# Congenital Pulmonary Airway Malformation — GCMD Library living collection Everything in the library about CPAM — built automatically from dossiers that name it. Updated: n/a · 23 episodes · 711 cited statements ## Episodes ### 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) ### Surgical Management - [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) - [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) - [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) - [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) - [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) - [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 - [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) - [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) - [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) - [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) ### Case-Based Learning - [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) - [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) - [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) ### In-Depth Reviews - [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) - [Open Fetal Surgery & EXIT Procedure with Dr. Jose Peiro](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333) — video · 10:23 · [machine version](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333.md) ## Chapters - [0:02](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=2) Case presentation and preoperative imaging (Ep 14) - [0:36](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=36) Patient positioning and control of systemic arterial supply (Ep 14) - [1:59](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=119) Fissure completion and pulmonary artery control (Ep 14) - [5:51](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=351) Completion of fissure and bronchial exposure (Ep 14) - [6:38](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=398) Inferior pulmonary vein dissection and control (Ep 14) - [9:14](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=554) Bronchial division, specimen extraction, and outcome (Ep 14) - [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 21) - [1:46](https://library.globalcastmd.com/watch/update-course-rewind-congenital-lung-lesions-2022-6996?t=106) Prenatal Diagnosis and PPB Risk (Ep 21) - [2:37](https://library.globalcastmd.com/watch/update-course-rewind-congenital-lung-lesions-2022-6996?t=157) Indications for Resection and Timing Considerations (Ep 21) - [0:01](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2242?t=1) Introduction and Technical Context (Ep 16) - [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 16) - [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 16) - [5:46](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2242?t=346) Outcomes (Ep 16) - [0:00](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=0) Introduction and Dr. Rothenberg's Background (Ep 18) - [3:06](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=186) Prenatal Evaluation and Workup of Lung Lesions (Ep 18) - [8:52](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=532) Spectrum of Congenital Lung Lesions (Ep 18) - [11:43](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=703) Postnatal Management and Timing of Imaging (Ep 18) - [17:28](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1048) Timing of Surgery and Rationale for Early Operation (Ep 18) - [21:52](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1312) Preoperative Preparation and Anesthetic Considerations (Ep 18) - [27:59](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1679) Patient Positioning, Port Placement, and Instrumentation (Ep 18) - [34:20](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2060) Vascular Control Technique and Device Selection (Ep 18) - [41:10](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2470) Left Lower Lobectomy: Step-by-Step Technique (Ep 18) - [51:03](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3063) Right Lower Lobectomy (Ep 18) - [51:42](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3102) Left Upper Lobectomy (Including Lingula) (Ep 18) - [55:40](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3340) Right Middle Lobectomy (Ep 18) - [57:02](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3422) Additional Technical Pearls for Lobectomy (Ep 18) - [58:27](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3507) Management of Extralobar Sequestration (Ep 18) - [62:32](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3752) Segmentectomy vs. Lobectomy (Ep 18) - [64:40](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3880) Postoperative Course and Discharge (Ep 18) - [65:50](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3950) Closing Remarks (Ep 18) - [0:09](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=9) Rationale for Fetal Surgery and Prenatal Diagnosis (Ep 23) - [2:11](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=131) Fetal Lung Lesions and CPAM Management (Ep 23) - [5:13](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=313) Sacrococcygeal Teratoma (Ep 23) - [5:45](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=345) Spina Bifida: Pathophysiology and Fetal Repair (Ep 23) - [8:58](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=538) EXIT Procedure (Ep 23) - [0:00](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=0) Malignancy risk in cystic lung lesions: CCAM versus PPB (Ep 4) - [3:44](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=224) Management of extralobar sequestrations (Ep 4) - [6:05](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=365) Limitations of surveillance for pulmonary lesions (Ep 4) - [7:08](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=428) Operative risk versus observation risk (Ep 4) - [11:20](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=680) Natural history debate: infection incidence (Ep 4) ## Statements Every statement is attributed, typed, and timestamped; the link is the citation. - "The malformation was a hybrid congenital pulmonary airway malformation diagnosed prenatally." (clinical) [Ep 14 · 0:02](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=2) - "The patient was asymptomatic at birth and remained asymptomatic through 9 months of age." (clinical) [Ep 14 · 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 a left lower lobe CPAM with systemic blood supply arising from the sub-diaphragmatic aorta." (clinical) [Ep 14 · 0:17](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=17) - "The operation was performed at 9 months of age." (clinical) [Ep 14 · 0:29](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=29) - "The left lung is isolated by right main stem intubation." (clinical) [Ep 14 · 0:36](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=36) - "The patient is placed in the right lateral decubitus position with surgeon and assistant operating facing the patient." (clinical) [Ep 14 · 0:41](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=41) - "A large arterial vessel coming through the diaphragm medial to the inferior pulmonary ligament and entering the left lower lobe confirms a hybrid lesion." (clinical) [Ep 14 · 0:48](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=48) - "The inferior pulmonary ligament is divided all the way to the border of the inferior pulmonary vein to mobilize the left lower lobe off the diaphragm." (clinical) [Ep 14 · 0:59](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=59) - "Division of the inferior pulmonary ligament allows stretching of the systemic arterial vessel for skeletonization with hook cautery." (clinical) [Ep 14 · 1:11](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=71) - "The systemic arterial vessel is double-clipped proximally and divided distally with a ligature device." (clinical) [Ep 14 · 1:20](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=80) - "The approach of proximal clipping and distal ligature division is used repeatedly for control of several major vessels." (clinical) [Ep 14 · 1:46](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=106) - "The fissure is completed using ligature and sharp dissection." (clinical) [Ep 14 · 1:59](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=119) - "Division of pulmonary parenchyma in the fissure allows visualization of pulmonary artery branches to the lower lobe." (clinical) [Ep 14 · 2:24](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=144) - "The dissection should be kept as bloodless as possible, with any bleeding from divided parenchyma controlled early with ligature." (opinion) [Ep 14 · 2:50](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=170) - "Excellent visualization is essential for adequate vascular control." (opinion) [Ep 14 · 3:13](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=193) - "A right angle dissector is extremely useful in skeletonizing vessels and gaining adequate distance for safe ligation." (opinion) [Ep 14 · 3:41](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=221) - "Dissection in the fissure always proceeds from medial to lateral." (clinical) [Ep 14 · 4:09](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=249) - "While ligature can be used as the sole method of vessel control, the surgeon prefers to apply clips proximally if adequate vessel length has been achieved." (opinion) [Ep 14 · 4:54](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=294) - "Once the pulmonary artery and all pulmonary parenchyma in the fissure is divided, the bronchus comes into view." (clinical) [Ep 14 · 6:21](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=381) - "The inferior pulmonary vein is skeletonized using a right angle dissector." (clinical) [Ep 14 · 6:38](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=398) - "The junction of the inferior pulmonary vein and the left atrium can be clearly seen after adequate dissection." (clinical) [Ep 14 · 7:58](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=478) - "It is quite common for the inferior pulmonary vein to consist of two major tributaries that join as they approach the left atrium, in addition to one or more small tributaries." (clinical) [Ep 14 · 8:15](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=495) - "When the inferior pulmonary vein has two major tributaries, it is best to dissect each tributary separately." (opinion) [Ep 14 · 8:31](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=511) - "Each pulmonary vein tributary is controlled by clipping on the cardiac side and applying ligature on the pulmonary side." (clinical) [Ep 14 · 8:36](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=516) - "Hook cautery is used to clean the bronchus of surrounding lymphatic and adventitial tissue." (clinical) [Ep 14 · 9:19](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=559) - "An endo-GIA device is introduced directly through the chest wall and used to staple and divide the bronchus." (clinical) [Ep 14 · 9:26](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=566) - "The specimen is extracted by slightly enlarging the posteriormost port site." (clinical) [Ep 14 · 9:36](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=576) - "A chest tube is placed at the end of the operation." (clinical) [Ep 14 · 9:41](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=581) - "The patient was extubated at the end of the procedure." (clinical) [Ep 14 · 9:46](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=586) - "The patient was discharged on the 2nd postoperative day with excellent recovery." (clinical) [Ep 14 · 9:46](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=586) - "Chest X-ray 2 years after the procedure showed good result." (clinical) [Ep 14 · 9:55](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2227?t=595) - "The incidence of congenital lung lesions has increased over the past decades because more prenatal screening has been occurring worldwide" (epidemiological) [Ep 21 · 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 21 · 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 21 · 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 21 · 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 21 · 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 21 · 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 21 · 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 21 · 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 21 · 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 21 · 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 21 · 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 21 · 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 21 · 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 21 · 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 21 · 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 21 · 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 21 · 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 21 · 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 21 · 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 21 · 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 21 · 4:12](https://library.globalcastmd.com/watch/update-course-rewind-congenital-lung-lesions-2022-6996?t=252) - "Pulmonary upper lobectomies are more technically challenging than lower lobectomies, especially following infection." (clinical) [Ep 16 · 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 16 · 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 16 · 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 16 · 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 16 · 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 16 · 1:51](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2242?t=111) - "Where distance allows, the segmental vessels are clipped proximally prior to division with the ligature." (clinical) [Ep 16 · 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 16 · 2:34](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2242?t=154) - "The inferior pulmonary ligament is divided to allow the lower lobe to rise in the chest." (clinical) [Ep 16 · 3:20](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2242?t=200) - "Left main stem intubation was used to isolate the right lung." (clinical) [Ep 16 · 3:37](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2242?t=217) - "The arteries are much smaller in this younger child and can be taken with a ligature after deliberate dissection." (clinical) [Ep 16 · 4:16](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2242?t=256) - "The superior pulmonary vein is identified in a slightly more superficial plane than the arteries." (clinical) [Ep 16 · 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 16 · 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 postoperatively." (clinical) [Ep 16 · 5:46](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2242?t=346) - "Serial prenatal ultrasounds are the best way to follow cystic lung lesions; they are noninvasive, quick, and performed every couple of weeks." — Steven Rothenberg (clinical) [Ep 18 · 3:48](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=228) - "Fetal MRI for lung lesions provides little additional benefit and does not change the management plan." — Steven Rothenberg (opinion) [Ep 18 · 4:11](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=251) - "Anywhere from 6 to 40% of prenatally detected lung lesions will regress over time, and in some cases appear to completely disappear." — Steven Rothenberg (epidemiological) [Ep 18 · 5:43](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=343) - "Fetal intervention (open surgery) for lung lesions is extremely rare; CHOP performs less than one open fetal surgery every couple of years." — Steven Rothenberg (epidemiological) [Ep 18 · 6:11](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=371) - "Fetal thoracentesis or thoracoamniotic shunt is done only if the fetus shows significant distress or evidence of hydrops, which significantly increases mortality." — Steven Rothenberg (clinical) [Ep 18 · 6:31](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=391) - "Steroids are given if larger cysts cause mediastinal shift, or to mature the lung if early delivery is anticipated." — Steven Rothenberg (clinical) [Ep 18 · 7:13](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=433) - "A cyst volume ratio (CVR) greater than 2 has an extremely bad prognosis and is more likely to require fetal intervention." — Steven Rothenberg (clinical) [Ep 18 · 7:54](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=474) - "Congenital lung lesions (CAMs, sequestrations, bronchogenic cysts) represent a spectrum; hybrid lesions are common on pathology." — Steven Rothenberg (clinical) [Ep 18 · 8:52](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=532) - "Sequestrations are classified by the presence of a systemic artery (usually from the aorta); intralobar sequestrations share pleura with the lobe, extralobar have their own pleural lining." — Steven Rothenberg (clinical) [Ep 18 · 9:37](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=577) - "If a baby is born doing well with no respiratory distress and a normal or mildly abnormal chest X-ray, the family can go home; CT scan is obtained at 4–6 weeks." — Steven Rothenberg (clinical) [Ep 18 · 11:43](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=703) - "A chest X-ray or ultrasound is not adequate to prove a prenatally detected lung lesion has completely resolved; CT scan is required." — Steven Rothenberg (clinical) [Ep 18 · 12:39](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=759) - "Some children with normal postnatal chest X-ray or ultrasound later present with pneumonia (9 months to 6–7 years) and are found to have an infected CPAM." — Steven Rothenberg (clinical) [Ep 18 · 14:44](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=884) - "Depending on the series, 20–40% of untreated congenital lung lesions will develop a significant infection at some point." — Steven Rothenberg (epidemiological) [Ep 18 · 15:47](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=947) - "The