third intercostal space when apical blebs are seen" — Todd (clinical) [Ep 14 · 21:48](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=1308) - "CT scan can reveal blebs in the superior segment of the lower lobe and contralateral side, not just upper lobe" — Mark (clinical) [Ep 14 · 11:43](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=703) - "In Argentina, chest tubes for pneumothorax are typically placed as thin double pigtail catheters attached to Heimlich valve under local anesthesia" — Marcello (clinical) [Ep 14 · 9:04](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=544) - "Hydrostatic pleurectomy technique involves making a small pleural incision, inserting suction irrigator, sealing pleura around it, and irrigating to dissect entire pleura which can then be rolled up" — Mark (clinical) [Ep 14 · 20:48](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=1248) - "CT scan is the best method to follow pulmonary lesions but induces a certain incidence of malignancy" (clinical) [Ep 17 · 0:12](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=12) - "CCAM cannot be differentiated from PPB radiologically until stage 2 or 3 occurrence" (clinical) [Ep 17 · 0:22](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=22) - "There are children who die from pulmonary lobectomy, particularly done thoracoscopically" — Jack (clinical) [Ep 17 · 1:25](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=85) - "Two cases of mortality from thoracoscopic lobectomy were reviewed by the speaker (not at their institution)" — Jack (clinical) [Ep 17 · 1:45](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=105) - "In experienced hands, thoracoscopic lobectomy should have no more morbidity than open and mortality should be zero" — Steve (opinion) [Ep 17 · 2:03](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=123) - "Massive bleeding during thoracoscopic lobectomy is harder to salvage than when already open" — Jack (opinion) [Ep 17 · 3:04](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=184) - "PPB can be indistinguishable radiologically from CCAM" — Jack (clinical) [Ep 17 · 3:42](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=222) - "The incidence of CPAM/CCAM is markedly different from (higher than) the incidence of PPB; PPBs remain extremely rare" — Jack (epidemiological) [Ep 17 · 3:42](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=222) - "One high-volume center sees PPB de novo extremely rarely, approximately once every 3 or 4 years" — Jack (epidemiological) [Ep 17 · 4:23](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=263) - "The same center sees probably 20 or 25 new cases of CCAM every year" — Jack (epidemiological) [Ep 17 · 4:35](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=275) - "The incidence of cancer in CPAM remains extremely low" — Jack (epidemiological) [Ep 17 · 4:39](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=279) - "One center's published data estimated a 20-30% lifelong risk of infection for CCAM, based on 10% infection rate with mean 4-year follow-up, tripled for lifetime estimate" — Jack (epidemiological) [Ep 17 · 4:50](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=290) - "A prospective study followed 21 asymptomatic patients (8 prenatally diagnosed, rest serendipitously found) and 18 of 21 developed infections or symptoms requiring resection over an average of 2 years up to 13 years" (epidemiological) [Ep 17 · 5:25](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=325) - "In the pre-prenatal diagnosis era, it was not common for patients to present in teenage years or adult thoracic surgery units with symptomatic infected CCAMs, though it happened from time to time" — Jack (epidemiological) [Ep 17 · 6:36](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=396) - "Infected CCAM surgery was not a rare event in San Francisco in the speaker's early career" (epidemiological) [Ep 17 · 7:20](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=440) - "Small asymptomatic extra-lobar sequestration is a relatively known finding at autopsy" — Jean Martin (clinical) [Ep 17 · 9:30](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=570) - "Asymptomatic CCAMs on autopsy series are nonexistent" — Jean Martin (epidemiological) [Ep 17 · 9:47](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=587) - "One center follows all prenatally diagnosed lesions with postnatal CT, and those not operated on are followed with chest X-ray and repeat CT" — Jack (clinical) [Ep 17 · 10:21](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=621) - "The speaker mentions the word cancer to every family during counseling for CCAM" — Jack (clinical) [Ep 17 · 10:42](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=642) - "Many families choose operative management once they hear the word cancer or infection despite being offered observation" — Jack (opinion) [Ep 17 · 11:07](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=667) - "A poll showed 23-25% of respondents do not advocate routine resection of asymptomatic CPAM" — Jack (epidemiological) [Ep 17 · 11:53](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=713) - "There is hidden mortality in pediatric surgery because people do not report bad results, only known through lawsuits" (opinion) [Ep 17 · 12:20](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=740) - "The American College of Surgeons Pediatric NSQIP will provide unbiased large-scale data on thoracoscopic and open surgery complications and mortality in approximately 10 years" (opinion) [Ep 17 · 12:33](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=753) - "Infants undergoing thoracoscopic lobectomy for CCAM are generally in the hospital for 2 days" (clinical) [Ep 17 · 13:37](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=817) - "A review of 100 thoracoscopic lobectomies (not sequestrations) by one surgeon showed only 2 transfusions and 2 prolonged air leaks as complications" (clinical) [Ep 17 · 13:44](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=824) - "CPAM is abnormally developed lung which doesn't participate in gas exchange" — Pam Choi (clinical) [Ep 25 · 3:47](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=227) - "CPAMs have overgrowth of bronchioles without good development of alveoli" — Rod Gerardo and Ellen Ancisco (clinical) [Ep 25 · 4:48](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=288) - "Type 1 CPAM (distal bronchi/proximal bronchioles) is most common, seen in 60-70% of cases" — Rod Gerardo and Ellen Ancisco (epidemiological) [Ep 25 · 5:31](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=331) - "CPAMs typically grow in first 20-25 weeks and plateau around week 28" — Rod Gerardo and Ellen Ancisco (clinical) [Ep 25 · 6:57](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=417) - "Hydrops is the strongest prognostic indicator of mortality in CPAM patients" — Rod Gerardo and Ellen Ancisco (clinical) [Ep 25 · 8:02](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=482) - "CVR (CPAM volume ratio) is calculated as length × width × height × 0.52 divided by head circumference" — Rod Gerardo and Ellen Ancisco (clinical) [Ep 25 · 8:41](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=521) - "CVR greater than 1.6 indicates increased risk of developing hydrops; 75% of patients with CVR >1.6 develop hydrops" — Rod Gerardo and Ellen Ancisco (clinical) [Ep 25 · 9:14](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=554) - "Microcystic CPAMs are less than 5 millimeters; macrocystic are larger than 5 millimeters" — Rod Gerardo and Ellen Ancisco (clinical) [Ep 25 · 10:14](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=614) - "Prenatal steroids (betamethasone 12 mg twice, 24 hours apart) can resolve hydrops and reduce CPAM size/CVR" — Pam Choi (clinical) [Ep 25 · 10:42](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=642) - "Thoracoamniotic shunt is placed for macrocystic lesions with high CVR or hydrops, with half in fetal chest and half in amniotic space" — Pam Choi (clinical) [Ep 25 · 13:29](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=809) - "Fetal resection involves partial delivery, thoracotomy, lung resection, and replacement of fetus in uterus, performed between 24-27 weeks as last resort" — Pam Choi (clinical) [Ep 25 · 15:11](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=911) - "Mirror syndrome occurs when mother develops edema, pleural effusion, and other symptoms mirroring fetal hydrops" — Pam Choi (clinical) [Ep 25 · 16:15](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=975) - "EXIT to resection involves partial delivery while maintaining umbilical cord attachment, allowing thoracotomy and resection before full delivery" — Pam Choi (clinical) [Ep 25 · 17:00](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1020) - "EXIT procedures have time constraints of typically 15 minutes to 1 hour before placental separation occurs" — Pam Choi (clinical) [Ep 25 · 17:53](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1073) - "Air trapping can occur postnatally where air enters CPAM but doesn't exit easily, causing progressive hyperinflation and rapid respiratory distress" — Pam Choi (clinical) [Ep 25 · 19:42](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1182) - "Incidence of CPAMs is estimated at 1 in 8,000 to 35,000 births" — Rod Gerardo and Ellen Ancisco (epidemiological) [Ep 25 · 52:39](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=3159) - "60% of prenatally diagnosed lung lesions are CPAMs" — Rod Gerardo and Ellen Ancisco (epidemiological) [Ep 25 · 52:53](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=3173) - "Pleuropulmonary blastoma (PPB) is the malignancy associated with CPAM" — Rod Gerardo and Ellen Ancisco (clinical) [Ep 25 · 27:47](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1667) - "Features suggesting higher PPB risk include multi-lobar involvement, bilateral disease, pneumothorax, and DICER1 mutation" — Jack Langer (clinical) [Ep 25 · 28:25](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1705) - "Features suggesting low PPB risk include feeding vessel and prenatal diagnosis" — Jack Langer (clinical) [Ep 25 · 28:59](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1739) - "Recent study found 0% malignancy in prenatally diagnosed lesions but 10% in postnatally diagnosed lesions" — Rod Gerardo and Ellen Ancisco (clinical) [Ep 25 · 30:17](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1817) - "Infected CPAMs result in more difficult surgery with increased blood loss and complications" — Jack Langer (clinical) [Ep 25 · 32:26](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1946) - "Lobectomy risks include bleeding, pneumothorax, air leak, infection, prolonged ventilation, nerve injury, and death" — Rod Gerardo and Ellen Ancisco (clinical) [Ep 25 · 26:13](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1573) - "Single-lung ventilation is preferable for thoracoscopic lobectomy, achieved by main stem intubation of contralateral bronchus" — Steven Rothenberg (clinical) [Ep 25 · 36:37](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=2197) - "For thoracoscopic lobectomy, scope port should be anterior to scapula tip in mid-axillary line over major fissure to allow front-to-back working approach" — Steven Rothenberg (clinical) [Ep 25 · 38:55](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=2335) - "Vascular control technique involves making two seals on vessel with space between, then cutting partway to visualize lumen before complete division" — Steven Rothenberg (clinical) [Ep 25 · 43:09](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=2589) - "Critical safety point: do not take pulmonary vein trunk near