incidence of malignancy in untreated congenital lung lesions is over 1% in Rothenberg's series, which he considers significant." — Steven Rothenberg (epidemiological) [Ep 18 · 16:56](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1016) - "Rothenberg prefers to operate by 3 months of age to avoid infection, because surgery is technically easier with smaller vessels and fresh anatomy, and to allow compensatory lung growth." — Steven Rothenberg (opinion) [Ep 18 · 17:49](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1069) - "In Rothenberg's series, hospital stay, chest tube duration, recovery, and operative time were shorter in patients under 5 kg compared to those under 10 kg." — Steven Rothenberg (clinical) [Ep 18 · 19:19](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1159) - "Most infants undergoing early lobectomy are discharged within 48 hours; by one month post-op, chest X-ray shows no evidence of surgery." — Steven Rothenberg (clinical) [Ep 18 · 19:46](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1186) - "Even in asymptomatic children, waiting until around one year of age often reveals significantly enlarged lymph nodes and inflammation in the fissure, suggesting low-grade infection." — Steven Rothenberg (clinical) [Ep 18 · 18:46](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1126) - "The key to success in small infants is proper setup and port placement; with the right approach, there is plenty of room to work." — Steven Rothenberg (clinical) [Ep 18 · 21:13](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1273) - "Blood is typed and crossed for all lobectomies; it is one of the few pediatric cases where this is routine, because bleeding can be significant." — Steven Rothenberg (clinical) [Ep 18 · 22:36](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1356) - "Most asymptomatic children on room air tolerate single-lung ventilation without problem." — Steven Rothenberg (clinical) [Ep 18 · 23:38](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1418) - "Single-lung ventilation is achieved by main-stem intubation of the contralateral bronchus; bronchial blockers are difficult to place and add time, so are avoided." — Steven Rothenberg (clinical) [Ep 18 · 24:06](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1446) - "After lung collapse, infants initially desaturate (low 90s to high 80s) due to shunting; saturations improve once shunting to the collapsed lung stops." — Steven Rothenberg (clinical) [Ep 18 · 26:02](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1562) - "Anesthesiologists should use lower peak ventilatory pressures and increase rate (not pressure) to improve ventilation, avoiding high-pressure bagging that re-inflates the operative lung." — Steven Rothenberg (clinical) [Ep 18 · 26:36](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1596) - "End-tidal CO₂ in the mid-40s is tolerable and does not cause significant acidosis during thoracoscopic lobectomy." — Steven Rothenberg (clinical) [Ep 18 · 27:41](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1661) - "The surgeon and assistant stand at the patient's front (nipple side) in lateral decubitus position; there is more room from the front of the chest to the hilum than from the back." — Steven Rothenberg (clinical) [Ep 18 · 28:59](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1739) - "The camera port is placed over the major fissure in the mid-axillary line (5th or 6th interspace for lower lobe), anterior to the scapula tip, to allow working from front to back without paradoxical instrument angles." — Steven Rothenberg (clinical) [Ep 18 · 30:39](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1839) - "A fourth port is almost never needed; gravity and lung collapse provide adequate retraction in small children." — Steven Rothenberg (clinical) [Ep 18 · 32:28](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1948) - "Rothenberg uses a 4 mm 30° short scope (20 cm) for wider angle view and to allow the assistant to stay close without interference." — Steven Rothenberg (clinical) [Ep 18 · 33:01](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1981) - "Low-profile reusable 3 mm ports are essential in small infants; large-headed 5 mm ports cause instruments to collide in the limited space." — Steven Rothenberg (clinical) [Ep 18 · 33:56](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2036) - "A 3 mm vessel sealer (bipolar technology) can seal vessels up to 5 mm in diameter." — Steven Rothenberg (clinical) [Ep 18 · 35:01](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2101) - "The dual-seal technique: make two separate seals on a vessel 4–5 mm apart, then cut partway between them to confirm hemostasis before full division." — Steven Rothenberg (clinical) [Ep 18 · 35:15](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2115) - "Vascular control is everything in thoracoscopic lobectomy; the dual-seal technique allows recovery if a seal fails, whereas full division without confirmation risks uncontrollable hemorrhage." — Steven Rothenberg (clinical) [Ep 18 · 35:52](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2152) - "Clips can be knocked off vessels; the dual-seal technique with vessel sealing is safer than routine clipping." — Steven Rothenberg (opinion) [Ep 18 · 36:59](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2219) - "Using energy devices that seal and cut simultaneously (e.g., Harmonic) on major vessels is a mistake and sets up the surgeon for unrecoverable bleeding." — Steven Rothenberg (opinion) [Ep 18 · 37:46](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2266) - "Rothenberg had one case using a seal-and-cut device that failed, resulting in bleeding and conversion to open." — Steven Rothenberg (clinical) [Ep 18 · 39:09](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2349) - "If using the LigaSure device, do not activate the cutting function; seal, remove the device, and cut with scissors to allow partial division and confirmation of hemostasis." — Todd Ponsky (host_summary) [Ep 18 · 39:28](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2368) - "The first step in left lower lobectomy is to take down the inferior pulmonary ligament to check for a systemic vessel and to expose the inferior pulmonary vein." — Steven Rothenberg (clinical) [Ep 18 · 42:01](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2521) - "The ease of lobectomy depends on fissure completeness; incomplete fissures require layer-by-layer completion using the vessel sealer, similar to finger fracture in liver surgery." — Steven Rothenberg (clinical) [Ep 18 · 42:54](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2574) - "In a left lower lobectomy, the pulmonary artery trunk bifurcates into four basal segment branches; the superior segmental branch comes off higher and more posteriorly." — Steven Rothenberg (clinical) [Ep 18 · 44:06](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2646) - "The bronchus sits directly underneath the pulmonary artery and can be palpated to aid dissection behind the artery." — Steven Rothenberg (clinical) [Ep 18 · 45:23](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2723) - "If the main arterial trunk has good length, a 5 mm stapler can be used; otherwise, dissect and seal individual basal segmental branches for safer vascular control." — Steven Rothenberg (clinical) [Ep 18 · 45:35](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2735) - "When using a stapler on a major vessel, always have proximal control (clamp) in place before firing, in case the staple line bleeds." — Steven Rothenberg (clinical) [Ep 18 · 46:25](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2785) - "Rothenberg now works 'front to back' through the fissure (like turning pages of a book) rather than flipping the lung, because it is hard to change exposure thoracoscopically." — Steven Rothenberg (clinical) [Ep 18 · 47:35](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2855) - "After dividing the artery, the next step is the bronchus (superior segmental first, then main trunk); the pulmonary vein lies directly behind the bronchus." — Steven Rothenberg (clinical) [Ep 18 · 48:04](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2884) - "In children over 10 kg, a 12 mm stapler is needed for the bronchus; under 10 kg, a 5 mm stapler or clips suffice." — Steven Rothenberg (clinical) [Ep 18 · 49:11](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2951) - "After dividing the bronchus, dissect the inferior pulmonary vein to its first bifurcation, seal the smaller branch for length, then staple the main trunk—never take the vein near the pericardium." — Steven Rothenberg (clinical) [Ep 18 · 49:46](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2986) - "If a vascular device fails near the pericardium, the vessel retracts and the child will bleed to death before you can intervene; always ensure adequate length for proximal control." — Steven Rothenberg (clinical) [Ep 18 · 50:33](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3033) - "Right lower lobectomy is the mirror image of left lower lobe; the key caution is that middle lobe vessels branch off just above the lower lobe artery." — Steven Rothenberg (clinical) [Ep 18 · 51:03](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3063) - "For left upper lobectomy, retract the apex inferiorly to expose the apical/anterior arterial trunk at the apex of the chest; divide its branches first." — Steven Rothenberg (clinical) [Ep 18 · 52:02](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3122) - "After taking the upper lobe arteries, retract the lung posteriorly to expose and divide the superior pulmonary vein and lingular vein." — Steven Rothenberg (clinical) [Ep 18 · 53:23](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3203) - "In left upper lobectomy, the lingula is almost always taken with the upper lobe; on the right, the middle lobe is usually preserved." — Steven Rothenberg (clinical) [Ep 18 · 54:06](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3246) - "Working through the fissure in upper lobectomy, the lingular artery is encountered first, then a large posterior segmental branch, then the upper lobe bronchus." — Steven Rothenberg (clinical) [Ep 18 · 54:30](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3270) - "For right middle lobectomy, complete the minor fissure anteriorly; the pulmonary artery enters posteriorly and bifurcates into upper and lower branches." — Steven Rothenberg (clinical) [Ep 18 · 55:47](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3347) - "If the lung has large cysts limiting visualization, use the vessel sealer to pop the cysts at the start of the case to decompress and improve exposure." — Steven Rothenberg (clinical) [Ep 18 · 57:38](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3458) - "Extralobar sequestrations can have up to 6 systemic vessels; Rothenberg has seen vessels as large as 15 mm in diameter." — Steven Rothenberg (clinical) [Ep 18 · 58:40](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3520) - "For sequestration vessels, use clips or vessel sealer with dual-seal technique; a 5 mm stapler can be used for very large vessels (e.g., 15 mm)." — Steven Rothenberg (clinical) [Ep 18 · 58:58](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3538) - "Never use both clips and energy sealing on the same vessel; energy changes the vessel wall, causing clips to lose purchase and leading to delayed bleeding." — Steven Rothenberg (clinical) [Ep 18 · 59:45](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3585) - "Systemic vessels to sequestrations come off the aorta under higher pressure than pulmonary vessels, so meticulous technique is critical." — Steven Rothenberg (clinical) [Ep 18 · 60:43](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3643) - "Extralobar sequestrations can become infected; Rothenberg removes them all thoracoscopically with no chest tube and next-day discharge, so embolization is not indicated." — Steven Rothenberg (opinion) [Ep 18 · 61:07](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3667) - "Rothenberg historically performed complete lobectomy but now considers segmentectomy (superior segment of lower lobe, lingula) if CT shows disease confined to one segment; approximately 20 cases with no recurrence on follow-up." — Steven Rothenberg (clinical) [Ep 18 · 62:42](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3762) - "A chest tube is left overnight after lobectomy; if no air leak or drainage, it is removed the morning of postoperative day 1, chest X-ray obtained 2 hours later, and patient discharged that afternoon." — Steven Rothenberg (clinical) [Ep 18 · 64:46](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3886) - "Average length of stay for lobectomy is 2.5 days; it is shorter (under 2 days) in infants under 5 kg." — Steven Rothenberg (clinical) [Ep 18 · 65:33](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3933) - "Prenatal ultrasound at mid-gestation around 20 weeks is the most important tool for prenatal diagnosis" — Jose Peiro (clinical) [Ep 23 · 0:47](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=47) - "The rate of detection of malformations is very high in developed countries at 20 weeks gestation" (epidemiological) [Ep 23 · 0:55](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=55) - "Doppler can analyze hemodynamic status by measuring flows in umbilical artery, ductus venosus, and middle cerebral artery" — Jose Peiro (clinical) [Ep 23 · 1:27](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=87) - "Fetal MRI contributes to defining diagnosis after ultrasound, mostly for findings in brain, chest, and abdomen" — Jose Peiro (clinical) [Ep 23 · 1:41](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=101) - "Open fetal surgery requires opening the uterus, which produces a scar and can activate uterine dynamics" (clinical) [Ep 23 · 2:37](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=157) - "Preterm delivery can happen a few days after fetal surgery even if the surgery was successful, despite tocolysis" (clinical) [Ep 23 · 2:45](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=165) - "Open fetal surgery is still used for large solid masses in the chest, sacrococcygeal teratomas, and spina bifida" — Jose Peiro (clinical) [Ep 23 · 3:12](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=192) - "CVR (congenital pulmonary airway malformation volume ratio) is calculated by mass volume (width × height × length × 0.523) divided by head circumference, with cutoff of 1.6" (clinical) [Ep 23 · 4:12](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=252) - "CVR less than 1.6 indicates very low risk of developing hydrops; more than 1.6 indicates high risk" — Jose Peiro (clinical) [Ep 23 · 4:25](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=265) - "Maternal intramuscular betamethasone is first-line therapy for CPAM, given in 1, 2, or 3 rounds weekly to decrease CVR" (clinical) [Ep 23 · 4:36](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=276) - "Steroids rescue more than half of CPAM cases; approximately 40% do not respond well" — Jose Peiro (clinical) [Ep 23 · 4:53](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=293) - "For solid CPAM before 30 weeks that does not respond to steroids, open fetal surgery with lobectomy is the only option" — Jose Peiro (clinical) [Ep 23 · 4:56](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=296) - "In spina bifida, the spinal cord malformation occurs at 4 weeks of embryonic time" — Jose Peiro (clinical) [Ep 23 · 6:04](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=364) - "Neural tissue in spina bifida is exposed to amniotic fluid rich in meconium and enzymes that progressively damage and destroy the spinal cord and nerves" — Jose Peiro (clinical) [Ep 23 · 6:25](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=385) - "At 24 weeks gestation, half of fetuses with spina bifida already have hydrocephalus" (epidemiological) [Ep 23 · 7:20](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=440) - "95% of fetuses with spina bifida will develop hydrocephalus later in pregnancy if they do not have it at 24 weeks" (epidemiological) [Ep 23 · 7:20](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=440) - "The MOMS trial showed prenatal spina bifida surgery reduced the need for shunting by at least half" (clinical) [Ep 23 · 8:17](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=497) - "Prenatal spina bifida repair improved mental scores and motor outcomes" (clinical) [Ep 23 · 8:22](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=502) - "Prenatal spina bifida repair completely reversed hindbrain herniation in most cases" (clinical) [Ep 23 · 8:29](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=509) - "EXIT procedure can maintain oxygenation from mother through placenta for 1 to 3 hours" — Jose Peiro (clinical) [Ep 23 · 9:25](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=565) - "EXIT procedure uses inhalational anesthetics for uterine relaxation" (clinical) [Ep 23 · 9:41](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=581) - "Most experts now believe CCAMs do not become pleuropulmonary blastoma (PPB); rather, PPB is a de novo tumor that is cystic and cannot be differentiated from CCAM on imaging." — Jean Martin (clinical) [Ep 4 · 0:31](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=31) - "There are cases of prenatally diagnosed cystic lung lesions that turned out to be PPB after resection." — Jean Martin (clinical) [Ep 4 · 0:51](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=51) - "A Toronto series estimates that approximately 4% of cystic lesions that appear to be CCAM will actually turn out to be pleuropulmonary blastoma." — Jean Martin (epidemiological) [Ep 4 · 1:24](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=84) - "There is approximately 1% risk of bronchioloalveolar carcinoma arising from CCAM, typically in teenage years or early adulthood." — Jean Martin (epidemiological) [Ep 4 · 1:34](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=94) - "If thoracoscopic resection is performed, the specimen should be placed in a bag before extraction to avoid tumor spillage in case the lesion is PPB, as there is a risk of recurrence." — Jean Martin (clinical) [Ep 4 · 2:11](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=131) - "Non-communicating extralobar sequestrations have a very low infection rate; hematogenous infection is possible but rare, similar to any other body tissue." — Jean Martin (clinical) [Ep 4 · 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 perhaps one or two cases of squamous cell carcinoma described in world literature." — Jean Martin (epidemiological) [Ep 4 · 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 4 · 3:11](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=191) - "The incidence of infection and malignancy in extralobar sequestrations is very low, but has occurred." — Steve (clinical) [Ep 4 · 3:44](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=224) - "Current imaging is not perfect and cannot always definitively diagnose extralobar sequestration or rule out hybrid lesions." — Steve (clinical) [Ep 4 · 3:51](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=231) - "The morbidity of resecting extralobar sequestrations is very low, which favors resection over observation." — Steve (opinion) [Ep 4 · 4:03](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=243) - "There is no role for embolization of extralobar sequestrations; it is much easier to resect them using minimally invasive techniques than to subject an infant or child to embolization." — Steve (opinion) [Ep 4 · 4:49](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=289) - "The differential diagnosis for infradiaphragmatic lesions prenatally includes adrenal hemorrhage and neuroblastoma (including cystic neuroblastoma)." — Alan (clinical) [Ep 4 · 5:18](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=318) - "Small infradiaphragmatic lesions can be followed by ultrasound; if they stay the same size or get smaller, they do not require resection." — Alan (clinical) [Ep 4 · 5:24](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=324) - "Adrenal hemorrhage will evolve over time and become recognizable on imaging." — Alan (clinical) [Ep 4 · 5:37](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=337) - "A Children's Oncology Group (COG) study showed it is safe to observe adrenal masses suspicious for neuroblastoma, though they must be watched." — Jean Martin (clinical) [Ep 4 · 5:52](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=352) - "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 4 · 6:17](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=377) - "CT scan cannot differentiate CCAM from pleuropulmonary blastoma, so surveillance imaging will not allow earlier detection of malignancy until stage 2 or 3 disease occurs." — Alan (clinical) [Ep 4 · 6:32](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=392) - "It is almost universal that families cannot be counseled with the word 'cancer' and then choose to watch the lesion." (opinion) [Ep 4 · 6:56](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=416) - "When deciding whether to operate, the risks of not operating must be weighed against the risks of operating." — Jack (opinion) [Ep 4 · 7:10](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=430) - "There has been very little discussion about the risks of performing lobectomy during the panel." — Jack (opinion) [Ep 4 · 7:23](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=443) - "The risks of pulmonary lobectomy are low, especially in experienced hands, but there are still children who die from pulmonary lobectomy, particularly when done thoracoscopically." — Jack (clinical) [Ep 4 · 7:29](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=449) - "Thoracoscopic lobectomy should not be performed unless the surgeon is experienced; in experienced hands, thoracoscopic lobectomy should have no more morbidity than open lobectomy." — Steve (opinion) [Ep 4 · 8:08](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=488) - "Thoracoscopic lobectomy should only be performed by surgeons with advanced thoracic and minimally invasive skills; in such hands, mortality should be zero." — Steve (opinion) [Ep 4 · 8:26](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=506) - "If you do enough of any operation, you will have significant complications, whether open or thoracoscopic." — Jack (opinion) [Ep 4 · 8:40](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=520) - "If massive bleeding occurs during thoracoscopic lobectomy, the chance of salvaging the situation is probably better if the case is already open rather than thoracoscopic." — Jack (opinion) [Ep 4 · 9:04](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=544) - "Pleuropulmonary blastoma (PPB) can be indistinguishable radiologically from CCAM, but the incidence of CCAM/CPAM is markedly higher than the incidence of PPB; PPBs remain extremely rare." — Jack (epidemiological) [Ep 4 · 9:47](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=587) - "Peter Kim's paper used the Stalker classification in which one histological category has been termed PPB, but the natural history of that histological finding is unknown." — Jack (clinical) [Ep 4 · 10:06](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=606) - "At a high-volume center, de novo PPB is seen extremely rarely, approximately once every 3-4 years, while approximately 20-25 new cases of CCAM are seen annually." — Jack (epidemiological) [Ep 4 · 10:28](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=628) - "The incidence of cancer in CCAM remains extremely low and must be balanced against the risk of the operation." — Jack (opinion) [Ep 4 · 10:44](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=644) - "The estimated lifelong risk of infection for observed CCAM is approximately 20-30%, based on institutional data showing 10% infection rate with a mean follow-up of 4 years, tripled to estimate lifetime risk." — Jack (epidemiological) [Ep 4 · 10:54](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=654) - "The only prospective study that followed asymptomatic CCAM patients long-term was small and showed 18 of 21 asymptomatic patients developed symptomatology during follow-up (average 2 years, up to 13 years)." — Alan (epidemiological) [Ep 4 · 11:29](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=689) - "Before prenatal diagnosis became common, it was not common for patients to present during teenage years or in adult thoracic surgery units with symptomatic infected CCAMs, though it happened from time to time." — Jack (epidemiological) [Ep 4 · 12:40](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=760) - "In the early career of one surgeon in San Francisco, infected CCAMs were not a rare event and were seen on several occasions in the first few years." — Alan (epidemiological) [Ep 4 · 13:22](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=802) - "Small asymptomatic extralobar sequestrations are a relatively known finding at autopsy, but asymptomatic CCAMs are essentially nonexistent in autopsy series." — Jean Martin (epidemiological) [Ep 4 · 15:44](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=944) - "The majority of CCAMs become symptomatic; CCAM is not a normal variant." — Jean Martin (opinion) [Ep 4 · 16:04](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=964) - "At one institution, all prenatally diagnosed lesions are followed with postnatal CT, and those not operated on are followed with chest X-ray and repeat CT." — Jack (clinical) [Ep 4 · 16:26](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=986) - "One surgeon does not advocate non-operative management of all CCAMs; families are counseled about risks including cancer and infection, and many choose resection after hearing these risks." — Jack (opinion) [Ep 4 · 16:40](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=1000) - "A balanced approach should be given to families, allowing them to decide, rather than taking an approach where every single CCAM needs an operation." — Jack (opinion) [Ep 4 · 17:20](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=1040) - "Management decisions for CCAM should be made selectively based on resources, family preferences, patient factors, and location, rather than a dogmatic approach of operating on everyone." (host_summary) [Ep 4 · 17:32](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=1052) - "In a poll, 25% of respondents do not advocate routine resection of asymptomatic CCAMs." — Jack (epidemiological) [Ep 4 · 17:58](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=1078) - "There is a hidden mortality in pediatric surgery because people do not report bad results; the only way to know about them is through lawsuits." (opinion) [Ep 4 · 18:25](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=1105) - "Future participation in the American College of Surgeons NSQIP-Pediatric will provide unbiased, large-scale data on thoracoscopic versus open surgery complications and mortality rates." (opinion) [Ep 4 · 18:48](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=1128) - "Currently there is insufficient data to make fully informed consent regarding CCAM management." (opinion) [Ep 4 · 18:58](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=1138) - "Thoracoscopic lobectomy should not be taken lightly; it requires a major investment in time and learning to become proficient." — Alan (opinion) [Ep 4 · 19:17](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=1157) - "Centers that routinely perform thoracoscopic lobectomy and see high volumes of CCAMs can treat them with extremely low morbidity and no mortality." — Alan (opinion) [Ep 4 · 19:29](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=1169) - "Infants generally do very well after thoracoscopic lobectomy, typically staying in the hospital for two days before going home." — Alan (clinical) [Ep 4 · 19:46](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=1186) - "In a review of the last 100 thoracoscopic lobectomies (not including sequestrations), there were only two transfusions and two prolonged air leaks as complications." — Alan (epidemiological) [Ep 4 · 19:49](https://library.globalcastmd.com/watch/management-of-asymptomatic-lung-lesions-pediatric-thoracic-surgery-part-883?t=1189) - "The malformation was a hybrid congenital pulmonary airway malformation diagnosed prenatally." (clinical) [Ep 15 · 0:02](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=2) - "CT scan at 4 months of age showed a left lower lobe CPAM with systemic blood supply arising from the sub-diaphragmatic aorta." (clinical) [Ep 15 · 0:17](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=17) - "The patient remained asymptomatic and operation was performed at 9 months of age." (clinical) [Ep 15 · 0:29](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=29) - "The left lung is isolated by right main stem intubation." (clinical) [Ep 15 · 0:36](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=36) - "The patient is placed in the right lateral decubitus position with surgeon and assistant operating facing the patient." (clinical) [Ep 15 · 0:41](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=41) - "A large arterial vessel coming through the diaphragm medial to the inferior pulmonary ligament and entering the left lower lobe confirms a hybrid lesion." (clinical) [Ep 15 · 0:48](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=48) - "The inferior pulmonary ligament is divided all the way to the border of the inferior pulmonary vein to mobilize the left lower lobe off the diaphragm." (clinical) [Ep 15 · 0:59](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=59) - "Dividing the inferior pulmonary ligament allows stretching of the systemic arterial vessel for skeletonization with hook cautery." (clinical) [Ep 15 · 1:11](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=71) - "The systemic arterial vessel is double clipped proximally and a ligature device is applied distally to coagulate and divide the vessel." (clinical) [Ep 15 · 1:20](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=80) - "The fissure is completed using ligature and sharp dissection." (clinical) [Ep 15 · 2:10](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=130) - "Division of pulmonary parenchyma in the fissure allows visualization of pulmonary artery branches to the lower lobe." (clinical) [Ep 15 · 2:24](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=144) - "The dissection should be kept as bloodless as possible, with any bleeding from divided parenchyma controlled early with ligature." (opinion) [Ep 15 · 2:50](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=170) - "Excellent visualization is essential for adequate vascular control." (opinion) [Ep 15 · 3:13](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=193) - "A right angle dissector is extremely useful in skeletonizing vessels and allows gaining adequate distance for safe ligation when applied precisely." (opinion) [Ep 15 · 3:41](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=221) - "Dissection in the fissure always proceeds from medial to lateral." (clinical) [Ep 15 · 4:09](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=249) - "While ligature can be used as the sole method of vessel control, clips are preferred proximally if adequate vessel length has been achieved." (opinion) [Ep 15 · 4:54](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=294) - "Once the pulmonary artery and all pulmonary parenchyma in the fissure is divided, the bronchus comes into view." (clinical) [Ep 15 · 6:21](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=381) - "It is quite common for the inferior pulmonary vein to consist of two major tributaries that join as they approach the left atrium." (clinical) [Ep 15 · 8:15](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=495) - "When the inferior pulmonary vein has two major tributaries, it is best to dissect each tributary separately." (opinion) [Ep 15 · 8:31](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=511) - "Pulmonary vein tributaries are controlled by clipping on the cardiac side and applying ligature on the pulmonary side." (clinical) [Ep 15 · 8:36](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=516) - "Hook cautery is used to clean the bronchus of surrounding lymphatic and adventitial tissue." (clinical) [Ep 15 · 9:19](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=559) - "An endo-GIA device is introduced directly through the chest wall and used to staple and divide the bronchus." (clinical) [Ep 15 · 9:26](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=566) - "The specimen is extracted by slightly enlarging the posteriormost port site." (clinical) [Ep 15 · 9:36](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=576) - "The patient was extubated at the end of the procedure and discharged on the 2nd postoperative day with excellent recovery." (clinical) [Ep 15 · 9:46](https://library.globalcastmd.com/watch/thoracoscopic-left-lower-lobectomy-for-congenital-pulmonary-airway-malformation-2243?t=586) - "The study was retrospective and aimed to investigate safety and efficacy of surgery in asymptomatic versus symptomatic CPAM patients" — Cecilia Gigena (clinical) [Ep 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 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 22 · 0:39](https://library.globalcastmd.com/watch/clinical-symptoms-affect-treatment-and-prognosis-in-pediatric-patients-with-congenital-pulmonary-airway-malformation-7843?t=39) - "At 32 weeks gestation, ultrasound is performed to prognosticate whether the fetus will be asymptomatic or symptomatic at birth based on mediastinal shift." (clinical) [Ep 2 · 0:05](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=5) - "If there is no mediastinal shift and a relatively small lesion at 32 weeks, the child is considered likely to be asymptomatic at birth and can deliver close to home with elective resection after CT scan." (clinical) [Ep 2 · 0:18](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=18) - "If mediastinal shift is present at 32 weeks without major cardiac or lung compression, delivery should occur at a surgical center with postnatal resection during the first few days of life." (clinical) [Ep 2 · 0:40](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=40) - "Major mediastinal shift with lung or cardiac compression requires delivery at a tertiary center with EXIT procedure or ECMO availability." (clinical) [Ep 2 · 1:00](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=60) - "All CPAMs, intralobar BPS, and hybrid lesions should be resected routinely." (opinion) [Ep 2 · 1:20](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=80) - "Extralobar BPS in some cases do not need resection and can be observed." (opinion) [Ep 2 · 1:33](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=93) - "CPAMs are prone to infection and routinely have mucoid stasis; many show inflammatory evidence at 2-3 months of age when resected." (clinical) [Ep 2 · 2:05](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=125) - "CPAMs have established malignant potential, with reported cases of pleuropulmonary blastoma, bronchoalveolar carcinoma, and rhabdomyosarcoma." (clinical) [Ep 2 · 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 and is highly malignant and lethal if allowed to progress beyond stage 1." (clinical) [Ep 2 · 2:31](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=151) - "The speaker personally resected three CPAMs that turned out to be stage 1 pleuropulmonary blastomas, which could not be differentiated from relatively small asymptomatic CPAMs." (clinical) [Ep 2 · 2:51](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=171) - "There is anatomical and histological overlap between congenital lung lesion types; they exist on a continuum rather than as discrete categories." (clinical) [Ep 2 · 3:15](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=195) - "A sequestration lesion with small cysts cannot be assumed to lack CPAM histology based on imaging