pericardium; if device fails, vessel will retract into pericardium causing fatal hemorrhage" — Steven Rothenberg (clinical) [Ep 25 · 48:53](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=2933) - "Typical postoperative course includes chest tube removal at 24 hours and discharge on postoperative day 2" — Pam Choi (clinical) [Ep 25 · 51:27](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=3087) - "Follow-up occurs at 3-4 weeks post-surgery with chest X-ray" — Rod Gerardo and Ellen Ancisco (clinical) [Ep 25 · 51:40](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=3100) - "40% of patients ultimately required a central venous line within 30 days after ECMO decannulation" — Ellen Encisco (clinical) [Ep 26 · 1:09](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-november-2021-4911?t=69) - "In neonates (babies less than 28 days), the primary reason for needing a central line after ECMO decannulation was access, with many being CDH babies" — Ellen Encisco (clinical) [Ep 26 · 2:27](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-november-2021-4911?t=147) - "In older children or babies, the primary reason for needing a line after ECMO decannulation was hemodialysis" — Ellen Encisco (clinical) [Ep 26 · 2:41](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-november-2021-4911?t=161) - "If you just need access, then just use a PICC line" — Todd (opinion) [Ep 26 · 2:49](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-november-2021-4911?t=169) - "Leaving a central line at ECMO decannulation may be reasonable in older patients because they'll need hemodialysis more often" — Todd (opinion) [Ep 26 · 2:53](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-november-2021-4911?t=173) - "60% of patients did not need a central line within a month after ECMO decannulation" — Rod Gerardo (clinical) [Ep 26 · 1:53](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-november-2021-4911?t=113) - "In the congenital lung malformation study, approximately 30 patients had infections before surgery and 60 did not" — Pablo Laje (clinical) [Ep 26 · 5:16](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-november-2021-4911?t=316) - "Every parameter examined (time of operation, needed transfusions, need for re-operations, more conversions, operative time) was worse in the group that had previous infections" — Pablo Laje (clinical) [Ep 26 · 5:24](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-november-2021-4911?t=324) - "There were no differences in complications between patients with and without prior infection in congenital lung malformation surgery" — Pablo Laje (clinical) [Ep 26 · 5:34](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-november-2021-4911?t=334) - "A lung that was infected is going to be a more difficult lung to operate on" — Rod Gerardo (clinical) [Ep 26 · 6:09](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-november-2021-4911?t=369) - "The main reason to operate early on congenital lung malformations is not only that it's easier, but you have a much less chance of having an infection beforehand" — Todd (opinion) [Ep 26 · 6:17](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-november-2021-4911?t=377) - "Training for congenital lung malformation surgery timing has shifted from 6-8 months down to 3 months" — Todd (clinical) [Ep 26 · 6:42](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-november-2021-4911?t=402) - "At Children's Hospital of Philadelphia, the median age for elective lobectomy for asymptomatic congenital lung lesions is about 8 weeks" — Pablo Laje (clinical) [Ep 26 · 6:48](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-november-2021-4911?t=408) - "For asymptomatic congenital lung lesions, babies go home to bond with family, get a follow-up CT scan around 4 weeks of age, and undergo elective lobectomy around 8-10 weeks" — Pablo Laje (clinical) [Ep 26 · 6:57](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-november-2021-4911?t=417) - "The partial splenectomy study reviewed cases from 2002 to 2019, spanning 17 years" — Ellen Encisco (clinical) [Ep 26 · 8:35](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-november-2021-4911?t=515) - "Patients were divided into two groups: those who underwent partial splenectomy without subsequent re-operation and those who subsequently underwent total splenectomy" — Nellie Hafezy (clinical) [Ep 26 · 8:42](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-november-2021-4911?t=522) - "The most common indication for partial splenectomy was hereditary spherocytosis" — Rod Gerardo (clinical) [Ep 26 · 9:26](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-november-2021-4911?t=566) - "Other indications included splenomegaly or hereditary pyropoikilocytosis in about 3 patients" — Ellen Encisco (clinical) [Ep 26 · 9:33](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-november-2021-4911?t=573) - "The completion splenectomy rate was about 29%, which is on the higher end of what's been recorded in the literature" — Nellie Hafezy (clinical) [Ep 26 · 9:40](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-november-2021-4911?t=580) - "Partial splenectomies are not undergoing completions until years after the initial index procedure" — Nellie Hafezy (clinical) [Ep 26 · 9:58](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-november-2021-4911?t=598) - "Patients with retained spleen after partial splenectomy go through years where they're fairly high risk for post-splenectomy sepsis, although it's a low risk" — Frederick Scola (clinical) [Ep 26 · 10:22](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-november-2021-4911?t=622) - "Partial splenectomy works 70% of the time without requiring completion" — Todd (clinical) [Ep 26 · 10:52](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-november-2021-4911?t=652) - "Partial splenectomy is very uncommon practice at Children's Hospital of Philadelphia" — Pablo Laje (clinical) [Ep 26 · 10:35](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-november-2021-4911?t=635) - "Most children with prenatally diagnosed CPAMs are born asymptomatic" (clinical) [Ep 27 · 1:44](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=104) - "A prospective study followed prenatally diagnosed congenital cystic lung lesions for a median of 10 years" — Ellen Encisco (clinical) [Ep 27 · 2:30](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=150) - "57% or 68% of patients in the prospective study were managed conservatively" — Ellen Encisco (clinical) [Ep 27 · 2:38](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=158) - "Of the conservatively managed patients who were followed up, none became symptomatic" — Rod Gerardo (clinical) [Ep 27 · 2:43](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=163) - "Respiratory compromise at birth from CPAM is very unusual, not seen in 20 years by one speaker" (clinical) [Ep 27 · 2:49](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=169) - "The argument for early resection is that CPAMs will go on to cause pneumonia, pulmonary abscesses, and potentially cancer" (clinical) [Ep 27 · 2:58](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=178) - "Retrospective studies show a huge range of 3% to 85% for risk of becoming symptomatic" — Jose Campos (clinical) [Ep 27 · 3:37](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=217) - "Systematic reviews report symptomatic rates of 3.2% in one review and 25% in another" — Jose Campos (clinical) [Ep 27 · 3:37](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=217) - "Out of 344 prenatally diagnosed lesions, none had malignant pathology when resected" — Rod Gerardo (clinical) [Ep 27 · 4:36](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=276) - "Of 177 children with postnatal diagnosis of CPAM, 15 (8.7%) were classified as having a malignant tumor" — Ellen Encisco (clinical) [Ep 27 · 4:47](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=287) - "The International Pleuropulmonary Blastoma Registry has 350 cases reported worldwide and found only 9 cases of prenatally diagnosed lesions that turned out to be pleuropulmonary blastoma" — Jose Campos (epidemiological) [Ep 27 · 5:49](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=349) - "Patients without prior pulmonary infection had shorter operative times" — Ellen Encisco (clinical) [Ep 27 · 7:18](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=438) - "Patients without prior infection had fewer postoperative fevers and less need for antibiotics postoperatively" — Ellen Encisco (clinical) [Ep 27 · 7:18](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=438) - "There were no significant differences in postoperative complications between groups with and without prior infection" — Ellen Encisco (clinical) [Ep 27 · 7:37](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=457) - "There was no significant difference in conversion rate from thoracoscopic to open between groups with and without prior infection" — Rod Gerardo (clinical) [Ep 27 · 7:50](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=470) - "After infection, there is a higher rate of conversion from thoracoscopic to open surgery" — Jose Campos (clinical) [Ep 27 · 8:17](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=497) - "The number of patients who will have an infection is so low that the benefit of lesser conversion rate does not justify preemptive surgery" — Jose Campos (opinion) [Ep 27 · 8:25](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=505) - "If you only operate on those that get infected, you will miss those that get pleuropulmonary blastoma without a pre-existing infection" (clinical) [Ep 27 · 8:38](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=518) - "Operative time increased with each increase in age group" — Ellen Encisco (clinical) [Ep 27 · 9:32](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=572) - "At younger ages, the tissue planes are easier to dissect" — Ellen Encisco (clinical) [Ep 27 · 9:39](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=579) - "Between 1 and 3 months, operative time was 115 minutes compared to 163 minutes in the 6 to 12 months group" — Ellen Encisco (clinical) [Ep 27 · 9:50](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=590) - "There were no differences in major complications, conversion rates, or readmissions between age groups" — Rod Gerardo (clinical) [Ep 27 · 10:08](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=608) - "The 1 to 3 month group had a 40% thoracotomy rate" — Jose Campos (clinical) [Ep 27 · 10:28](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=628) - "The complication rate of operating on a perforated appendix with an abscess is the same as when doing an interval appendectomy, according to Kansas City data" (clinical) [Ep 27 · 10:42](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=642) - "Prophylactic operations should have nearly zero complications" — Jose Campos (opinion) [Ep 27 · 11:13](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=673) - "The study was retrospective and aimed to investigate safety and efficacy of surgery in asymptomatic versus symptomatic CPAM patients" — Cecilia Gigena (clinical) [Ep 30 · 0:11](https://library.globalcastmd.com/watch/clinical-symptoms-affect-treatment-and-prognosis-in-pediatric-patients-with-congenital-pulmonary-airway-malformation-7843?t=11) - "The study included 110 patients" — Cecilia Gigena (epidemiological) [Ep 30 · 0:22](https://library.globalcastmd.com/watch/clinical-symptoms-affect-treatment-and-prognosis-in-pediatric-patients-with-congenital-pulmonary-airway-malformation-7843?t=22) - "Patients who underwent surgery before becoming symptomatic had shorter length of stay" — Cecilia Gigena (clinical) [Ep 30 · 0:22](https://library.globalcastmd.com/watch/clinical-symptoms-affect-treatment-and-prognosis-in-pediatric-patients-with-congenital-pulmonary-airway-malformation-7843?t=22) - "Patients who underwent surgery before becoming symptomatic had shorter mechanical ventilation after surgery" — Cecilia Gigena (clinical) [Ep 30 · 0:22](https://library.globalcastmd.com/watch/clinical-symptoms-affect-treatment-and-prognosis-in-pediatric-patients-with-congenital-pulmonary-airway-malformation-7843?t=22) - "Patients who underwent surgery before becoming symptomatic had shorter operating times" — Cecilia Gigena (clinical) [Ep 30 · 0:22](https://library.globalcastmd.com/watch/clinical-symptoms-affect-treatment-and-prognosis-in-pediatric-patients-with-congenital-pulmonary-airway-malformation-7843?t=22) - "There was no significant difference in conversion rates between asymptomatic and symptomatic groups" — Cecilia Gigena (clinical) [Ep 30 · 0:39](https://library.globalcastmd.com/watch/clinical-symptoms-affect-treatment-and-prognosis-in-pediatric-patients-with-congenital-pulmonary-airway-malformation-7843?t=39) - "There was no significant difference in postoperative complications between asymptomatic and symptomatic groups" — Cecilia Gigena (clinical) [Ep 30 · 0:39](https://library.globalcastmd.com/watch/clinical-symptoms-affect-treatment-and-prognosis-in-pediatric-patients-with-congenital-pulmonary-airway-malformation-7843?t=39) - "It appears safer to operate on CPAM patients before they become symptomatic" — Cecilia Gigena (opinion) [Ep 30 · 0:39](https://library.globalcastmd.com/watch/clinical-symptoms-affect-treatment-and-prognosis-in-pediatric-patients-with-congenital-pulmonary-airway-malformation-7843?t=39) - "There are no randomized controlled trials on prophylactic acid suppression after esophageal atresia repair" — Madina Chakraborty (epidemiological) [Ep 31 · 2:30](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=150) - "In a meta-analysis of 1,395 patients, 753 received acid suppression medication but it did not increase the odds of having an esophageal stricture" — Cecilia Gigena (clinical) [Ep 31 · 2:37](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=157) - "There was no evidence to associate prophylactic acid suppression with protection from stricture formation after esophageal atresia repair" — Cecilia Gigena (clinical) [Ep 31 · 2:57](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=177) - "No significant differences were found in secondary outcomes including gastroesophageal reflux disease, anastomotic leak, and esophagitis between infants receiving prophylactic acid suppression and those who did not" — Em Gootee (clinical) [Ep 31 · 3:14](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=194) - "There was a tendency toward higher incidence of strictures with anti-acid medication" — Pablo Laje (clinical) [Ep 31 · 3:33](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=213) - "Potential risks of long-term acid suppression therapy include dysbiosis, necrotizing enterocolitis, and increased neonatal infection rates, particularly relevant in preterm and low birth weight infants" — Em Gootee (clinical) [Ep 31 · 3:51](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=231) - "The use of anti-acid medication is not without cost and is not as innocent as once thought" — Pablo Laje (opinion) [Ep 31 · 4:20](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=260) - "A large prospective study demonstrated that even children with sizable pneumothorax can be safely observed" — Elizabeth Speck (clinical) [Ep 31 · 5:43](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=343) - "Not all patients with pneumothorax have an active leak" — Pablo Laje (clinical) [Ep 31 · 6:08](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=368) - "Cross-sectional imaging should not be done on children to help make clinical decisions about spontaneous pneumothorax" — Elizabeth Speck (guideline) [Ep 31 · 6:22](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=382) - "If air reaccumulates after observation, the patient has an ongoing air leak and warrants an operation" — Elizabeth Speck (clinical) [Ep 31 · 6:42](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=402) - "Data support doing some pleural-based management rather than just staple lobectomy for spontaneous pneumothorax" — Elizabeth Speck (clinical) [Ep 31 · 6:51](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=411) - "Studies are not available to demonstrate one pleural-based procedure is better than another" — Elizabeth Speck (epidemiological) [Ep 31 · 7:28](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=448) - "For the asymptomatic contralateral side in children with pneumothorax, do not do anything unless it develops symptoms" — Cecilia Gigena (guideline) [Ep 31 · 7:40](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=460) - "For recurrent pneumothorax, whatever was done before, do something more" — Elizabeth Speck (guideline) [Ep 31 · 7:52](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=472) - "In a study of 110 CPAM patients, the asymptomatic group had shorter operating times, shorter post-operative mechanical ventilation, shorter chest tube durations, and shorter hospital stays" — Cecilia Gigena (clinical) [Ep 31 · 8:57](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=537) - "Factors associated with symptomatic CPAM lesions include age older than 4 years, postnatal diagnosis, and maximum cyst diameter bigger than 39.9 millimeters" — Em Gootee (clinical) [Ep 31 · 9:20](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=560) - "The CPAM study did not enroll patients who accepted conservative treatment" — Em Gootee (epidemiological) [Ep 31 · 9:50](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=590) - "The CPAM study had insufficient sample size and was from a single center" — Em Gootee (epidemiological) [Ep 31 · 10:00](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=600) - "The CPAM study excluded patients who underwent thoracotomy, including only thoracoscopic resections" — Pablo Laje (epidemiological) [Ep 31 · 10:31](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=631) - "6-40% of prenatally diagnosed lung lesions regress with time and may appear to completely disappear" — Steven Rothenberg (epidemiological) [Ep 23 · 5:43](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=343) - "Fetal surgery for lung lesions is extremely rare, performed less than once every couple of years even at high-volume centers" — Steven Rothenberg (epidemiological) [Ep 23 · 6:11](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=371) - "Cyst volume ratio (CVR) greater than 2 has an extremely bad prognosis in prenatal lung lesions" — Steven Rothenberg (clinical) [Ep 23 · 7:54](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=474) - "Hybrid lesions showing features of both CPAM and sequestration are not uncommon on pathology" — Steven Rothenberg (clinical) [Ep 23 · 9:09](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=549) - "Chest X-ray or ultrasound are inadequate to ensure there is no lesion present after prenatal diagnosis" — Steven Rothenberg (clinical) [Ep 23 · 14:44](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=884) - "20-40% of untreated congenital lung lesions will develop significant infection at some point" — Steven Rothenberg (epidemiological) [Ep 23 · 15:55](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=955) - "The incidence of malignancy in untreated congenital lung lesions is over 1%" — Steven Rothenberg (epidemiological) [Ep 23 · 16:58](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1018) - "Surgery is technically easier in smaller infants because vessels are smaller and anatomy is fresh" — Steven Rothenberg (clinical) [Ep 23 · 18:24](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1104) - "Even in asymptomatic children, significantly enlarged lymph nodes and inflammation are often found in the fissures around one year of age" — Steven Rothenberg (clinical) [Ep 23 · 18:46](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1126) - "Hospital stay, chest tube duration, recovery, and operative time are less in patients under 5 kg compared to those under 10 kg" — Steven Rothenberg (clinical) [Ep 23 · 19:32](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1172) - "Most asymptomatic children on room air will tolerate single lung ventilation without problem" — Steven Rothenberg (clinical) [Ep 23 · 23:38](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1418) - "All babies initially desaturate when the lung is collapsed, sometimes to high 80s or low 90s, but saturations come up once shunting to the collapsed lung stops" — Steven Rothenberg (clinical) [Ep 23 · 26:02](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1562) - "Using energy devices that seal and cut simultaneously on major vessels is dangerous and can lead to unrecoverable bleeding" — Steven Rothenberg (clinical) [Ep 23 · 37:46](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2266) - "Making two separate seals 4-5mm apart on vessels and cutting partway between them allows recovery if the seal fails" — Steven Rothenberg (clinical) [Ep 23 · 35:15](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2115) - "The pulmonary vein trunk must not be taken near the pericardium because device failure will cause the vessel to retract and result in fatal bleeding" — Steven Rothenberg (clinical) [Ep 23 · 50:33](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3033) - "Using both sealing technology and clips on the same vessel can cause delayed bleeding as the vessel changes and clips lose secure footing" — Steven Rothenberg (clinical) [Ep 23 · 59:55](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3595) - "Extra-lobar sequestrations can have up to 6 systemic vessels, with diameters ranging from small to 15mm" — Steven Rothenberg (clinical) [Ep 23 · 58:42](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3522) - "Average length of stay for lobectomy in patients who come in the morning is about 2.5 days" — Steven Rothenberg (clinical) [Ep 23 · 65:33](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3933) - "CT scan at 4-6 weeks allows for less atelectasis during the study and easier interpretation compared to earlier imaging" — Steven Rothenberg (clinical) [Ep 23 · 13:11](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=791) - "The bronchus sits directly underneath the pulmonary artery in the lower lobe and can be felt to aid dissection" — Steven Rothenberg (clinical) [Ep 23 · 45:23](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2723) - "CVR greater than 1.6 in microcystic CCAM lesions predicts less than 3-5% likelihood of evolving hydrops" — Alan (clinical) [Ep 16 · 27:50](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1670) - "EXIT procedures at CHOP are reserved for cases with average CVR over 2, evidence of compression including diaphragmatic aversion and marked mediastinal shift" — Alan (clinical) [Ep 16 · 0:46](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=46) - "It is very rare to need ECMO in CCAM patients" — Alan (clinical) [Ep 16 · 1:41](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=101) - "There is no clear reduction in ability to have subsequent pregnancy after fetal surgery" — Alan (clinical) [Ep 16 · 2:46](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=166) - "Patients who have had fetal surgery should never labor with future pregnancies due to classical cesarean-type uterine incision" — Alan (guideline) [Ep 16 · 2:59](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=179) - "No cases of placenta accreta at hysterotomy site have been observed following fetal surgery" — Alan (clinical) [Ep 