alone." (clinical) [Ep 2 · 3:30](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=210) - "Intralobar BPS can have communications via the pores of Kohn leading to infection risk and potential for high-flow physiology." (clinical) [Ep 2 · 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 for resection can result in significant inflammation within fissures that changes the complexion of the dissection." (clinical) [Ep 2 · 4:15](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=255) - "Earlier resection is surgically easier and less traumatic for the infant than later resection." (opinion) [Ep 2 · 6:36](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=396) - "Thoracoscopic resection has a difficult learning curve but is superior to open thoracotomy with shorter hospital stay, less pain, no thoracotomy morbidity, and better cosmesis." (opinion) [Ep 2 · 7:04](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=424) - "Segmental bronchial stenoses have a very confluent appearance, almost like emphysematous pulmonary parenchyma, and may not require routine resection, though this is controversial." (opinion) [Ep 2 · 7:46](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=466) - "If any cysts are visible in a segmental bronchial stenosis, that usually indicates CPAM histology." (clinical) [Ep 2 · 7:58](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=478) - "Imaging studies are not good enough to definitively differentiate bronchial atresia from CPAM; lesions thought to be bronchial atresia can have CPAM elements and vice versa." (clinical) [Ep 2 · 8:12](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=492) - "CPAMs often have abnormal fissures and globulated appearance related to developmental effects, so normal anatomy cannot be depended upon during lobectomy." (clinical) [Ep 2 · 10:28](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=628) - "Some prenatally large CPAMs regress predominantly by birth but can air-trap and enlarge in the first weeks of life, requiring resection when symptoms develop." (clinical) [Ep 2 · 11:09](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=669) - "Feeding vessels in sequestrations can arise from essentially any systemic source, not just the thoracic or abdominal aorta." (clinical) [Ep 2 · 15:55](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=955) - "Some sequestrations have abnormal pleural investments or pleural caps that must be dissected during resection." (clinical) [Ep 2 · 16:11](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=971) - "The speaker had a pulmonary artery hemorrhage when a ligature seal broke down during lobectomy, leading to conversion to open thoracotomy." (clinical) [Ep 2 · 17:26](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=1046) - "After the hemorrhage experience, the speaker tied every pulmonary artery and ligatured distally until the newer Force Triad energy source became available." (clinical) [Ep 2 · 17:52](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=1072) - "Tying all vessels intracorporeally takes about twice as long as using energy devices but is a safe alternative." (clinical) [Ep 2 · 18:12](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=1092) - "Many sequestrations are edematous due to restricted venous and lymphatic outflow, often with associated pleural effusions." (clinical) [Ep 2 · 19:17](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=1157) - "Edematous extralobar BPS typically have small vascular pedicles and are very easy to resect." (clinical) [Ep 2 · 19:30](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=1170) - "Intralobar sequestrations can drain almost directly into a pulmonary vein, creating a very high-output potential shunt that can lead to cardiac failure by 3-4 years of age." (clinical) [Ep 2 · 20:32](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=1232) - "Feeding vessels in sequestrations are often abnormal, tortuous, and have abnormal integrity similar to PDAs; they can cut through if tied too tightly or clipped too firmly." (clinical) [Ep 2 · 21:14](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=1274) - "When taking the inferior pulmonary ligament during lobectomy, careful inspection is needed because blood flow through small systemic vessels can be phenomenal." (clinical) [Ep 2 · 22:21](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=1341) - "If a systemic feeding vessel is missed and the pulmonary vein is taken first, tremendous congestion of the lobe will occur." (clinical) [Ep 2 · 22:32](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=1352) - "In high-output sequestrations, the pulmonary vein dilates dramatically and can become huge." (clinical) [Ep 2 · 22:56](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=1376) - "Extralobar BPS have separate pleural investment, no bronchial connection, systemic arterial supply from almost any source, and systemic or pulmonary venous drainage." (clinical) [Ep 2 · 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 CPAM histology, usually indicated by a visible cyst on imaging." (clinical) [Ep 2 · 23:31](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=1411) - "Extralobar BPS have mucostasis but no airway communication, so there is no infection risk from that route." (clinical) [Ep 2 · 23:37](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=1417) - "Extralobar BPS can get infected, likely via hematogenous route, and present as pneumonias; infected lesions are much more difficult to resect." (clinical) [Ep 2 · 24:24](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=1464) - "A purely extralobar sequestration that is prenatally diagnosed is a relatively straightforward case and a great place to start when learning thoracoscopic resection." (opinion) [Ep 2 · 24:41](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=1481) - "Extralobar BPS could potentially be done as outpatient procedures with two ports and no chest tube." (opinion) [Ep 2 · 24:59](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=1499) - "The speaker previously thought intralobar and extralobar BPS could be differentiated by pulmonary versus systemic venous drainage, but has encountered extralobar BPS with pulmonary venous drainage." (clinical) [Ep 2 · 28:10](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=1690) - "Some sequestrations are essentially pure AV fistulas—a small piece of lung tissue with large blood vessels going in and out." (clinical) [Ep 2 · 28:31](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=1711) - "Arterialization of vasculature occurs in sequestrations, with even pulmonary veins becoming thickened like arteries due to high flow." (clinical) [Ep 2 · 21:19](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=1279) - "There are often multiple feeding vessels to sequestrations; what looks like one vessel on CT scan may be three or four vessels, or they may branch very early." (clinical) [Ep 2 · 21:57](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=1317) - "When a sequestration is against the esophagus and difficult to separate, an esophageal bronchus should be suspected." (clinical) [Ep 2 · 30:53](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=1853) - "Esophageal bronchi can be small and may be missed if the surgeon is not aware they may be present." (clinical) [Ep 2 · 31:00](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=1860) - "Sequestrations with esophageal bronchi are cesspools full of mucoid material." (clinical) [Ep 2 · 30:38](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-i-pediatric-thoracic-surgery-part-420?t=1838) - "Fetal MRI for congenital cystic lung lesions does not change management in most cases unless the fetus shows signs of hydrops or the center uses prenatal steroids." — Steven Rothenberg (opinion) [Ep 3 · 1:02](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=62) - "Prenatal steroids are indicated for microcystic lesions with CVR (congenital pulmonary airway malformation volume ratio) >1.6, based on UCSF findings that steroids can reduce lesion size or prevent growth relative to fetal growth." — Abdullah (guideline) [Ep 3 · 5:57](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=357) - "Prenatal steroids do not work on macrocystic lesions, only microcystic lesions." — Abdullah (clinical) [Ep 3 · 6:30](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=390) - "Operative time and complication rate are lower when congenital cystic lung lesions are resected earlier (3 months) compared to later (9+ months), supported by published data." — Steven Rothenberg (clinical) [Ep 3 · 10:41](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=641) - "Asymptomatic infants with congenital cystic lung lesions develop subclinical inflammation and infection between 3 and 9 months of age, manifesting as enlarged lymph nodes and fissure inflammation that complicate surgery." — Steven Rothenberg (clinical) [Ep 3 · 10:51](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=651) - "At 3 months of age, thoracoscopic lobectomy in a 5kg infant provides adequate working space with 3mm instruments; space is not a limiting factor." — Steven Rothenberg (clinical) [Ep 3 · 16:01](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=961) - "A 3mm vessel sealer can safely seal and divide vessels up to 5mm in diameter during pediatric thoracoscopic surgery." — Steven Rothenberg (clinical) [Ep 3 · 14:40](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=880) - "Even in asymptomatic infants who have never had a cold or chest infection, significant inflammation can develop in congenital cystic lung lesions by 1 year of age, making surgery more difficult." — Steven Rothenberg (clinical) [Ep 3 · 15:02](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=902) - "30-40% of children with congenital cystic lung disease will have a significant pulmonary infection at some point during their life." — Steven Rothenberg (epidemiological) [Ep 3 · 21:17](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=1277) - "Once congenital cystic lung lesions become infected, they are much more difficult to resect surgically." — Steven Rothenberg (clinical) [Ep 3 · 21:32](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=1292) - "In a personal series of over 300 lobectomies for cystic lung disease, the malignancy rate was 1-2%, including 2 pulmonary blastomas and 1 adenocarcinoma." — Steven Rothenberg (epidemiological) [Ep 3 · 20:36](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=1236) - "All three malignancies (2 blastomas, 1 adenocarcinoma) in the surgeon's series occurred in children under 1 year of age." — Steven Rothenberg (epidemiological) [Ep 3 · 24:27](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=1467) - "Neoplastic mucinogenic 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 3 · 20:50](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=1250) - "Columbia pathology review identified 4 additional cases of CPAM with neoplastic mucinogenic proliferations, a finding not previously reported in the literature." — Steven Rothenberg (clinical) [Ep 3 · 21:02](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=1262) - "Morsellating tumor-containing lung tissue during specimen extraction does not upstage the tumor or change treatment according to hematology-oncology consultation, though patients require surveillance." — Steven Rothenberg (clinical) [Ep 3 · 23:06](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=1386) - "All thoracoscopic lobectomies for congenital cystic lung lesions should be performed thoracoscopically at centers with expertise; if a center cannot perform the procedure thoracoscopically, referral should be considered to avoid thoracotomy morbidity." — Steven Rothenberg (opinion) [Ep 3 · 21:35](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=1295) - "Long-term pulmonary function studies are needed to document that infants who undergo lobectomy compensate with growth of remaining lung tissue and do not have significant disability." — Steven Rothenberg (opinion) [Ep 3 · 21:51](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=1311) - "In Germany, the standard practice is to operate on any cystic lung lesion at 3-6 months of age because of potential malignancy risk later in life." — Benno (guideline) [Ep 3 · 17:46](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=1066) - "The Netherlands takes a more conservative approach to congenital cystic lung lesions compared to Germany." — Benno (guideline) [Ep 3 · 17:40](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=1060) - "CT scan can identify multifocal disease in congenital cystic lung lesions, which may change surgical management (e.g., disease in all three lobes of one lung)." — Todd Ponsky (clinical) [Ep 3 · 9:24](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=564) - "Approximately 3 patients in several hundred cases had bilateral congenital cystic lung disease, requiring altered management." — Steven Rothenberg (epidemiological) [Ep 3 · 9:44](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=584) - "Anatomic segmental resection is key when performing limited resection for congenital cystic lung lesions; non-anatomic resection carries risk of recurrent cystic disease." — Steven Rothenberg (clinical) [Ep 3 · 18:55](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=1135) - "One child who underwent segmental resection for CPAM has shown evidence of recurrent cystic disease on follow-up." — Steven Rothenberg (clinical) [Ep 3 · 19:08](https://library.globalcastmd.com/watch/congenital-cystic-lung-lesions-update-course-2014-643?t=1148) - "6-40% of prenatally diagnosed lung lesions regress with time and may appear to completely disappear" — Steven Rothenberg (epidemiological) [Ep 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 7 · 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 (host_summary) [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 out of Toronto estimates that cystic lesions that look like CCAM, about 4% of them will actually turn out to be PPB." — Jean-Martin (host_summary) [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 bronchioalveolar carcinoma in the teenage years or early adulthood." — Jean-Martin (host_summary) [Ep 1 · 1:43](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=103) - "If you do thoracoscopic resection, put the specimen in a bag before extraction, because if it turns out to be PPB and you mush it up, there is a risk of recurrence." — 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 with no communication and no air on CT scan do not have a high infection rate; hematogenous infection is possible but rare." — 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) - "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) - "Infection and cancer are not good arguments to resect a non-communicating extralobar sequestration." — Jean-Martin (opinion) [Ep 1 · 3:20](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=200) - "The incidence of infection and malignancy in extralobar sequestration is very low, but it has occurred." — Steve (clinical) [Ep 1 · 3:53](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=233) - "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." — 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, they do not require resection." — 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 that it was safe to observe adrenal masses (in the context of neuroblastoma concern)." — Jean-Martin (host_summary) [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." — 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) - "You cannot counsel a family, say the word cancer, and have them watch; that is almost universally unacceptable." — Alan (opinion) [Ep 1 · 7:04](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=424) - "When deciding to operate or not, we must weigh the risks of not doing the operation versus the risks of doing the operation." — Jack (clinical) [Ep 1 · 7:19](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=439) - "There are children who die from pulmonary lobectomy, particularly done thoracoscopically." — Jack (clinical) [Ep 1 · 7:38](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=458) - "Jack knows of two cases of death from thoracoscopic lobectomy that he was asked to review." — Jack (clinical) [Ep 1 · 7:58](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=478) - "Thoracoscopic lobectomy should not be done unless the surgeon is experienced; in experienced hands it should have no more morbidity than open." — Steve (opinion) [Ep 1 · 8:16](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=496) - "The mortality for thoracoscopic lobectomy in experienced hands should be zero." — Steve (opinion) [Ep 1 · 8:41](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=521) - "If you do enough of any operation, you will have significant complications, whether open or thoracoscopic." — Jack (clinical) [Ep 1 · 8:48](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=528) - "If you have massive bleeding when already open, your chance of salvaging the situation is probably better than if you have that bleeding in a thoracoscopic case." — 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 can be indistinguishable radiologically from CCAM, but the incidence of PPB remains extremely rare." — Jack (clinical) [Ep 1 · 9:55](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=595) - "The paper by Peter Kim used the Stalker classification in which one classification has been termed PPB, but the natural history of that histological finding is unknown." — Jack (host_summary) [Ep 1 · 10:14](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=614) - "In a high-volume center (Toronto), de novo PPB is seen extremely rarely, like once every 3 or 4 years, while 20-25 new CCAM cases are seen every year." — Jack (epidemiological) [Ep 1 · 10:36](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=636) - "The estimate of lifelong risk of infection for CCAM is somewhere around 20 or 30%." — 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 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) - "The only prospective study that followed