16 · 3:22](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=202) - "EXIT procedure requires anesthetic team expertise in uterine relaxation and maternal issues, distinct from standard cesarean section" — Alan (clinical) [Ep 16 · 4:03](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=243) - "CHOP has performed close to 100 EXIT procedures in the past 10 years" — Alan (epidemiological) [Ep 16 · 4:49](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=289) - "Maternal expertise must be available at the hospital performing EXIT procedures to protect the mother" (guideline) [Ep 16 · 5:13](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=313) - "Four or five centers in the US clearly have qualifications and background to do good EXIT procedures" — Alan (epidemiological) [Ep 16 · 6:04](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=364) - "EXIT procedures require weeks of planning and involve 15-20 people in the team" (clinical) [Ep 16 · 6:56](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=416) - "One EXIT procedure per year is probably not enough volume to justify doing them; 3-5 per year is a reasonable threshold" — Alan (opinion) [Ep 16 · 7:15](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=435) - "Most bronchopulmonary sequestrations causing hydrops have associated pleural effusions and mediastinal shift rather than high-output failure physiology" — Alan (clinical) [Ep 16 · 8:27](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=507) - "Injecting alcohol into fetal vessels has potential for systemic thrombosis, with documented case of thrombi in heart chambers" — Alan (clinical) [Ep 16 · 16:27](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=987) - "Neurologic effects of using alcohol as sclerosant in the fetus have not been adequately studied and are very worrisome" — Alan (opinion) [Ep 16 · 17:06](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1026) - "Radiofrequency ablation in fetus causes uncontrolled heat dispersion due to 90% water content, with energy dispersing unpredictably and causing collateral damage" — Alan (clinical) [Ep 16 · 17:26](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1046) - "Probably 95% of CCAMs seen now are prenatally diagnosed" (epidemiological) [Ep 16 · 18:11](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1091) - "Almost none of prenatally diagnosed congenital lung lesions require prenatal intervention, and very few require intervention the day the child is born" (clinical) [Ep 16 · 18:18](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1098) - "Many large congenital lung lesions have been referred after recommendation for termination by practitioners who don't understand natural history" — Alan (clinical) [Ep 16 · 19:46](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1186) - "True cystic CCAMs often regress and become isoechogenic in third trimester but remain present and prominent on CT scan one month after birth" — Alan (clinical) [Ep 16 · 20:56](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1256) - "CCAM is a pathological diagnosis once specimen is in the bucket, not a prenatal diagnosis" — Jean-Martin (guideline) [Ep 16 · 22:18](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1338) - "Congenital lung lesions should be classified as macrocystic, hyperechoic, or mixed rather than called CCAMs prenatally" — Jean-Martin (opinion) [Ep 16 · 22:18](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1338) - "Lung agenesis is frequently misdiagnosed as microcystic CCAM elsewhere and referred to fetal centers" — Alan (clinical) [Ep 16 · 23:58](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1438) - "EXIT is more invasive than regular C-section for the mother" — Jean-Martin (clinical) [Ep 16 · 24:25](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1465) - "Pleuro-amniotic shunts are used specifically for macrocystic CCAMs with evidence of hydrops" — Alan (guideline) [Ep 16 · 25:34](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1534) - "Hydrops requires more than just ascites; must include pleural effusion, pericardial effusion, and skin or scalp edema" — Alan (clinical) [Ep 16 · 25:50](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1550) - "Pure ascites is not necessarily hydrops and can be related to mediastinal shift and hepatic venous return" — Alan (clinical) [Ep 16 · 25:53](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1553) - "Fetal tissue at 20-23 weeks becomes very gelatinous and friable, requiring careful handling" — Alan (clinical) [Ep 16 · 10:53](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=653) - "Fetus is anesthetized from maternal anesthesia plus direct fetal anesthetic and paralytic injection" — Alan (clinical) [Ep 16 · 11:48](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=708) - "Small piece of residual lung tissue grows dramatically after fetal lobectomy as long as airway and vasculature are preserved" — Alan (clinical) [Ep 16 · 13:43](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=823) - "No successful fetal pneumonectomies have been performed; one case of bronchial atresia with attempted pneumonectomy resulted in fetal death" — Alan (clinical) [Ep 16 · 12:58](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=778) - "Most C-sections are done through lower uterine segment and do not interfere with fetal surgery incision" — Alan (clinical) [Ep 16 · 14:08](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=848) - "6-40% of prenatally diagnosed lung lesions regress with time and may appear to completely disappear" — Steven Rothenberg (epidemiological) [Ep 8 · 5:43](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=343) - "Fetal intervention for lung lesions is extremely rare; CHOP performs open fetal surgery less than once every couple of years" — Steven Rothenberg (epidemiological) [Ep 8 · 6:11](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=371) - "Cyst volume ratio (CVR) greater than 2 has an extremely bad prognosis for fetal lung lesions" — Steven Rothenberg (clinical) [Ep 8 · 7:54](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=474) - "Hybrid lesions showing features of both CPAM and sequestration are not uncommon on pathology" — Steven Rothenberg (clinical) [Ep 8 · 9:09](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=549) - "Intralobar sequestration shares a common pleura with the lobe, usually the lower lobe" — Steven Rothenberg (clinical) [Ep 8 · 9:48](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=588) - "Extralobar sequestration has its own pleural lining and is 90% separate from the lobe" — Steven Rothenberg (clinical) [Ep 8 · 9:52](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=592) - "Sequestrations are defined by having a systemic artery coming directly off the aorta" — Steven Rothenberg (clinical) [Ep 8 · 10:02](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=602) - "Systemic vessels to sequestrations can come off the abdominal aorta and pass through the diaphragm" — Steven Rothenberg (clinical) [Ep 8 · 10:14](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=614) - "CPAM type 3 lesions are more solid and have the worst prognosis" — Steven Rothenberg (clinical) [Ep 8 · 10:40](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=640) - "Chest X-ray alone is not adequate to ensure there is no residual lung lesion after prenatal diagnosis" — Steven Rothenberg (clinical) [Ep 8 · 14:50](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=890) - "20-40% of untreated congenital lung lesions will develop significant infection at some point" — Steven Rothenberg (epidemiological) [Ep 8 · 15:47](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=947) - "The incidence of malignancy in untreated congenital lung lesions is over 1% in Rothenberg's series" — Steven Rothenberg (epidemiological) [Ep 8 · 16:58](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=1018) - "Operating by 3 months of age avoids pneumonia or severe respiratory infection before surgery" — Steven Rothenberg (opinion) [Ep 8 · 18:04](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=1084) - "Surgery is technically easier in younger infants because vessels are smaller and anatomy is fresh" — Steven Rothenberg (opinion) [Ep 8 · 18:20](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=1100) - "Even asymptomatic patients often have enlarged lymph nodes and inflammation in fissures by one year of age" — Steven Rothenberg (clinical) [Ep 8 · 18:46](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=1126) - "Hospital stay, chest tube duration, recovery, and operative time are less in patients under 5 kg compared to those under 10 kg" — Steven Rothenberg (clinical) [Ep 8 · 19:32](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=1172) - "Most infants undergoing early lobectomy are discharged within 48 hours" — Steven Rothenberg (clinical) [Ep 8 · 19:46](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=1186) - "By one month post-op, chest X-ray shows no evidence of prior surgery due to compensatory lung growth" — Steven Rothenberg (clinical) [Ep 8 · 19:46](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=1186) - "Most asymptomatic infants will tolerate single lung ventilation without problem" — Steven Rothenberg (clinical) [Ep 8 · 23:38](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=1418) - "Babies initially desaturate after lung collapse but saturations improve once they stop shunting blood to the collapsed lung" — Steven Rothenberg (clinical) [Ep 8 · 26:02](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=1562) - "End-tidal CO2 in the mid-40s during thoracoscopy does not cause significant acidosis or deleterious effects" — Steven Rothenberg (clinical) [Ep 8 · 27:41](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=1661) - "Standing at the patient's front provides more room from the chest wall to the hilum than standing at the back" — Steven Rothenberg (opinion) [Ep 8 · 30:02](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=1802) - "The camera port should be anterior to the tip of the scapula in the mid-axillary line to allow working from front to back" — Steven Rothenberg (opinion) [Ep 8 · 30:39](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=1839) - "A 4mm scope provides a more wide-angle view comparable to a 5mm scope compared to a 3mm scope" — Steven Rothenberg (opinion) [Ep 8 · 33:01](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=1981) - "Short scopes (20cm) allow the surgeon to get close to the patient without the assistant getting in the way" — Steven Rothenberg (opinion) [Ep 8 · 33:22](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=2002) - "3mm vessel sealing devices can seal vessels up to 5mm in diameter" — Steven Rothenberg (clinical) [Ep 8 · 35:01](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=2101) - "Making two separate seals 4-5mm apart on vessels and cutting between them maximizes safety" — Steven Rothenberg (opinion) [Ep 8 · 35:15](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=2115) - "Cutting partway through a sealed vessel until seeing the lumen allows detection of bleeding while maintaining control" — Steven Rothenberg (opinion) [Ep 8 · 36:11](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=2171) - "Clips on vessels can be knocked off and are less reliable than vessel sealing" — Steven Rothenberg (opinion) [Ep 8 · 36:50](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=2210) - "Using energy devices that seal and cut simultaneously is a mistake that sets up the surgeon for trouble" — Steven Rothenberg (opinion) [Ep 8 · 37:44](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=2264) - "Every sealing device can fail at some point, so techniques should allow