patients long-term showed 18 of 21 asymptomatic patients developed symptomatology during an interval averaging 2 years up to 13 years." — Alan (host_summary) [Ep 1 · 11:38](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=698) - "Jack's data showed 10% infection rate with a mean follow-up of 4 years, which was tripled to estimate 30% lifetime risk." — Jack (epidemiological) [Ep 1 · 12:17](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=737) - "Before prenatal diagnosis, it was not common for people to present in teenage years or adulthood with symptomatic infected CCAMs, though it happened from time to time." — Jack (clinical) [Ep 1 · 12:49](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=769) - "If 25 new prenatally diagnosed asymptomatic CCAM cases are seen per year in Toronto and none were operated on, we should be seeing 25 infected cases per year if the infection rate were 100%." — Jack (clinical) [Ep 1 · 14:03](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=843) - "Autopsy series show that small asymptomatic extralobar sequestration is a relatively known finding, but asymptomatic CCAM on autopsy is nonexistent." — Jean-Martin (host_summary) [Ep 1 · 15:43](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=943) - "The majority of CCAMs do become symptomatic; it is not a normal variant." — Jean-Martin (opinion) [Ep 1 · 16:12](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=972) - "Toronto follows all prenatally diagnosed lesions with CT postnatally, and those not operated on are followed with chest X-ray and another CT." — Jack (clinical) [Ep 1 · 16:35](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=995) - "Jack is not advocating non-operative management of all CCAMs; he counsels families about risks including cancer, and many choose surgery." — Jack (opinion) [Ep 1 · 16:49](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=1009) - "Jack advocates a balanced approach to families, allowing them to decide, rather than operating on every single lesion." — Jack (opinion) [Ep 1 · 17:29](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=1049) - "There is a hidden mortality in pediatric surgery because people do not report bad results; the only way to know is through lawsuits or future unbiased registry data like NSQIP." — Alan (clinical) [Ep 1 · 18:34](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=1114) - "We do not have the data to make truly informed consent, so we must give families the whole picture and let them decide." — Alan (opinion) [Ep 1 · 19:06](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=1146) - "Centers that do thoracoscopic lobectomy routinely and see high volumes of CCAMs can treat them with extremely low morbidity and no mortality." — Alan (opinion) [Ep 1 · 19:26](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=1166) - "In a review of the last 100 thoracoscopic lobectomies (not sequestrations), there were 2 transfusions and 2 latent pneumothoraces as the only 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, but duration depends on symptoms (fever, ongoing symptoms)." — Starla (clinical) [Ep 1 · 20:46](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=1246) - "Large abscesses in CCAM can be drained percutaneously and treated with antibiotics for a couple of weeks, then re-evaluated for residual mass." — 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." — 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 study because children require more anesthesia for MRI than for CT." — Starla (clinical) [Ep 1 · 21:53](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=1313) - "MRI has been tried for follow-up of non-operated patients, but it does not give as clear a picture as CT." — Jack (clinical) [Ep 1 · 22:09](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=1329) - "Bronchial blocker is not needed in infants for single-lung ventilation and is potentially harmful (risk of 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) - "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) - "Prophylactic antibiotics are given as one preoperative dose only; patients are not sent home on antibiotics if waiting a month for surgery." — Steve (clinical) [Ep 1 · 24:52](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=1492) - "Macrocystic lesions can always be reduced thoracoscopically by chipping away at them with a ligature." — 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 CCAM specimens can be removed through a 5 millimeter incision, though hybrid lesions with big arteries are tougher." — 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; you can evaluate thoracoscopically and convert to open if the fissure is obliterated or anatomy is difficult." — Steve (opinion) [Ep 1 · 27:32](https://library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-iii-pediatric-thoracic-surgery-418?t=1652) - "Radiofrequency ablation for vessel occlusion in fetal bronchopulmonary sequestrations 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) - "Coils were used for vessel occlusion with initial success, 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 can travel through the vasculature and cause thrombosis in the systemic circulation, including thrombi in the heart chambers." — Alan (clinical) [Ep 5 · 1:52](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=112) - "The effects of systemic alcohol injection on fetal neural development and other organ development have not been studied experimentally, even in sheep models." — Alan (clinical) [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; energy can disperse unpredictably causing collateral damage." — Alan (clinical) [Ep 5 · 3:00](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=180) - "In a laboratory study, a radiofrequency ablation probe placed in one side of a resected fetal teratoma caused the other side to boil when activated." — Alan (clinical) [Ep 5 · 3:12](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=192) - "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 lung lesions 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 because the numbers are so small." (opinion) [Ep 5 · 4:09](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=249) - "Many lung lesions have been referred after a recommendation for termination by people 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) - "The 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; they regress but remain present and prominent on CT scan a month after birth." — Alan (clinical) [Ep 5 · 6:43](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=403) - "Some lesions that look like CCAMs in utero, such as segmental bronchial stenosis, 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) - "Prenatal lung lesions should be called 'congenital lung lesions' (macrocystic, hyperechoic, or mixed) rather than CCAMs, since CCAM is a pathological diagnosis requiring a specimen." — Jean Martin (clinical) [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 a huge 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) - "Lung agenesis can be misdiagnosed as a microcystic CCAM with mediastinal shift on prenatal imaging." — Alan (clinical) [Ep 5 · 9:33](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=573) - "EXIT procedures are more invasive than regular C-sections for the mother." — Jean Martin (clinical) [Ep 5 · 9:59](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=599) - "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 requires pleural effusion, pericardial effusion, and skin or scalp edema; pure ascites alone is not necessarily hydrops." — Alan (clinical) [Ep 5 · 11:18](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=678) - "Pure ascites can be related to mediastinal shift and hepatic venous return rather than true hydrops." — Alan (clinical) [Ep 5 · 11:27](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=687) - "Pleuro-amniotic shunts are not placed prophylactically; large macrocystic lesions may be tapped just prior to delivery to improve ventilation." — Alan (clinical) [Ep 5 · 11:48](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=708) - "A CVR cutoff of 1.6 is used; if a CCAM presents with CVR less than 1.6, the likelihood of evolving hydrops is about 3-5%." — Alan (clinical) [Ep 5 · 13:33](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=813) - "CVR greater than 1.6 requires close watching with much higher likelihood of evolving into hydrops." — 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 the 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 better for some fetal anomalies and not as good for others; it depends on the specific anomaly." — Alan (clinical) [Ep 5 · 15:55](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=955) - "There is no registry for fetal surgery or EXIT procedures similar to the ECMO registry." — Alan (clinical) [Ep 5 · 16:17](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=977) - "Taking a lobectomy from an infant gives normal pulmonary function when the child is older." — Alan (clinical) [Ep 6 · 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 6 · 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 6 · 9:51](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=591) - "For a superior-segment lower-lobe CPAM, the morbidity of segmentectomy is extremely low." — Steven Rothenberg (opinion) [Ep 6 · 11:24](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=684) - "If you do 100 segmentectomy cases, the likelihood of missing disease is significantly higher than with lobectomy, and the likelihood of complications is higher." — Alan (clinical) [Ep 6 · 11:45](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=705) - "Patients with spontaneous pneumothorax who undergo simple chest-tube placement have an upwards of 50% recurrence rate if they have bleb disease." — Alan (epidemiological) [Ep 6 · 22:56](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=1376) - "There is no study separating patients with blebs versus no blebs on first pneumothorax event to determine differential recurrence risk." — Alan (clinical) [Ep 6 · 23:18](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=1398) - "A recent study from Saint Peter's in Kansas City found CT scan is very poor at defining bleb disease compared to subsequent thoracoscopy." — Alan (host_summary) [Ep 6 · 28:32](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=1712) - "Almost all kids with spontaneous pneumothorax have some degree of bleb disease whether we define it early or not." — Alan (opinion) [Ep 6 · 28:46](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=1726) - "Bleb disease does not necessarily mean recurrence of pneumothorax." — Alan (clinical) [Ep 6 · 29:01](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=1741) - "Treating every kid with blebs on first pneumothorax results in a 50% rate of unnecessary pleurodesis." — Alan (clinical) [Ep 6 · 29:46](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=1786) - "Performing apical pleurectomy limited to the third interspace avoids whole-chest adhesions, unlike talc pleurodesis." — Steven Rothenberg (clinical) [Ep 6 · 36:03](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=2163) - "Hydrostatic pleurectomy involves injecting saline under the pleura to dissect it off the chest wall, allowing removal of a larger area than apical pleurectomy alone." — Alan (clinical) [Ep 6 · 36:20](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=2180) - "Talc pleurodesis causes solid adhesions throughout the pleural space, making future thoracotomy difficult." — Alan (clinical) [Ep 6 · 36:55](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=2215) - "For bilateral bleb disease, performing bilateral surgery prevents contralateral recurrence in the immediate postoperative period." — Giovanna (clinical) [Ep 6 · 33:23](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=2003) - "In hydatid cyst surgery, there is a good plane between the lung and the parasitic membrane, making thoracoscopic removal feasible before adhesions form." — Marcelo (clinical) [Ep 6 · 52:24](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=3144) - "Once the parasitic membrane is removed in hydatid cyst surgery, the patient is cured; subsequent bronchial fistulas are a mechanical closure problem." — Marcelo (clinical) [Ep 6 · 53:13](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=3193) - "Intracavitary thoracoscopic suturing of bronchial fistulas may work for small fistulas but is not appropriate for large fistulas." — Yama (opinion) [Ep 6 · 55:12](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=3312) - "Hem-o-lok clips are more reliable than metal clips for vascular and bronchial control." — Yama (opinion) [Ep 6 · 58:59](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=3539) - "Large-size Hem-o-lok clips (10 mm diameter) can be used for very wide and large bronchi, even in patients over 7 years old undergoing lobectomy." — Marcelo (clinical) [Ep 6 · 59:22](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=3562) - "Persistent air leak has not been a problem in infant lobectomies with incomplete fissures, even without tissue sealant." — Alan (clinical) [Ep 6 · 61:28](https://library.globalcastmd.com/watch/panel-discussion-pediatric-thoracic-surgery-part-1-lung-lesions-2012-921?t=3688) - "Open fetal surgery for CPAM is now rare due to maternal steroid therapy; CHOP and UCSF combined have performed one case in the past 5 years." (clinical) [Ep 8 · 28:44](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1724) - "The CPAM volume ratio (CVR) is calculated by measuring the CPAM in 3 dimensions, applying an ellipse formula, and dividing by head circumference to standardize for gestational age." — Alan Flake (clinical) [Ep 8 · 26:38](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1598) - "CVR >1.6 predicts high risk for CPAM evolving into hydrops, particularly for microcystic lesions." — Alan Flake (clinical) [Ep 8 · 6:11](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=371) - "Maternal steroids are first-line therapy for high-risk CPAM (CVR >1.6); the majority respond, but open fetal surgery is considered if hydrops persists despite steroids at an early gestational age." — Alan Flake (clinical) [Ep 8 · 6:23](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=383) - "CHOP's open fetal surgery for CPAM has approximately 60% survival; thoracoamniotic shunts have 70-75% survival." — Alan Flake (epidemiological) [Ep 8 · 10:34](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=634) - "Bronchial atresia is more difficult to treat by fetal intervention than CPAM; CHOP has had one intraoperative fetal death, one postnatal hepatic necrosis death, and one likely survivor out of three cases." — Alan Flake (clinical) [Ep 8 · 10:49](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=649) - "Sacrococcygeal teratoma fetal intervention targets tumor vascular steal leading to high-output cardiac failure; surgical debulking interrupts the arteriovenous steal." — Alan Flake (clinical) [Ep 8 · 12:18](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=738) - "CHOP's recent SCT algorithm emphasizes preemptive early delivery (≥27 weeks) at the first sign of maternal or fetal decompensation, with improved outcomes in 5 recent cases." — Alan Flake (clinical) [Ep 8 · 16:33](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=993) - "Watchful waiting for SCT between 27-32 weeks can be hazardous; the majority of patients who go into preterm labor or evolve significant high-output failure will die." — Alan Flake (clinical) [Ep 8 · 16:03](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=963) - "The EXIT procedure maintains uteroplacental blood flow using complete uterine relaxation with deep maternal gaseous anesthetic and intrauterine volume maintenance." — Alan Flake (clinical) [Ep 8 · 18:41](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1121) - "The EXIT procedure was initially developed to remove tracheal clips after tracheal occlusion for CDH." — Alan Flake (clinical) [Ep 8 · 18:25](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1105) - "A massive cervical teratoma case required 11.5 hours on placental support during EXIT, with retrograde and antegrade cannulation attempts, ultimately requiring tumor dissection to reach the trachea." — Alan Flake (clinical) [Ep 8 · 20:04](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1204) - "CHAOS (congenital high airway obstruction syndrome) can result in marked diaphragm inversion, ascites, and thoracic abnormalities; the first survivor was delivered by EXIT." — Alan Flake (clinical) [Ep 8 · 21:05](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1265) - "CHAOS has a strong rationale for prenatal treatment due to morbidity associated with treating at birth and the need for patients to grow into their ventilatory mechanics." — Alan Flake (opinion) [Ep 8 · 21:33](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1293) - "Steroids may drive lung development and maturation of microcystic CPAM tissue, though this is unproven." (host_summary) [Ep 8 · 29:41](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1781) - "Preterm labor in hydropic CPAM patients may be secondary to a maternal-fetal immune response, and steroids may ameliorate this response." (opinion) [Ep 8 · 30:24](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1824) - "Echocardiographic assessment of cardiac function is a more specific indicator of fetal heart failure than fluid in body compartments alone." (clinical) [Ep 8 · 31:39](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1899) - "Some fetuses with massive ascites and mild pleural effusion can be observed if cardiac function remains intact, even before steroids became popular." (clinical) [Ep 8 · 31:49](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1909) - "The CVR has been a very good way to counsel families and determine the pace of follow-up; high CVR may warrant follow-up 2-3 times per week." (clinical) [Ep 8 · 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; this is useful for counseling." (clinical) [Ep 8 · 34:11](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=2051) - "Steroids