for recovery" — Steven Rothenberg (opinion) [Ep 8 · 38:30](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=2310) - "The inferior pulmonary ligament should be taken down first to check energy source function and identify systemic vessels" — Steven Rothenberg (opinion) [Ep 8 · 42:01](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=2521) - "Systemic vessels to sequestrations can be missed on CT scan and should be actively looked for during surgery" — Steven Rothenberg (clinical) [Ep 8 · 42:24](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=2544) - "Incomplete fissures can be completed by working through tissue layer by layer, similar to finger fracturing in liver surgery" — Steven Rothenberg (opinion) [Ep 8 · 43:13](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=2593) - "The bronchus sits directly underneath the pulmonary artery and can be felt to aid dissection" — Steven Rothenberg (clinical) [Ep 8 · 45:20](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=2720) - "The pulmonary vein is directly behind the bronchus in the same plane as the fissure dissection" — Steven Rothenberg (clinical) [Ep 8 · 48:31](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=2911) - "A 5mm stapler is inadequate for bronchus or vessels in children over 10 kg" — Steven Rothenberg (clinical) [Ep 8 · 49:11](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=2951) - "The pulmonary vein trunk must never be taken near the pericardium because retraction into the pericardium after device failure causes fatal hemorrhage" — Steven Rothenberg (clinical) [Ep 8 · 50:33](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=3033) - "Middle lobe vessels come off just above the right lower lobe pulmonary artery and can be damaged if dissection migrates too cephalad" — Steven Rothenberg (clinical) [Ep 8 · 51:10](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=3070) - "Large cysts should be decompressed with the sealing device at the beginning of the procedure to improve visualization and lung manipulation" — Steven Rothenberg (opinion) [Ep 8 · 57:38](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=3458) - "Systemic vessels to sequestrations can number up to 6 and range from small to 15mm in diameter" — Steven Rothenberg (clinical) [Ep 8 · 58:40](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=3520) - "Using both sealing technology and clips on the same vessel risks delayed bleeding as the vessel changes nature and clips lose secure footing" — Steven Rothenberg (clinical) [Ep 8 · 59:55](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=3595) - "Systemic vessels to sequestrations have higher pressure from the aorta compared to low-pressure pulmonary vessels" — Steven Rothenberg (clinical) [Ep 8 · 60:43](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=3643) - "Extralobar sequestrations become infected and can cause problems even if malignant potential is uncertain" — Steven Rothenberg (clinical) [Ep 8 · 61:07](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=3667) - "Embolization of sequestrations requires general anesthesia and significant arterial intervention with no advantage over thoracoscopic resection" — Steven Rothenberg (opinion) [Ep 8 · 61:23](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=3683) - "Extralobar sequestration resection does not require a chest tube and patients go home the next day" — Steven Rothenberg (clinical) [Ep 8 · 61:35](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=3695) - "Segmentectomy is feasible when disease is confined to the superior segment of lower lobe or lingula with favorable anatomy" — Steven Rothenberg (opinion) [Ep 8 · 63:48](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=3828) - "Average length of stay for lobectomy in patients coming in the morning is about 2.5 days" — Steven Rothenberg (clinical) [Ep 8 · 65:33](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=3933) - "Most people believe now that CCAMs do not become PPB, but PPB is a de novo tumor that is cystic and cannot be differentiated on imaging" — Jean-Martin (clinical) [Ep 1 · 0:40](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=40) - "There are several cases of prenatally diagnosed lesions that turned out to be PPB after birth" — Jean-Martin (clinical) [Ep 1 · 0:59](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=59) - "One series from Toronto estimates that cystic lesions that look like CCAM, about 4% will actually turn out to be PPB" — Jean-Martin (epidemiological) [Ep 1 · 1:33](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=93) - "There is about a 1% risk of cystic lung lesions becoming bronchioalveolar carcinoma in teenage years or early adulthood" — Jean-Martin (epidemiological) [Ep 1 · 1:45](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=105) - "If doing thoracoscopy for suspected CCAM, put the specimen in a bag before extraction because if it turns out to be PPB there is a risk of recurrence from specimen fragmentation" — Jean-Martin (clinical) [Ep 1 · 2:20](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=140) - "Extralobar sequestrations by definition have no communication and no air on CT scan, and their infection rate is not very high" — Jean-Martin (clinical) [Ep 1 · 2:48](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=168) - "Extralobar sequestrations can get hematogenous infection like any tissue but that is pretty rare" — Jean-Martin (clinical) [Ep 1 · 3:02](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=182) - "Malignant transformation of extralobar sequestration is extremely rare with maybe one or two cases of squamous cell carcinoma in world literature" — Jean-Martin (epidemiological) [Ep 1 · 3:09](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=189) - "Imaging is not perfect and we cannot always be absolutely sure of the diagnosis or whether it is a hybrid lesion" — Steve (clinical) [Ep 1 · 4:00](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=240) - "The morbidity of resecting extralobar sequestration is so low that removal is favored over observation" — Steve (opinion) [Ep 1 · 4:28](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=268) - "There is no role for embolization of extralobar sequestrations; it is much easier to resect them using minimally invasive techniques" — Steve (opinion) [Ep 1 · 4:58](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=298) - "The differential diagnosis for infradiaphragmatic lesions prenatally is adrenal hemorrhage or neuroblastoma (cystic neuroblastoma)" — Alan (clinical) [Ep 1 · 5:26](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=326) - "Small infradiaphragmatic lesions can be followed by ultrasound; if they stay the same or get smaller, no intervention is needed" — Alan (clinical) [Ep 1 · 5:33](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=333) - "The COG study showed it was safe to observe adrenal masses in neonates" — Jean-Martin (guideline) [Ep 1 · 6:00](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=360) - "There is no good way to follow pulmonary lesions; CT scan is the best method but induces a certain incidence of malignancy itself" — Alan (clinical) [Ep 1 · 6:26](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=386) - "You cannot differentiate CCAM from PPB on CT scan until you have a stage two or three occurrence" — Alan (clinical) [Ep 1 · 6:40](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=400) - "There are children who die from pulmonary lobectomy, particularly done thoracoscopically" — Jack (clinical) [Ep 1 · 7:32](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=452) - "In experienced hands, thoracoscopic lobectomy should have no more morbidity than open and mortality should be zero" — Steve (opinion) [Ep 1 · 8:22](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=502) - "If you have massive bleeding when already open, your chance of salvaging the situation is probably better than if thoracoscopic" — Jack (opinion) [Ep 1 · 9:12](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=552) - "PPB remains extremely rare; in a high-volume center it is seen de novo once every 3-4 years while seeing 20-25 new CCAM cases per year" — Jack (epidemiological) [Ep 1 · 10:11](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=611) - "The estimated lifelong risk of infection for CCAM is somewhere around 20-30% based on published data showing 10% infection with mean 4-year follow-up" — Jack (epidemiological) [Ep 1 · 11:03](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=663) - "Most infections in observed CCAM can be treated and lobectomy can be done afterwards" — Jack (clinical) [Ep 1 · 11:15](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=675) - "In a prospective observation study, 18 of 21 asymptomatic patients developed symptomatology during follow-up averaging 2 years up to 13 years" — Alan (clinical) [Ep 1 · 11:38](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=698) - "Before prenatal diagnosis era, it was not common for patients to present in teenage years or adulthood with symptomatic infected CCAMs" — Jack (epidemiological) [Ep 1 · 12:49](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=769) - "Small asymptomatic extralobar sequestration is a relatively known finding at autopsy, but asymptomatic CCAM on autopsy series is nonexistent" — Jean-Martin (epidemiological) [Ep 1 · 15:43](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=943) - "Not all prenatally diagnosed echogenic lesions are true CCAMs; some disappear and leave nothing on postnatal CT" — Jean-Martin (clinical) [Ep 1 · 16:20](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=980) - "Many families choose surgery once they hear the word cancer or infection, despite being offered observation" — Jack (opinion) [Ep 1 · 16:56](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=1016) - "A poll showed 76% advocate routine resection of asymptomatic CCAM while 23% do not" (epidemiological) [Ep 1 · 18:07](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=1087) - "There is hidden mortality in pediatric surgery because people do not report bad results; the only way to know is through lawsuits or unbiased registries like NSQIP" — Alan (opinion) [Ep 1 · 18:34](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=1114) - "Review of 100 consecutive thoracoscopic lobectomies showed only 2 transfusions and 2 delayed pneumothoraces as complications" — Alan (clinical) [Ep 1 · 19:58](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=1198) - "For infected CCAM with abscess, 6 weeks of IV antibiotics is reasonable before resection, though duration depends on symptom resolution" — Starla (clinical) [Ep 1 · 20:28](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=1228) - "Large abscesses in CCAM can be drained percutaneously and treated for a couple weeks, then re-evaluated for residual mass requiring resection" — Alan (clinical) [Ep 1 · 21:10](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=1270) - "It is very hard to clear infection from a macrocystic CCAM with antibiotics alone" — Alan (clinical) [Ep 1 · 21:21](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=1281) - "MRI is not used as primary imaging because children require more anesthesia for MRI than for CT" — Starla (clinical) [Ep 1 · 21:47](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=1307) - "MRI does not give nearly as clear a picture as CT for lung lesions" — Jack (clinical) [Ep 1 · 22:16](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=1336) - "Bronchial blockers in infants are potentially harmful and a great prep for bronchial stenosis" — Alan (clinical) [Ep 1 · 22:39](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=1359) - "Single-lung ventilation in infants can be achieved with a size 3 cuffed or uncuffed endotracheal tube placed under fluoroscopy without needing to inflate the cuff" — Alan (clinical) [Ep 1 · 22:50](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=1370) - "The incidence of extralobar sequestration in diaphragmatic hernia is probably 15%; they are often small and can be ignored" — Alan (epidemiological) [Ep 1 · 23:30](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=1410) - "Bilateral lung lesions are managed sequentially, not at the same time" — Alan (clinical) [Ep 1 · 23:56](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=1436) - "Macrocystic lesions can always be reduced thoracoscopically by persistent decompression" — Alan (clinical) [Ep 1 · 25:17](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=1517) - "Most lobectomy specimens can be extracted through a 5mm incision unless hybrid lesions have large arteries" — Alan (clinical) [Ep 1 · 25:44](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=1544) - "You never lose anything by putting a scope in first; if the fissure is obliterated or anatomy is difficult, you can convert to open" — Steve (opinion) [Ep 1 · 27:29](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=1649) - "Patient is a 3 month old, 5 kg baby undergoing thoracoscopic lobectomy" — Steve (clinical) [Ep 11 · 0:06](https://library.globalcastmd.com/watch/thoracoscopic-right-lower-lobe-cystic-lesion-excision-update-course-2014-1041?t=6) - "3 millimeter instruments are used for the procedure" — Steve (clinical) [Ep 11 · 0:14](https://library.globalcastmd.com/watch/thoracoscopic-right-lower-lobe-cystic-lesion-excision-update-course-2014-1041?t=14) - "Child had an unseen sequestration associated with the cystic lesion, located along the lower lobe at the inferior pulmonary ligament" — Steve (clinical) [Ep 11 · 0:16](https://library.globalcastmd.com/watch/thoracoscopic-right-lower-lobe-cystic-lesion-excision-update-course-2014-1041?t=16) - "Patient had an incomplete fissure" — Steve (clinical) [Ep 11 · 0:28](https://library.globalcastmd.com/watch/thoracoscopic-right-lower-lobe-cystic-lesion-excision-update-course-2014-1041?t=28) - "Enlarged lymph nodes are visible at 3 months of age in the major fissure" — Steve (clinical) [Ep 11 · 0:36](https://library.globalcastmd.com/watch/thoracoscopic-right-lower-lobe-cystic-lesion-excision-update-course-2014-1041?t=36) - "In totally asymptomatic kids aged 9 months to 1 year, lymph nodes are massive and inflammation in the fissure is massive, making the operation more difficult" — Steve (clinical) [Ep 11 · 0:40](https://library.globalcastmd.com/watch/thoracoscopic-right-lower-lobe-cystic-lesion-excision-update-course-2014-1041?t=40) - "3 millimeter sealer will take vessels safely up to 5 millimeters" — Steve (clinical) [Ep 11 · 1:26](https://library.globalcastmd.com/watch/thoracoscopic-right-lower-lobe-cystic-lesion-excision-update-course-2014-1041?t=86) - "The operation with the fellow assisting and doing about half of it took about 90 minutes" — Steve (clinical) [Ep 11 · 1:21](https://library.globalcastmd.com/watch/thoracoscopic-right-lower-lobe-cystic-lesion-excision-update-course-2014-1041?t=81) - "When waiting to do asymptomatic kids around a year of age, dissection becomes much tougher due to inflammation, even in children who never had a cold or chest infection" — Steve (clinical) [Ep 11 · 1:44](https://library.globalcastmd.com/watch/thoracoscopic-right-lower-lobe-cystic-lesion-excision-update-course-2014-1041?t=104) - "At this age (3 months), clips can be safely used at the segmental level" — Steve (clinical) [Ep 11 · 2:21](https://library.globalcastmd.com/watch/thoracoscopic-right-lower-lobe-cystic-lesion-excision-update-course-2014-1041?t=141) - "Specimen is morsellated through the trochar site and taken out piecemeal" — Steve (clinical) [Ep 11 · 3:02](https://library.globalcastmd.com/watch/thoracoscopic-right-lower-lobe-cystic-lesion-excision-update-course-2014-1041?t=182) - "At 3 months, the operation does not feel like a limited space operation, with good lung collapse" (opinion) [Ep 11 · 3:30](https://library.globalcastmd.com/watch/thoracoscopic-right-lower-lobe-cystic-lesion-excision-update-course-2014-1041?t=210) - "It is easier to do the operation when infants are smaller (3 months)" (opinion) [Ep 11 · 3:44](https://library.globalcastmd.com/watch/thoracoscopic-right-lower-lobe-cystic-lesion-excision-update-course-2014-1041?t=224) - "In Germany, the practice is to operate on any kind of cystic lesion at 3 to 6 months of age because of potential malignancy later on" — Benno (clinical) [Ep 11 · 4:32](https://library.globalcastmd.com/watch/thoracoscopic-right-lower-lobe-cystic-lesion-excision-update-course-2014-1041?t=272) - "The operation is most easily done when patients are about 3 to 6 months of age" — Benno (opinion) [Ep 11 · 4:47](https://library.globalcastmd.com/watch/thoracoscopic-right-lower-lobe-cystic-lesion-excision-update-course-2014-1041?t=287) - "Chest tube was removed on post-op day 2, could have been removed on post-op day 1" — Steve (clinical) [Ep 11 · 6:54](https://library.globalcastmd.com/watch/thoracoscopic-right-lower-lobe-cystic-lesion-excision-update-course-2014-1041?t=414) - "Child went home on post-op day 3" — Steve (clinical) [Ep 11 · 7:00](https://library.globalcastmd.com/watch/thoracoscopic-right-lower-lobe-cystic-lesion-excision-update-course-2014-1041?t=420) - "Pathology showed lung tissue with cystic congenital pulmonary airway malformation, type 1 and type 2 changes, with exuberant neoplastic mucinous proliferations and negative bronchial margin" — Steve (clinical) [Ep 11 · 7:02](https://library.globalcastmd.com/watch/thoracoscopic-right-lower-lobe-cystic-lesion-excision-update-course-2014-1041?t=422) - "The finding of exuberant neoplastic mucinous proliferations had not been reported before" — Steve (clinical) [Ep 11 · 7:22](https://library.globalcastmd.com/watch/thoracoscopic-right-lower-lobe-cystic-lesion-excision-update-course-2014-1041?t=442) - "Speaker has done a little over 300 lobectomies for cystic lung disease" — Steve (clinical) [Ep 11 · 7:22](https://library.globalcastmd.com/watch/thoracoscopic-right-lower-lobe-cystic-lesion-excision-update-course-2014-1041?t=442) - "In the speaker's series, there have been two pulmonary blastomas and one adenocarcinoma" — Steve (clinical) [Ep 11 · 7:31](https://library.globalcastmd.com/watch/thoracoscopic-right-lower-lobe-cystic-lesion-excision-update-course-2014-1041?t=451) - "The mucinous proliferation finding is maybe associated with the KRAS mutation, which is also a marker in adult small cell carcinoma and colon cancer" — Steve (clinical) [Ep 11 · 7:36](https://library.globalcastmd.com/watch/thoracoscopic-right-lower-lobe-cystic-lesion-excision-update-course-2014-1041?t=456) - "Columbia pathology reviewed cases and found 4 others with this finding" — Steve (clinical) [Ep 11 · 7:47](https://library.globalcastmd.com/watch/thoracoscopic-right-lower-lobe-cystic-lesion-excision-update-course-2014-1041?t=467) - "Literature shows that 30-40% of kids with cystic lung disease will have a significant pulmonary infection at some point during their life" — Steve (epidemiological) [Ep 11 · 8:03](https://library.globalcastmd.com/watch/thoracoscopic-right-lower-lobe-cystic-lesion-excision-update-course-2014-1041?t=483) - "Once cystic lesions become infected, they are much more difficult to operate on" — Steve (clinical) [Ep 11 · 8:17](https://library.globalcastmd.com/watch/thoracoscopic-right-lower-lobe-cystic-lesion-excision-update-course-2014-1041?t=497) - "All these operations should be done thoracoscopically at this point" — Steve (opinion) [Ep 11 · 8:21](https://library.globalcastmd.com/watch/thoracoscopic-right-lower-lobe-cystic-lesion-excision-update-course-2014-1041?t=501) - "If you take a lobe in an infant, the rest of the lung will grow and they will compensate without significant disability, though long-term pulmonary function studies are needed to document this" — Steve (clinical) [Ep 11 · 8:37](https://library.globalcastmd.com/watch/thoracoscopic-right-lower-lobe-cystic-lesion-excision-update-course-2014-1041?t=517) - "In the speaker's personal series, malignancy incidence is almost 2%, certainly 1%" — Steve (epidemiological) [Ep 11 · 9:02](https://library.globalcastmd.com/watch/thoracoscopic-right-lower-lobe-cystic-lesion-excision-update-course-2014-1041?t=542) - "Hematologist-oncologist stated that morcellation did not upgrade the tumor and does not change treatment; patients are being watched but not receiving chemotherapy" — Steve (clinical) [Ep 11 · 9:51](https://library.globalcastmd.com/watch/thoracoscopic-right-lower-lobe-cystic-lesion-excision-update-course-2014-1041?t=591) - "The three tumors (blastomas and adenocarcinoma) were all found in children around one year of age" — Steve (clinical) [Ep 11 · 11:11](https://library.globalcastmd.com/watch/thoracoscopic-right-lower-lobe-cystic-lesion-excision-update-course-2014-1041?t=671) - "Fetal MRI for cystic lung lesions is justified only if it will change management, such as administration of prenatal steroids" — Abdullah (opinion) [Ep 4 · 1:21](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=81) - "Prenatal steroids are indicated for microcystic lesions with CVR (congenital pulmonary airway malformation volume ratio) above 1.6" — Abdullah (guideline) [Ep 4 · 5:49](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=349) - "Prenatal steroids do not work on macrocystic lesions, only microcystic lesions" — Abdullah (clinical) [Ep 4 · 6:30](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=390) - "The benefit of prenatal steroids was discovered incidentally at UCSF when given for other indications" — Abdullah (clinical) [Ep 4 · 6:33](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=393) - "Operative time is less and complication rate is lower when congenital lung lesions are resected earlier (3 months) rather than later" — Steven Rothenberg (clinical) [Ep 4 · 10:41](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=641) - "Patients with congenital cystic lung disease have subclinical inflammation and infection that increases between 3 and 9 months of age" — Steven Rothenberg (clinical) [Ep 4 · 10:51](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=651) - "The amount of inflammation in fissures and number of enlarged lymph nodes is significantly greater at 9 months compared to 3 months" — Steven Rothenberg (clinical) [Ep 4 · 10:55](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=655) - "Asymptomatic children at one year of age can have massive lymph nodes and massive inflammation in the fissure" — Steven Rothenberg (clinical) [Ep 4 · 13:55](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=835) - "A 3 millimeter vessel sealer can safely take vessels up to 5 millimeters in diameter" — Steven Rothenberg (clinical) [Ep 4 · 14:40](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=880) - "At 3 months of age, thoracoscopic lobectomy does not feel like a limited space operation with adequate lung collapse and working room" (clinical) [Ep 4 · 16:44](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=1004) - "In Europe, the Netherlands has a more conservative approach to congenital lung lesions than Germany" — Benno (clinical) [Ep 4 · 17:40](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=1060) - "In Germany, all cystic lung lesions are operated at 3 to 6 months of age because of potential malignancy later on" — Benno (guideline) [Ep 4 · 17:46](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=1066) - "Anatomic segmental resection is key when performing partial lung resection for congenital lung lesions" — Steven Rothenberg (opinion) [Ep 4 · 