may put the CPAM further along the growth curve in terms of gestational age, which might explain their effect." (opinion) [Ep 8 · 34:30](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=2070) - "In Cincinnati's experience with 56 CPAM cases, prophylactic steroids for CVR >1.6 resulted in literally 100% survival." (epidemiological) [Ep 8 · 36:28](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=2188) - "In Cincinnati's experience, once hydrops was established, steroids resulted in 49% survival and good response." (epidemiological) [Ep 8 · 36:42](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=2202) - "If one course of steroids fails, a second course salvages about 2 out of 6 patients; others go on to fetal surgery." (clinical) [Ep 8 · 36:51](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=2211) - "Steroids are most effective in microcystic (solid) CPAM forms, but are used even in type 1 and type 2 lesions to arrest growth of the solid component, though less efficacious." (clinical) [Ep 8 · 35:52](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=2152) - "Macrocystic CPAM and bronchial atresia do not respond as well to steroids as microcystic CPAM." — Alan Flake (clinical) [Ep 8 · 29:19](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1759) - "Bronchial atresia can be differentiated from microcystic CPAM by the presence of a dilated central bronchus or mucocele and documentation of a contralateral lung to rule out lung agenesis." — Alan Flake (clinical) [Ep 8 · 3:45](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=225) - "Open fetal surgery for CPAM is indicated when hydrops persists despite steroids at an early gestational time point, if the capability exists." — Alan Flake (clinical) [Ep 8 · 6:31](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=391) - "Macrocystic CPAM can be treated by thoracoamniotic shunt rather than open fetal surgery." — Alan Flake (clinical) [Ep 8 · 9:40](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=580) - "RFA (radiofrequency ablation) technology for SCT has not identified a safe ablative technology that avoids collateral injury and bad outcomes; it is not recommended at present." — Alan Flake (clinical) [Ep 8 · 17:33](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1053) - "Future directions in fetal surgery include clinical trials, reduction of maternal and fetal risk, better imaging for physiologic information, and tissue engineering approaches to make open fetal surgery obsolete." — Alan Flake (opinion) [Ep 8 · 23:57](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1437) - "The EXIT procedure requires a multidisciplinary team with specific roles, and may require a second operating room team for definitive postnatal procedures and ECMO capability." — Alan Flake (clinical) [Ep 8 · 19:10](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1150) - "Prophylactic steroid treatment for CVR >1.6 in the absence of hydrops is practiced, though there was equipoise for a randomized study because most centers give steroids in that group." (host_summary) [Ep 8 · 37:17](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=2237) - "The average CVR (congenital pulmonary airway malformation volume ratio) for EXIT procedures with CCAM has been over 2.0, representing large lesions." — Alan (clinical) [Ep 10 · 0:46](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=46) - "EXIT procedures for CCAM are reserved for cases with evidence of compression including diaphragmatic aversion, marked mediastinal shift, and often ascites." — Alan (clinical) [Ep 10 · 0:46](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=46) - "It is very rare to need ECMO in CCAM patients." — Alan (clinical) [Ep 10 · 1:41](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=101) - "Complex CCAM cases requiring EXIT and fetal surgery are referred to specialized centers while simple cases stay at referring institutions, skewing the percentage of interventions at high-volume centers." — Jean-Martin (epidemiological) [Ep 10 · 2:04](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=124) - "There is no clear reduction in the ability to have subsequent pregnancy after fetal surgery, based on approximately four published studies." — Alan (clinical) [Ep 10 · 2:46](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=166) - "After fetal surgery, patients are not allowed to labor in future pregnancies because the hysterotomy is equivalent to a classical cesarean section in the upper part of the uterus." — Alan (guideline) [Ep 10 · 2:59](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=179) - "There has been no observed placenta accreta at the hysterotomy site following fetal surgery thus far." — Alan (clinical) [Ep 10 · 3:12](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=192) - "EXIT procedure requires an anesthetic team experienced with uterine relaxation and maternal issues, and expertise with hysterotomy." — Alan (clinical) [Ep 10 · 4:03](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=243) - "EXIT procedures can be learned and disseminated more widely than fetal surgery programs, with training through observation." — Alan (opinion) [Ep 10 · 4:23](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=263) - "CHOP has performed close to 100 EXIT procedures in the past 10 years for conditions including cervical teratomas and airway obstructive problems." — Alan (epidemiological) [Ep 10 · 4:43](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=283) - "Maternal expertise must be available at the hospital performing EXIT procedures, with protection of the mother being the first priority." (guideline) [Ep 10 · 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 the qualifications and background to perform EXIT procedures correctly." — Alan (epidemiological) [Ep 10 · 5:51](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=351) - "EXIT procedures require weeks of planning and involve 15 to 20 people in the team." (clinical) [Ep 10 · 6:44](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=404) - "A minimum case volume of 3 to 5 EXIT procedures per year is needed to justify establishing a program; one case per year is insufficient." — Alan (opinion) [Ep 10 · 7:15](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=435) - "Most bronchopulmonary sequestrations causing hydrops have associated pleural effusions and mediastinal shift, with hydrops due to mass effect rather than high-output cardiac failure." — Alan (clinical) [Ep 10 · 8:23](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=503) - "Embolization or sclerotherapy procedures for fetal vascular lesions, particularly using alcohol as a sclerosant, carry potential hazards including neurologic effects that have not been adequately studied." — Alan (opinion) [Ep 10 · 9:06](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=546) - "The main technical difference in fetal lobectomy compared to postnatal surgery is the delicacy and gelatinous, friable consistency of tissues, particularly at 20-23 weeks gestation." — Alan (clinical) [Ep 10 · 10:28](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=628) - "Mishaps in fetal surgery have usually been related to traction injuries that tear tissues more easily than in postnatal open surgery." — Alan (clinical) [Ep 10 · 11:04](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=664) - "The fetus is positioned before opening the uterus by converting it to the desired position within the amniotic fluid space." — Alan (clinical) [Ep 10 · 11:48](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=708) - "During fetal thoracotomy, the fetus is stabilized by extracting the ipsilateral arm through the hysterotomy and is buoyed by amniotic fluid infusion, creating a seal at the hysterotomy site." — Alan (clinical) [Ep 10 · 12:09](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=729) - "No successful complete pneumonectomy has been performed in fetal surgery; one attempted case for bronchial atresia resulted in fetal death." — Alan (clinical) [Ep 10 · 12:58](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=778) - "Bilobectomies have been successfully performed in fetal surgery." — Alan (clinical) [Ep 10 · 13:21](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=801) - "Small fragments of lung tissue left after fetal resection can grow dramatically postnatally if airway and vasculature are preserved." — Alan (clinical) [Ep 10 · 13:37](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=817) - "Fetal surgery can still be performed in mothers who have had previous cesarean sections because the uterus heals incisions well." — Alan (clinical) [Ep 10 · 14:07](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=847) - "Most cesarean sections are performed through the lower uterine segment, which does not interfere with the fetal surgery hysterotomy site." — Alan (clinical) [Ep 10 · 14:12](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=852) - "One center has performed close to 100 EXIT procedures in the past 10 years." — Alan (clinical) [Ep 11 · 4:56](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=296) - "EXIT procedures have been used for CCAMs with average CVR over 2, which are large lesions." — Alan (clinical) [Ep 11 · 0:46](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=46) - "EXIT is reserved for cases with evidence of compression: diaphragmatic aversion, marked mediastinal shift, often ascites." — Alan (clinical) [Ep 11 · 0:46](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=46) - "ECMO is very rare in CCAM patients and has not been used during EXIT procedures; conventional ventilation is tried first." — Alan (clinical) [Ep 11 · 1:39](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=99) - "Referral centers receive complex cases while simple cases stay local, skewing the percentage requiring EXIT and fetal surgery." — Jean-Martin (opinion) [Ep 11 · 2:04](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=124) - "There is no clear reduction in ability to have subsequent pregnancy after fetal surgery, based on approximately 4 published studies." — Alan (epidemiological) [Ep 11 · 2:46](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=166) - "After fetal surgery hysterotomy (equivalent to classical cesarean in upper uterus), patients should never labor with future pregnancies." — Alan (guideline) [Ep 11 · 2:59](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=179) - "No long-term maternal morbidity aside from requirement for cesarean delivery has been observed after fetal surgery." — Alan (clinical) [Ep 11 · 3:12](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=192) - "Feared complications like placenta accreta at the hysterotomy site have not been observed thus far." — Alan (clinical) [Ep 11 · 3:22](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=202) - "EXIT procedure requires an anesthetic team tuned into uterine relaxation and maternal issues, and expertise with hysterotomy." — Alan (clinical) [Ep 11 · 4:03](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=243) - "EXIT procedure can be learned and disseminated more widely than fetal surgery without requiring a full fetal surgery program." — Alan (opinion) [Ep 11 · 4:23](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=263) - "EXIT is valuable for cervical teratomas and airway obstructive problems; most large children's hospitals experience cases that would benefit from EXIT from time to time." — Alan (clinical) [Ep 11 · 4:43](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=283) - "Maternal expertise must be available at the hospital; bringing a mother into a freestanding children's hospital without maternal expertise is a bad idea." (opinion) [Ep 11 · 5:13](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=313) - "There are probably 4 or 5 centers in the US that clearly have the qualifications and background to do good EXIT procedures." — Alan (epidemiological) [Ep 11 · 6:04](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=364) - "EXIT procedure involves weeks of planning, discussions of the entire team, and 15 to 20 people in the operating room." (clinical) [Ep 11 · 6:44](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=404) - "If a center does only one EXIT per year, it is probably not enough to justify doing EXIT procedures; 3 to 5 per year is a reasonable threshold." — Alan (opinion) [Ep 11 · 7:15](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=435) - "Very few BPS cases with large feeding vessels have been seen where high-output failure was thought to be the mechanism of hydrops; most have associated pleural effusions, mediastinal shift, or mass effect." — Alan (clinical) [Ep 11 · 8:23](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=503) - "Injecting alcohol into fetal vessels has potential hazard including neurologic effects and has not been adequately studied." — Alan (opinion) [Ep 11 · 9:06](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=546) - "Alcohol injection can cause thrombosis in systemic circulation; one case showed thrombi in heart chambers that then embolized to various sites." — Alan (clinical) [Ep 11 · 16:18](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=978) - "Radiofrequency ablation cannot be controlled in the fetus due to 90% water content; energy can disperse unpredictably causing collateral damage." — Alan (clinical) [Ep 11 · 17:21](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1041) - "In one experiment, radiofrequency probe placed in one side of a teratoma caused the other side to boil when activated." — Alan (clinical) [Ep 11 · 17:38](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1058) - "Probably 95% of CCAMs seen now are prenatally diagnosed." (epidemiological) [Ep 11 · 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 11 · 18:18](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1098) - "The vast majority of congenital lung lesions do not fall in the realm of extreme treatments; only one or two centers in the world should be thinking about these interventions." (opinion) [Ep 11 · 18:35](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1115) - "The majority of children with prenatal lung lesions can be delivered without fetal distress." (clinical) [Ep 11 · 18:51](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1131) - "Many lesions have been referred after a recommendation for termination by people who don't understand the natural history." — Alan (clinical) [Ep 11 · 19:44](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1184) - "Even very large congenital lung lesions can regress and be asymptomatic at birth, or have very good survival rates with appropriate interventions." — Alan (clinical) [Ep 11 · 19:57](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1197) - "The garden variety postnatal CCAM is very different than some prenatal CCAMs." — Alan (clinical) [Ep 11 · 20:10](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1210) - "True cystic CCAMs do not disappear; they regress but remain present and prominent on CT scan one month after birth." — Alan (clinical) [Ep 11 · 20:30](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1230) - "Some things that look like CCAMs in utero (like segmental bronchial stenosis) can give an echogenic microcystic appearance but may be minimally apparent or non-apparent after birth." — Alan (clinical) [Ep 11 · 20:39](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1239) - "Congenital lung lesions should be called macrocystic, hyperechoic, or mixed rather than 'CCAM' prenatally, since CCAM is a pathological diagnosis once the specimen is in the bucket." — Jean-Martin (opinion) [Ep 11 · 22:11](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1331) - "Many tertiary centers have the capacity to do EXIT; it requires a huge team approach and somebody leading the team." — Jean-Martin (opinion) [Ep 11 · 22:40](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1360) - "Good prenatal diagnosis is essential; lung agenesis has been diagnosed as microcystic CCAM elsewhere, leading to potential catastrophic errors." — Alan (clinical) [Ep 11 · 23:45](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1425) - "Pleuro-amniotic shunts are used specifically for macrocystic CCAMs with evidence of hydrops (pleural effusion, pericardial effusion, and skin or scalp edema), not pure ascites alone." — Alan (clinical) [Ep 11 · 25:34](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1534) - "Large macrocystic lesions are sometimes tapped just prior to delivery to improve ventilation, but shunts are not placed prophylactically." — Alan (clinical) [Ep 11 · 26:14](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1574) - "CVR less than 1.6 on presentation predicts about 3% (less than 5%) likelihood of evolving hydrops in microcystic lesions; this has held true in prospective studies and ongoing experience." — Alan (clinical) [Ep 11 · 27:50](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1670) - "CVR greater than 1.6 requires close watching; there is much higher likelihood of evolving into hydrops." — Alan (clinical) [Ep 11 · 28:37](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1717) - "Macrocystic lesions are a wild card because the cystic component can grow very rapidly and can be worrisome even if CVR is less than 1.6." — Alan (clinical) [Ep 11 · 28:44](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1724) - "At one center, all lung lesions get a fetal MRI routinely; MRIs help define anatomy and general size of lesions." — Alan (clinical) [Ep 11 · 29:01](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1741) - "MRIs are not essential for all centers; they can clarify abnormalities if there is ambiguity on ultrasound or confusion about diagnosis." — Alan (opinion) [Ep 11 · 29:33](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1773) - "Prenatal diagnosis has had a tremendous impact on the understanding and management of lung lesions." (opinion) [Ep 9 · 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 9 · 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 4-7 years for microcystic CPAMs when hydrops is threatened." (clinical) [Ep 9 · 1:52](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=112) - "The CCAM volume ratio (CVR) is the volume of an ellipse (three dimensional volume of the CPAM) over the head circumference to standardize for gestational age." (clinical) [Ep 9 · 2:59](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=179) - "CVR has proven to be probably the most valuable prognostic indicator for CPAMs both retrospectively and prospectively." (clinical) [Ep 9 · 3:11](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=191) - "CPAMs typically grow up until about 25 to 28 weeks when they tend to plateau, and then they'll actually regress in size very often." (clinical) [Ep 9 · 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's less than a 3% chance of that lesion progressing to hydrops." (clinical) [Ep 9 · 3:46](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=226) - "CVR of greater than 1.6 has a very high likelihood of developing hydrops, as high as 75%." (clinical) [Ep 9 · 4:10](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=250) - "At the speaker's center, lesions with CVR greater than 1.6 are treated with steroids prophylactically to try to avoid heart failure." (clinical) [Ep 9 · 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 didn't respond to steroids at the speaker's center." (clinical) [Ep 9 · 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 9 · 5:44](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=344) - "If there is an anterior placenta, a posterior uterine incision is required, which necessitates dividing the rectus muscle and doing a bigger abdominal incision." (clinical) [Ep 9 · 7:27](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=447) - "IV access is extremely important in fetal surgery to allow resuscitation, transfusions, and other interventions." (clinical) [Ep 9 · 8:00](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=480) - "Continuous echocardiographic monitoring of the fetal heart by a scrubbed cardiologist is an invaluable component of fetal surgery." (clinical) [Ep 9 · 8:17](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=497) - "When tumors are decompressed out of the chest during fetal surgery, the fetus can become bradycardic due to loss of preload on the heart." (clinical) [Ep 9 · 8:40](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=520) - "Fetuses are usually preloaded via IV before chest decompression to prevent bradycardia." (clinical) [Ep 9 · 8:49](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=529) - "Amniotic fluid is replaced with warm lactated Ringer solution during fetal surgery." (clinical) [Ep 9 · 9:05](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=545) - "A three-layer closure of the uterus is performed after fetal surgery to prevent amniotic fluid leakage and control the membranes." (clinical) [Ep 9 · 9:36](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=576) - "Open fetal surgery is required very rarely for lung lesions." (clinical) [Ep 9 · 9:48](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=588) - "The fetus in the presented case was delivered at 35 weeks without ventilation required and showed good compensatory lung growth at 3.5 weeks post-op." (clinical) [Ep 9 · 9:58](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=598) - "At CHOP, overall survival for open fetal surgery for lung lesions is around 60%, consistent over all years." (epidemiological) [Ep 9 · 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 or other bad quality of life impacts." (clinical) [Ep 9 · 10:30](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=630) - "Losses in open fetal surgery are usually kids that have gone too far with their hydrops and can't tolerate the procedure or have early preterm labor." (clinical) [Ep 9 · 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 9 · 10:58](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=658) - "In the presented macrocystic CPAM case, a thoracoamniotic shunt converted CVR from 3.6 to 0.8 and reversed the associated hydrops." (clinical) [Ep 9 · 11:18](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=678) - "Many CPAMs have a large solid component, and the shunt can't entirely decompress that, but can still reverse the hydrops." (clinical) [Ep 9 · 11:43](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=703) - "The shunt experience has been about 70% survival." (epidemiological) [Ep 9 · 11:53](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=713) - "Losses after shunt placement are usually due to early delivery and associated prematurity, inadequate compensatory lung growth, or sometimes residual mass effect requiring invasive treatment." (clinical) [Ep 9 · 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 when shunts are done at 18 to 20 weeks." (clinical) [Ep 9 · 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 as opposed to the harpoon placement of the shunt." (opinion) [Ep 9 · 12:34](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=754) - "Chest wall deformity from shunt placement becomes less pronounced over time, and thus far affected children haven't required chest reconstructive procedures." (clinical) [Ep 9 · 12:41](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=761) - "CPAMs with multiple macrocysts generally communicate, so placement of a shunt can decompress those lesions dramatically." (clinical) [Ep 9 · 13:09](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=789) - "Ascites alone is not considered hydrops." (clinical) [Ep 9 · 13:28](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=808) - "The EXIT procedure is designed to maintain uteroplacental blood flow during delivery and resection of the mass." (clinical) [Ep 9 · 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 9 · 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." (epidemiological) [Ep 9 · 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 don't have the same effect on lung hypoplasia as CDH." (clinical) [Ep 9 · 15:49](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=949) - "Fetal intervention with twins is generally considered a contraindication." (clinical) [Ep 9 · 16:19](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=979) - "EXIT procedures are much trickier when you have twin gestations." (opinion) [Ep 9 · 16:27](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=987) - "The majority of kids with large CPAMs at birth don't need EXIT procedures and can be managed with C-section and immediate resection." (clinical) [Ep 9 · 17:48](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=1068) - "EXIT procedures are reserved for kids where you see mass effect with diaphragmatic aversion, can't visualize the opposite lung easily, or have dramatic mediastinal shift." (clinical) [Ep 9 · 18:01](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=1081) - "CT scan is the best method to follow pulmonary lesions but induces a certain incidence of malignancy." (clinical) [Ep 12 · 0:12](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=12) - "CPAM cannot be differentiated from pleuropulmonary blastoma (PPB) on imaging until stage 2 or 3 disease occurs." (clinical) [Ep 12 · 0:22](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=22) - "Surveillance cannot prevent malignancy or allow earlier detection than would otherwise occur." (opinion) [Ep 12 · 0:40](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=40) - "Families cannot be counseled to watch a lesion once the word cancer is mentioned." (opinion) [Ep 12 · 0:51](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=51) - "Children have died from pulmonary lobectomy, particularly done thoracoscopically." — Jack (clinical) [Ep 12 · 1:25](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=85) - "Jack (spk_3) has reviewed two cases of mortality from thoracoscopic lobectomy, not at his own institution." — Jack (clinical) [Ep 12 · 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 lobectomy." — Steve (opinion) [Ep 12 · 2:03](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=123) - "Thoracoscopic lobectomy should only be performed by surgeons with advanced thoracic and minimally invasive skills, and mortality should be zero." — Steve (opinion) [Ep 12 · 2:21](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=141) - "If massive bleeding occurs during thoracoscopic lobectomy, the chance of salvage is probably lower than if the case is already open." — Jack (opinion) [Ep 12 · 3:04](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=184) - "Pleuropulmonary blastoma (PPB) can be indistinguishable radiologically from CPAM." — Jack (clinical) [Ep 12 · 3:42](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=222) - "The incidence of CPAM is markedly higher than the incidence of PPB; PPBs remain extremely rare." — Jack (epidemiological) [Ep 12 · 3:55](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=235) - "Peter Kim published a paper on histological evaluation of pulmonary lesions using the Stocker classification, in which one classification has been termed PPB, but the natural history of that histological finding is unknown." — Jack (host_summary) [Ep 12 · 4:01](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=241) - "In a high-volume center, de novo PPB is seen extremely rarely, approximately once every 3 to 4 years, while 20 to 25 new cases of CPAM are seen annually." — Jack (epidemiological) [Ep 12 · 4:23](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=263) - "The incidence of cancer in CPAM is extremely low and must be balanced against the risk of lobectomy." — Jack (opinion) [Ep 12 · 4:39](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=279) - "The estimated lifelong risk of infection for untreated CPAM is approximately 20 to 30%, based on institutional data showing 10% infection at a mean follow-up of 4 years." — Jack (epidemiological) [Ep 12 · 4:50](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=290) - "Most infections in CPAM can be treated, and lobectomy can be performed afterwards rather than prophylactically." — Jack (opinion) [Ep 12 · 5:02](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=302) - "A prospective study (Wong, Pediatric Surgery International) followed 21 asymptomatic patients (8 prenatally diagnosed, rest serendipitous) and found 18 of 21 developed infections or symptoms requiring resection, with mean follow-up of 2 years and range up to 13 years." (host_summary) [Ep 12 · 5:25](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=325) - "Before prenatal diagnosis, it was not common for teenagers or adults to present with symptomatic infected CPAMs, despite the lesions being common prenatally." — Jack (epidemiological) [Ep 12 · 6:36](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=396) - "In early career in San Francisco, infected CPAMs were not a rare event." (clinical) [Ep 12 · 7:20](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=440) - "If 25 new prenatally diagnosed asymptomatic CPAMs are seen per year in the Toronto area and none are operated on, one would expect to see 25 infected cases per year if the infection rate is 100%." — Jack (opinion) [Ep 12 · 7:50](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=470) - "Small asymptomatic extralobar sequestrations are a relatively known finding at autopsy, but asymptomatic CPAMs are nonexistent in autopsy series." — Jean Martin (host_summary) [Ep 12 · 9:30](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=570) - "The majority of CPAMs become symptomatic; CPAM is not a normal variant." — Jean Martin (opinion) [Ep 12 · 10:00](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=600) - "Jack's institution follows all prenatally diagnosed cystic lung lesions with postnatal CT, and those not operated on are followed with chest X-ray and repeat CT." — Jack (clinical) [Ep 12 · 10:21](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=621) - "Jack does not advocate non-operative management of all CPAMs; he counsels families about risks including cancer and infection, and many choose surgery after hearing the risks." — Jack (opinion) [Ep 12 · 10:36](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=636) - "A balanced approach should be given to families, allowing them to decide, rather than a dogmatic approach that every CPAM needs operation." — Jack (opinion) [Ep 12 · 11:15](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=675) - "In an audience poll, 23-25% of respondents do not advocate routine resection of asymptomatic CPAM." — Jack (epidemiological) [Ep 12 · 11:53](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=713) - "There is a hidden mortality in pediatric surgery because people do not report bad results; the only way to know about them is through lawsuits." (opinion) [Ep 12 · 12:20](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=740) - "In 10 years, participation in the American College of Surgeons Pediatric NSQIP will provide unbiased large-scale data on thoracoscopic and open surgery complications and mortality." (opinion) [Ep 12 · 12:43](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=763) - "Currently, there is insufficient data to make fully informed consent regarding CPAM management." (opinion) [Ep 12 · 12:53](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=773) - "Thoracoscopic lobectomy requires a major investment in time and learning to become proficient." (opinion) [Ep 12 · 13:13](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=793) - "Centers that routinely perform thoracoscopic lobectomy and see high volumes of CPAMs can treat them with extremely low morbidity and no mortality." (opinion) [Ep 12 · 13:22](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=802) - "Infants undergoing thoracoscopic lobectomy are generally in the hospital for 2 days." (clinical) [Ep 12 · 13:44](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=824) - "In a review of the last 100 thoracoscopic lobectomies (not sequestrations), there were 2 transfusions and 2 prolonged air leaks as the only complications." (clinical) [Ep 12 · 13:44](https://library.globalcastmd.com/watch/should-we-resect-asymptomatic-cpam-flake-vs-langer-1391?t=824) - "Pulmonary upper lobectomies are more technically challenging than lower lobectomies, especially following infection." (clinical) [Ep 13 · 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 during left upper lobectomy." (clinical) [Ep 13 · 0:39](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2226?t=39) - "The fissure is completed by dividing the pulmonary tissue starting anteriorly and proceeding posteriorly." (clinical) [Ep 13 · 1:04](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2226?t=64) - "Not dividing the superior pulmonary vein initially allows further cephalad retraction of the upper lobe." (clinical) [Ep 13 · 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 13 · 1:51](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2226?t=111) - "Where distance allows, segmental vessels are clipped proximally prior to division with ligature." (clinical) [Ep 13 · 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 when managing the superior pulmonary vein." (clinical) [Ep 13 · 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 stapler." (clinical) [Ep 13 · 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 after upper lobectomy." (clinical) [Ep 13 · 3:20](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2226?t=200) - "Left main-stem intubation was used to isolate the right lung during right upper lobectomy." (clinical) [Ep 13 · 3:37](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2226?t=217) - "Segmental arteries are much smaller in younger children and can be taken with ligature after deliberate dissection." (clinical) [Ep 13 · 4:16](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2226?t=256) - "The superior pulmonary vein is located in a slightly more superficial plane than the arteries." (clinical) [Ep 13 · 4:43](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2226?t=283) - "A recurrent segmental artery to the upper lobe can arise from the main pulmonary trunk and is found in the fissure." (clinical) [Ep 13 · 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 postoperatively." (clinical) [Ep 13 · 5:46](https://library.globalcastmd.com/watch/thoracoscopic-upper-lobectomies-for-symptomatic-congenital-pulmonary-airway-2226?t=346) - "Journal of Pediatric Surgery partners with GlobalCastMD and Stay Current app to share key charts from articles through social media for educational purposes" — Todd Ponsky (host_summary) [Ep 17 · 0:11](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=11) - "In asymptomatic newborns with prenatally diagnosed lung lesions, most US practitioners obtain chest X-ray initially in NICU" — Jason Frischer (host_summary) [Ep 17 · 2:45](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=165) - "CT angiography for congenital lung lesions is typically performed at 3-6 months in clinic rather than in NICU for asymptomatic patients" — Jason Frischer (clinical) [Ep 17 · 4:45](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=285) - "If chest X-ray is negative for prenatally diagnosed lung lesion, some practitioners still obtain CT scan at 3 months while others follow with serial chest X-rays" — Mark Wulkan (clinical) [Ep 17 · 6:52](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=412) - "Neonatologists routinely obtain chest X-rays on newborns with prenatal diagnoses before surgical consultation" — Sean Barnhart (clinical) [Ep 17 · 6:05](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=365) - "Baseline chest X-ray may be useful if patient later presents with respiratory symptoms and consolidation, providing comparison" — Daniel von Allmen (clinical) [Ep 17 · 6:34](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=394) - "Three months is considered the optimal timing for congenital lung lesion resection; operating later results in more inflammation and increased difficulty" — Mark Wulkan (clinical) [Ep 17 · 8:26](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=506) - "For thoracoscopic lobectomy, surgeons should be proficient with all vessel control methods: clips, ties, energy