18:55](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=1135) - "One child who had segmental resection has shown evidence of recurrent cystic disease" — Steven Rothenberg (clinical) [Ep 4 · 19:08](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=1148) - "30-40% of children with cystic lung disease will have a significant pulmonary infection at some point during their life" — Steven Rothenberg (epidemiological) [Ep 4 · 21:17](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=1277) - "Once congenital lung lesions become infected, they are much more difficult to resect" — Steven Rothenberg (clinical) [Ep 4 · 21:32](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=1292) - "All thoracoscopic lobectomies for congenital lung lesions should be done thoracoscopically at this point" — Steven Rothenberg (opinion) [Ep 4 · 21:35](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=1295) - "The incidence of malignancy in congenital cystic lung lesions is almost 2%, certainly 1%" — Steven Rothenberg (epidemiological) [Ep 4 · 22:17](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=1337) - "In a series of over 300 lobectomies for cystic lung disease, there were 2 pulmonary blastomas and 1 adenocarcinoma" — Steven Rothenberg (epidemiological) [Ep 4 · 20:36](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=1236) - "Neoplastic mucinous proliferations in CPAM may be associated with KRAS mutation, which is also a marker in adult small cell carcinoma and colon cancer" — Steven Rothenberg (clinical) [Ep 4 · 20:50](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=1250) - "Columbia pathology review found 4 additional cases with neoplastic mucinous proliferations in CPAM specimens" — Steven Rothenberg (clinical) [Ep 4 · 21:02](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=1262) - "Morsellating tumor tissue does not upgrade the tumor stage and does not change treatment according to hematologist-oncologists" — Steven Rothenberg (clinical) [Ep 4 · 23:06](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=1386) - "All three malignant tumors (blastomas and adenocarcinoma) occurred in children under one year of age" — Steven Rothenberg (epidemiological) [Ep 4 · 24:24](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=1464) - "In North America, the preferred approach for resectable renal tumors is primary nephrectomy and ureterectomy with lymph node sampling" — Peter Ehrlich (guideline) [Ep 24 · 6:23](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=383) - "Preoperative chemotherapy is recommended if tumor extends into IVC beyond the infrahepatic vena cava" — Peter Ehrlich (guideline) [Ep 24 · 7:33](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=453) - "Wilms tumors tend to push structures out of the way rather than growing around them, unlike neuroblastoma" — Peter Ehrlich (clinical) [Ep 24 · 4:16](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=256) - "The claw sign on CT scan—normal kidney displaced into horseshoe pattern with tumor in the center—is classic for Wilms tumor" — Peter Ehrlich (clinical) [Ep 24 · 3:49](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=229) - "Tumors between 13-15 centimeters or larger have higher risk of rupture and may warrant preoperative chemotherapy" — Peter Ehrlich (clinical) [Ep 24 · 14:33](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=873) - "Core needle biopsy should include 10-20 cores to increase diagnostic accuracy; fine needle aspiration cannot diagnose anaplasia" — Peter Ehrlich (guideline) [Ep 24 · 18:03](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1083) - "Stage 1 and 2 Wilms tumor patients receive only two-drug chemotherapy (vincristine and dactinomycin) for 19 weeks without radiation" — Peter Ehrlich (guideline) [Ep 24 · 20:36](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1236) - "Stage 3 patients receive three-drug chemotherapy (adding doxorubicin) plus abdominal radiation" — Peter Ehrlich (guideline) [Ep 24 · 20:28](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1228) - "A patient with lung metastases but stage 1-2 abdominal disease does not require abdominal radiation if primary tumor is completely resected with negative lymph nodes" — Peter Ehrlich (clinical) [Ep 24 · 24:15](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1455) - "Approximately 40% of patients with pulmonary metastases achieve complete response by 6 weeks of chemotherapy and can avoid pulmonary radiation" — Peter Ehrlich (clinical) [Ep 24 · 26:44](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1604) - "Fifteen percent of girls who receive pulmonary radiation for Wilms tumor develop breast cancer as a late effect" — Peter Ehrlich (epidemiological) [Ep 24 · 26:08](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1568) - "The main late effects of Wilms tumor treatment are renal failure, second malignancies, pregnancy complications, hypertension, and cardiovascular disease, primarily from radiation and doxorubicin" — Peter Ehrlich (clinical) [Ep 24 · 23:37](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1417) - "Loss of heterozygosity at both 1p and 16q occurs in 5-7% of patients and predicts 10% lower survival in stage 1-2 and 18% lower survival in stage 3-4" — Peter Ehrlich (clinical) [Ep 24 · 54:41](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3281) - "Patients with tumors less than 550g, stage 1, favorable histology, and age under 2 years can be treated with surgery alone with greater than 95% survival" — Peter Ehrlich (clinical) [Ep 24 · 43:41](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2621) - "IVC tumor thrombus extension is not a negative prognostic factor if completely resected" — Peter Ehrlich (clinical) [Ep 24 · 46:14](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2774) - "Major complication rate for tumors extending beyond infrahepatic IVC operated upfront is 26-30% with documented mortality" — Peter Ehrlich (clinical) [Ep 24 · 48:49](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2929) - "Bilateral Wilms tumor occurs in 8-10% of cases with historically lower survival: 61% event-free and 80% overall compared to 88% and 95% for unilateral disease" — Peter Ehrlich (epidemiological) [Ep 24 · 58:51](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3531) - "Maximum tumor response to chemotherapy typically occurs by 12 weeks, with early response at 6 weeks predicting late response" — Peter Ehrlich (clinical) [Ep 24 · 59:37](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3577) - "In bilateral Wilms tumor, there is discordant pathology between kidneys in up to 20% of cases" — Peter Ehrlich (clinical) [Ep 24 · 62:14](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3734) - "SIOP protocols use preoperative chemotherapy for all patients with post-treatment staging based on blastemal predominance" — Peter Ehrlich (guideline) [Ep 24 · 30:31](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1831) - "Lymph node positivity is the main prognostic factor in stage 3 disease" — Peter Ehrlich (clinical) [Ep 24 · 32:45](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1965) - "Acquired von Willebrand disease occurs in Wilms tumor patients and may rarely cause significant intraoperative bleeding" — Peter Ehrlich (clinical) [Ep 24 · 35:11](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2111) - "Minimum lymph node sampling should be 5-6 nodes, though more than one may be better based on secondary evidence" — Peter Ehrlich (guideline) [Ep 24 · 39:49](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2389) - "Taking a rim of adherent diaphragm or liver capsule to avoid tumor violation does not upstage the tumor if the tumor itself is not divided" — Peter Ehrlich (clinical) [Ep 24 · 42:31](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2551) - "Positive surgical margins automatically make a tumor stage 3" — Peter Ehrlich (guideline) [Ep 24 · 41:24](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2484) - "Favorable histology Wilms tumor has three components: blastemal, stromal, and epithelial; tumors with only two components are still considered favorable" — Peter Ehrlich (clinical) [Ep 24 · 52:52](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3172) - "In COG protocols, the amount of blastema in favorable histology tumors has never correlated with outcome" — Peter Ehrlich (clinical) [Ep 24 · 53:13](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3193) - "Stage 2 patients receive vincristine and dactinomycin for 19 weeks; stage 3 patients receive DD4A regimen (adding doxorubicin) for 25 weeks" — Peter Ehrlich (guideline) [Ep 24 · 53:56](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3236) - "Renal cell carcinoma is the second most common renal tumor in children, with no effective therapy for metastatic disease" — Peter Ehrlich (clinical) [Ep 24 · 56:51](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3411) - "Rhabdoid tumors have terrible outcomes except for stage 1; most present at stage 3 or 4" — Peter Ehrlich (clinical) [Ep 24 · 57:27](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3447) - "Microaggressions are verbal, nonverbal, environmental slights, snubs, invalidations, or insults that send hostile, derogatory, or negative messages to individuals based solely on their marginalized group membership" — Craig Lillehei (clinical) [Ep 28 · 3:30](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=210) - "Microaggressions have a cumulative impact causing isolation and self-doubt despite being termed 'micro'" — Craig Lillehei (clinical) [Ep 28 · 4:00](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=240) - "In the TOTAL trial for severe CDH, FETO significantly improved survival" — Craig Lillehei (clinical) [Ep 28 · 10:00](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=600) - "In the TOTAL trial for moderate CDH, FETO showed some improvement in survival but did not approach statistical significance" — Craig Lillehei (clinical) [Ep 28 · 10:20](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=620) - "The TOTAL trial was conducted over an 11-year period at multiple centers with variable CDH management protocols" — Craig Lillehei (clinical) [Ep 28 · 10:50](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=650) - "FETO is associated with prematurity and premature rupture of membranes as complications" — Craig Lillehei (clinical) [Ep 28 · 11:20](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=680) - "NPO guidelines for children are based on very poor evidence and vary significantly between institutions" (clinical) [Ep 28 · 15:00](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=900) - "Pulmonary aspiration during elective pediatric surgery is very rare and usually occurs in emergency surgeries in high-risk children" (epidemiological) [Ep 28 · 15:20](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=920) - "Clear liquids containing carbohydrates empty the stomach very quickly regardless of patient age" (clinical) [Ep 28 · 15:50](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=950) - "British and Irish consensus recommends one hour NPO for clear liquids, four hours for breast milk, six hours for solid foods in children under 17" (guideline) [Ep 28 · 16:10](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=970) - "ASA currently recommends two hours for clear liquids, four hours for breast milk, six hours for non-human milk and light meals, eight hours for heavy meals" (guideline) [Ep 28 · 16:40](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1000) - "European Society of Anesthesia recommends one hour for clear liquids, three hours for breast milk, four hours for formula, six hours for everything else" (guideline) [Ep 28 · 17:10](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1030) - "Prolonged NPO periods cause ketone body generation, hypoglycemia, and patient irritability" (clinical) [Ep 28 · 17:40](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1060) - "In standard C-arm configuration, the x-ray source is below the table and the image intensifier is above" (clinical) [Ep 28 · 23:20](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1400) - "Placing lead shields on top of the patient during fluoroscopy does nothing to protect them because radiation comes from below the table" (clinical) [Ep 28 · 23:40](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1420) - "If a shield is in the fluoroscopy field, automatic brightness control increases x-ray energy, increasing patient exposure" (clinical) [Ep 28 · 24:10](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1450) - "Collimation focuses the x-ray beam to a specific area, increasing detail while decreasing total patient dose by reducing the irradiated surface area" (clinical) [Ep 28 · 25:00](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1500) - "Magnification setting on fluoroscopy significantly increases radiation dose to both patient and room personnel" (clinical) [Ep 28 · 25:30](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1530) - "Pulse mode fluoroscopy is feasible for most pediatric surgery applications and reduces radiation compared to continuous mode" (clinical) [Ep 28 · 25:50](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1550) - "CT scan for suspected airway foreign body has 94% accuracy in identifying foreign bodies when present" (clinical) [Ep 28 · 33:20](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2000) - "CT scan can identify non-radiopaque foreign bodies including plastic" (clinical) [Ep 28 · 33:40](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2020) - "In the Midwest Pediatric Surgery Consortium study of 521 primary lung lesions, none of the prenatally diagnosed lesions were malignant" (clinical) [Ep 28 · 36:40](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2200) - "Approximately 10% of postnatally diagnosed lung lesions were malignant in the consortium study" (epidemiological) [Ep 28 · 37:10](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2230) - "About half of malignant lung lesions were associated with DICER1 mutation" (clinical) [Ep 28 · 37:30](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2250) - "No malignant lung lesion had a systemic feeding vessel in the consortium study" (clinical) [Ep 28 · 37:50](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2270) - "CT scan sensitivity and specificity for detecting malignancy in lung lesions was poor with low inter-rater reliability among radiologists" (clinical) [Ep 28 · 38:10](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2290) - "The IMPACT study showed piperacillin-tazobactam had significantly lower postoperative abscess rate, ER visit rate, and CT scan rate compared to ceftriaxone-metronidazole for perforated appendicitis" (clinical) [Ep 28 · 43:20](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2600) - "A NSQIP study of 654 patients showed opposite results, suggesting ceftriaxone-metronidazole was preferred over piperacillin-tazobactam" (clinical) [Ep 28 · 44:00](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2640) - "Mechanical bowel preparation has no effect on surgical site infection rates" — Paul Yzotrak (clinical) [Ep 28 · 50:00](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=3000) - "Some data suggests mechanical bowel prep actually increases surgical site infections" — Paul Yzotrak (clinical) [Ep 28 · 50:20](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=3020) - "The NEC trial showed neurodevelopmental outcomes are improved with laparotomy compared to peritoneal drainage" — Paul Yzotrak (clinical) [Ep 28 · 53:20](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=3200) - "The NEC trial cutoff for laparotomy was approximately one kilogram" — Paul Yzotrak (clinical) [Ep 28 · 53:50](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=3230) - "Neuroblastoma with segmental chromosomal abnormalities but no MYCN amplification is now classified as high risk based on 2020-21 COG data" — Paul Yzotrak (guideline) [Ep 28 · 62:30](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=3750) - "Prenatal diagnosis has had a tremendous impact on the understanding and management of lung lesions" (opinion) [Ep 13 · 0:06](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=6) - "Right CDHs are frequently misdiagnosed as CPAMs and vice versa because of the similar echogenicity of the liver and the right chest" (clinical) [Ep 13 · 1:09](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=69) - "Steroids have reduced the need for surgical fetal intervention to almost zero in most fetal centers over the past 4-8 years" (clinical) [Ep 13 · 1:52](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=112) - "CPAMs tend to grow up until about 25 to 28 weeks when they plateau, then they actually regress in size very often" (clinical) [Ep 13 · 3:27](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=207) - "If the CVR is less than 1.6 with a solid lesion at presentation, there is less than a 3% chance of that lesion progressing to hydrops" (clinical) [Ep 13 · 3:46](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=226) - "CVR greater than 1.6 has a very high likelihood of developing hydrops, as high as 75%" (clinical) [Ep 13 · 4:10](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=250) - "Lesions with CVR greater than 1.6 are treated with steroids prophylactically to prevent hydrops at their center" (clinical) [Ep 13 · 4:24](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=264) - "The presented case is probably the only case in the last 5 years of a microcystic CPAM that did not respond to steroids at their center" (clinical) [Ep 13 · 4:51](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=291) - "Complete uterine relaxation with deep inhalational anesthetic is required before touching the uterus in fetal surgery" (clinical) [Ep 13 · 5:46](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=346) - "With an anterior placenta, a posterior uterine incision is required, necessitating division of the rectus muscle and a bigger abdominal incision" (clinical) [Ep 13 · 7:27](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=447) - "Fetuses can become bradycardic when tumors are decompressed out of the chest due to loss of preload on the heart" (clinical) [Ep 13 · 8:40](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=520) - "Fetuses are preloaded via IV before chest decompression to prevent bradycardia" (clinical) [Ep 13 · 8:49](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=529) - "The fetus was delivered at 35 weeks without ventilation required after fetal lobectomy at 23 weeks" (clinical) [Ep 13 · 10:01](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=601) - "At CHOP, overall survival for open fetal surgery is around 60%, consistent over all years" (clinical) [Ep 13 · 10:20](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=620) - "Survivors of open fetal surgery have good quality of life outcomes with no major neurologic sequelae" (clinical) [Ep 13 · 10:30](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=630) - "Losses in open fetal surgery are usually due to hydrops progressing too far, inability to tolerate the procedure, or early preterm labor" (clinical) [Ep 13 · 10:44](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=644) - "Macrocystic CPAMs are less predictable, and even patients with CVR less than 1.6 will occasionally grow rapidly and induce hydrops" (clinical) [Ep 13 · 10:58](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=658) - "Thoracoamniotic shunt converted CVR from 3.6 to 0.8 and reversed hydrops in a macrocystic CPAM case" (clinical) [Ep 13 · 11:27](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=687) - "Shunt experience has been about 70% survival" (clinical) [Ep 13 · 11:53](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=713) - "Losses with shunts are usually due to early delivery and associated prematurity, inadequate compensatory lung growth, or residual mass effect" (clinical) [Ep 13 · 11:57](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=717) - "Marked chest wall deformity can occur if shunts are placed for giant macrocystic CPAMs early in gestation, most prominent at 18-20 weeks" (clinical) [Ep 13 · 12:13](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=733) - "Chest wall deformity from early shunt placement is related to collapse of the chest wall rather than harpoon placement of the shunt" (clinical) [Ep 13 · 12:34](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=754) - "Chest wall deformity from shunts becomes less pronounced over time and thus far has not required chest reconstructive procedures" (clinical) [Ep 13 · 12:42](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=762) - "CPAMs with multiple macrocysts generally communicate, so placement of a shunt can decompress those lesions dramatically" (clinical) [Ep 13 · 13:09](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=789) - "Ascites alone is not considered hydrops" (clinical) [Ep 13 · 13:28](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=808) - "EXIT procedure is designed to maintain uteroplacental blood flow during delivery and resection of the mass" (clinical) [Ep 13 · 13:56](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=836) - "Infants can be maintained with normal blood gases for an hour and a half by a well-performed EXIT procedure" (clinical) [Ep 13 · 15:36](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=936) - "CHOP has performed 16 EXIT procedures for lung lesions, with 4 requiring ECMO and 15 survivors" (clinical) [Ep 13 · 15:44](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=944) - "ECMO is a very unusual requirement for lung lesions because of their late enlargement, so they do not have the same effect on lung hypoplasia as CDH" (clinical) [Ep 13 · 15:50](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=950) - "Fetal intervention is generally considered a contraindication in twin gestations" (clinical) [Ep 13 · 16:19](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=979) - "EXIT procedures are much trickier with twin gestations" (clinical) [Ep 13 · 16:27](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=987) - "EXIT procedures are reserved for cases with mass effect showing diaphragmatic aversion, inability to visualize the opposite lung easily, and dramatic mediastinal shift" (clinical) [Ep 13 · 18:01](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=1081) - "Most large CPAMs at birth do not need EXIT procedures and can be managed with C-section and immediate resection" (clinical) [Ep 13 · 17:48](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=1068) ## Changelog - Aug 31: 29 doctors auto-found from episode dossiers - Aug 30: 27 doctors auto-found from episode dossiers - Aug 30: 25 doctors auto-found from episode dossiers - Aug 30: Members-only episodes removed from this collection - Aug 29: 26 doctors auto-found from episode dossiers - Aug 29: 28 doctors auto-found from episode dossiers - Aug 29: Collection generated from campaign corpus: 45 items, 31 dossiers, summaries for 4 audience(s) - Aug 29: Collection reviewed and published - Aug 29: Collection generated from campaign corpus: 33 items, 31 dossiers, summaries for 2 audience(s) - Aug 29: Collection generated from campaign corpus: 33 items, 31 dossiers, summaries for 2 audience(s) --- Educational content from recorded physician discussions — not medical advice. 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