devices, and staplers" — Mark Wulkan (clinical) [Ep 17 · 13:17](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=797) - "Energy devices work well for vessel control in small babies and can be used in bigger children with larger energy devices" — Mark Wulkan (clinical) [Ep 17 · 13:22](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=802) - "Staplers can fail during lobectomy and are not perfect; surgeons must be prepared for this complication" — Mark Wulkan (clinical) [Ep 17 · 14:06](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=846) - "When using energy devices for vessel control, leave enough remnant tissue so the vessel doesn't retract if seal fails, allowing purchase for clip or suture" — Jason Frischer (clinical) [Ep 17 · 17:23](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=1043) - "Obtain proximal control or partially cut across vessel with energy device to detect failure before complete division" — Jason Frischer (clinical) [Ep 17 · 17:47](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=1067) - "When using staplers, visualize the stapler end, use appropriate staple size for tissue, and leave extra tissue around stapler edge for adequate coaptation" — Jason Frischer (clinical) [Ep 17 · 17:56](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=1076) - "Before firing any vessel control device, think through the next two steps if the device fails" — Mark Wulkan (clinical) [Ep 17 · 18:14](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=1094) - "Placing a silk suture on the pulmonary vein before using energy device or stapler provides backup control if primary method fails, preventing patient death from loss of visibility during hemorrhage" — Sean Barnhart (clinical) [Ep 17 · 18:40](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=1120) - "When vessel is dissected too cleanly with all adventitia removed, it may no longer be suitable for stapling" — Sean Barnhart (clinical) [Ep 17 · 19:52](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=1192) - "Until the true malignancy risk of congenital lung lesions is established, debate between observation (Canadian approach) versus resection (US approach) will continue" — Todd Ponsky (host_summary) [Ep 17 · 20:24](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=1224) - "For flat-surface bleeding from vessel stump, suture is most reliable control method; clips and staplers can worsen bleeding" — Todd Ponsky (clinical) [Ep 17 · 21:17](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=1277) - "Surgeons performing thoracoscopic lobectomy must be proficient in intracorporeal suturing and tying before attempting the procedure" — Todd Ponsky (clinical) [Ep 17 · 21:27](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=1287) - "Paraesophageal hernias after fundoplication will inevitably progress and create larger defects even if initially small" — Sean Barnhart (clinical) [Ep 17 · 24:18](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=1458) - "Medical acid suppression therapy will not provide lifelong solution for symptomatic paraesophageal hernia; repair is eventually necessary" — Sean Barnhart (clinical) [Ep 17 · 24:03](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=1443) - "Paraesophageal hernia repair after prior fundoplication requires maximal esophageal mobilization" — Mark Wulkan (clinical) [Ep 17 · 24:38](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=1478) - "If crura come together easily during paraesophageal hernia repair, primary closure without mesh is preferred" — Daniel von Allmen (clinical) [Ep 17 · 25:54](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=1554) - "Biologic mesh is preferred over non-absorbable mesh in pediatric hiatal hernia repair because non-absorbable mesh erodes into esophageal lumen" — Mark Wulkan (clinical) [Ep 17 · 26:52](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=1612) - "Adult data shows mesh reinforcement reduces recurrence risk in paraesophageal hernia repair, justifying low threshold for mesh use" — Sean Barnhart (host_summary) [Ep 17 · 27:19](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=1639) - "Steve Rothenberg makes relaxing incision on diaphragm and places mesh laterally to prevent esophageal erosion" — Todd Ponsky (host_summary) [Ep 17 · 27:51](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=1671) - "Absorbable mesh has not shown erosion problems but adult surgeons question its long-term effectiveness" — Sean Barnhart (host_summary) [Ep 17 · 28:12](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=1692) - "Overlay mesh technique with SIS reduced redo-redo hernia rate in one center's experience" — Sean Barnhart (clinical) [Ep 17 · 28:25](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=1705) - "Since abandoning phrenoesophageal membrane dissection during fundoplication, herniation is less frequent; fundoplication failure is now more common and easier to repair" — Sean Barnhart (clinical) [Ep 17 · 28:38](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=1718) - "Mesh is placed with midline cut and central circle, brought down to sit naturally without crossing anteriorly; posterior crossing depends on posterior crural appearance" — Sean Barnhart (clinical) [Ep 17 · 29:01](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=1741) - "Posterior defect is the usual problem site in paraesophageal hernia; mesh should cover the posterior repair" — Daniel von Allmen (clinical) [Ep 17 · 29:25](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=1765) - "Horseshoe mesh configuration from underneath, wide on good tissue on either side below, addresses the posterior recurrence site" — Mark Wulkan (clinical) [Ep 17 · 29:41](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=1781) - "Severe dysphagia two weeks after paraesophageal hernia repair warrants contrast study as first step" — Miguel Guelfand (clinical) [Ep 17 · 30:22](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=1822) - "Dilation within two weeks of fundoplication risks disrupting the wrap and causing recurrent reflux" — Mark Wulkan (clinical) [Ep 17 · 33:10](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=1990) - "If temporizing with feeding tube for post-fundoplication dysphagia, wait 4-6 weeks for swelling to resolve, as this is when inflammation truly decreases" — Mark Wulkan (clinical) [Ep 17 · 33:00](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=1980) - "Waiting only 3-4 weeks for revision risks operating during maximal inflammation period" — Daniel von Allmen (clinical) [Ep 17 · 33:35](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=2015) - "After Nissen fundoplication, swelling typically resolves and swallowing normalizes around day 18 based on personal experience" — Mark Wulkan (clinical) [Ep 17 · 33:54](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=2034) - "Single posterior crural suture can cause mechanical esophageal obstruction if placed too anteriorly, as esophagus courses anterior-to-posterior crossing diaphragm" — Sean Barnhart (clinical) [Ep 17 · 36:46](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=2206) - "Intraoperative contrast injection after removing suspected obstructing stitch can confirm resolution before replacing fundoplication sutures" — Sean Barnhart (clinical) [Ep 17 · 37:11](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=2231) - "After completing fundoplication and crural repair, pass bougie into thorax then back to stomach to verify no step-off at crural repair" — Miguel Guelfand (clinical) [Ep 17 · 37:57](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=2277) - "Post-fundoplication obstruction can result from four sites: mesh, top stitch, bottom stitch, or fundus itself" — Todd Ponsky (clinical) [Ep 17 · 38:20](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=2300) - "EGD can be used throughout revision case to assess each intervention's effect on obstruction" — Sean Barnhart (clinical) [Ep 17 · 38:45](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=2325) - "If operating soon after initial fundoplication, may be able to release obstructing structure without taking down entire wrap; if a year or more out, likely scarred and requires complete redo" — Mark Wulkan (clinical) [Ep 17 · 39:33](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=2373) - "Bougie size for fundoplication should be based on patient age and weight using published charts; anesthesiologist must pass bougie carefully watching for hang-up at GE junction" — Mark Wulkan (clinical) [Ep 17 · 41:07](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=2467) - "Kansas City group has eliminated posterior crural sutures in fundoplication using minimal dissection technique, creating retroesophageal window but leaving posterior crura alone" — Sean Barnhart (clinical) [Ep 17 · 41:51](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=2511) - "Kansas City group has eliminated collar stitches in fundoplication, now using only 3 stitches all on the fundus" — Sean Barnhart (clinical) [Ep 17 · 43:07](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=2587) - "Patients who cycle between reflux and obstruction after multiple fundoplication revisions may never achieve perfect outcome" — Todd Ponsky (opinion) [Ep 17 · 43:45](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=2625) - "Fundoplication attempts mechanical fix for physiologic problem, making it inherently difficult operation" — Daniel von Allmen (opinion) [Ep 17 · 44:09](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=2649) - "Gastric disconnect is excellent operation in cognitively impaired patients who don't eat much and have refractory reflux or multiple failed fundoplications" — Daniel von Allmen (clinical) [Ep 17 · 45:22](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=2722) - "Gastric disconnect performed as initial operation or after one failed fundo results in smooth recovery; after multiple fundos, recovery is prolonged" — Mark Wulkan (clinical) [Ep 17 · 46:01](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=2761) - "Gastric disconnect can be performed thoracoscopically" — Mark Wulkan (clinical) [Ep 17 · 46:14](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=2774) - "Virginia Commonwealth performs gastric disconnects in cognitively normal patients with acceptable outcomes" — Todd Ponsky (host_summary) [Ep 17 · 44:57](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=2697) - "Newborn with esophageal atresia, dextrocardia, and respiratory instability at birth suggests complex anatomy beyond typical EA/TEF" — Jason Frischer (clinical) [Ep 17 · 46:59](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=2819) - "Echo findings of mesocardia, hypoplastic pulmonary arteries, persistent left SVC, and dilated right ventricle indicate significant cardiac anomalies" — Jason Frischer (clinical) [Ep 17 · 48:23](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=2903) - "Dextrocardia makes thoracoscopic visualization challenging for EA/TEF repair" — Daniel von Allmen (clinical) [Ep 17 · 49:43](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=2983) - "For unstable EA/TEF patient, laparotomy with G-tube and vessel loop around GE junction allows fistula control and ventilation, deferring thoracic repair until patient stabilizes" — Daniel von Allmen (clinical) [Ep 17 · 49:56](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=2996) - "Gastric distention from large TEF causing respiratory compromise requires emergent decompression, but decompression itself can cause hemodynamic collapse" — Todd Ponsky (clinical) [Ep 17 · 52:48](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=3168) - "For EA/TEF patient decompensating from gastric distention, fastest control is open gastrostomy with immediate esophageal control rather than laparoscopic approach" — Todd Ponsky (clinical) [Ep 17 · 52:59](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=3179) - "Vessel loop can be placed around esophagus from abdomen as high as possible, brought out through skin, then removed during subsequent thoracoscopic surgery" — Miguel Guelfand (clinical) [Ep 17 · 53:00](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=3180) - "Bronchoscopy should be performed in all EA/TEF cases to identify additional fistulas" — Daniel von Allmen (clinical) [Ep 17 · 54:34](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=3274) - "Esophageal lung is rare congenital anomaly with approximately 30 reported cases where bronchus arises directly from esophagus rather than trachea" — Jason Frischer (epidemiological) [Ep 17 · 64:12](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=3852) - "In esophageal lung, right lung is aerated through esophageal fistula rather than tracheal connection" — Mark Wulkan (clinical) [Ep 17 · 57:24](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=3444) - "Tracheal reconstruction for esophageal lung can be performed via median sternotomy: divide trachea, repair esophagus posteriorly, reconstruct trachea and fish-mouth abnormal bronchus to create lung connection" — Daniel von Allmen (clinical) [Ep 17 · 58:19](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=3499) - "Tracheal reconstruction for esophageal lung is performed on cardiopulmonary bypass" — Daniel von Allmen (clinical) [Ep 17 · 61:43](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=3703) - "If initial TEF ligation is performed too far from trachea (2cm), significant esophageal length is lost, potentially preventing primary anastomosis" — Daniel von Allmen (clinical) [Ep 17 · 59:03](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=3543) - "Magnet anastomosis can be attempted when esophageal ends are tacked together but gap prevents primary anastomosis" — Daniel von Allmen (clinical) [Ep 17 · 59:24](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=3564) - "Nottingham UK group is collecting series of esophageal lung cases and seeking collaboration with other institutions" — Todd Ponsky (clinical) [Ep 17 · 64:31](https://library.globalcastmd.com/watch/complications-and-beyond-2993?t=3871) - "CPAMs are abnormally developed lung tissue that doesn't participate in gas exchange, coming off normal bronchial airways but lacking normal alveoli." — Pam Choi and Dr. Beth Romesky (clinical) [Ep 19 · 3:47](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=227) - "The Stocker classification for CPAMs ranges from type 0 to type 4, moving from proximal to distal in the bronchial tree, with type 1 (distal bronchi/proximal bronchioles) being most common at 60-70% of cases." — Rod Gerardo and Ellen Ancisco (host_summary) [Ep 19 · 5:12](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=312) - "CPAMs typically grow during the first 20-25 weeks of gestation and plateau around week 28." — Rod Gerardo and Ellen Ancisco (host_summary) [Ep 19 · 6:57](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=417) - "The CPAM volume ratio (CVR) is calculated as the CPAM's length times width times height times 0.52 divided by the head circumference." — Rod Gerardo and Ellen Ancisco (host_summary) [Ep 19 · 8:41](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=521) - "In patients with CVR over 1.6, it is estimated that 75% develop hydrops." — Rod Gerardo and Ellen Ancisco (host_summary) [Ep 19 · 9:14](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=554) - "The presence of hydrops is the strongest prognostic indicator of mortality in fetuses with CPAMs." — Rod Gerardo and Ellen Ancisco (host_summary) [Ep 19 · 8:02](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=482) - "Prenatal steroids (betamethasone 12mg given twice, 24 hours apart) have been shown to resolve hydrops and reduce the size of CPAM lesions such that the CVR can decrease." — Pam Choi and Dr. Beth Romesky (clinical) [Ep 19 · 10:42](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=642) - "CPAMs are differentiated as microcystic (less than 5 millimeters) or macrocystic (larger than 5 millimeters)." — Rod Gerardo and Ellen Ancisco (host_summary) [Ep 19 · 10:14](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=614) - "A thoracoamniotic shunt is placed so that half is inside the fetal chest and half is in the amniotic space, allowing egress of fluid from the fetal chest into the amniotic space for continued decompression throughout pregnancy." — Pam Choi and Dr. Beth Romesky (clinical) [Ep 19 · 13:33](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=813) - "Fetal resection involves partially delivering the fetus, performing a thoracotomy, removing part of the lung, and placing the fetus back in the uterus to continue the pregnancy." — Pam Choi and Dr. Beth Romesky (clinical) [Ep 19 · 15:11](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=911) - "Mirror syndrome means the mother is showing evidence of what the baby has going on, with the mother developing significant edema, pleural effusion, and other symptoms very quickly." — Pam Choi and Dr. Beth Romesky (clinical) [Ep 19 · 16:15](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=975) - "During an EXIT procedure, the baby remains attached to mom through the umbilical cord while a thoracotomy and resection are performed, with the time available depending on how well mom tolerates it and uterine relaxation, typically ranging from a few minutes to rarely longer than an hour." — Pam Choi and Dr. Beth Romesky (clinical) [Ep 19 · 17:05](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1025) - "Air trapping can occur where air enters the CPAM area as the infant breathes in but doesn't come out as easily, causing progressive hyperinflation of the non-functioning lobe and rapid progressive respiratory distress." — Pam Choi and Dr. Beth Romesky (clinical) [Ep 19 · 19:42](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1182) - "CPAMs are not well-visualized on chest X-rays and can regress or get smaller over time." — Rod Gerardo and Ellen Ancisco (host_summary) [Ep 19 · 22:25](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1345) - "In the United States, most surgeons resect CPAMs even if asymptomatic, while in Europe and Canada, surgeons sometimes choose to monitor asymptomatic lesions and avoid surgery." — Rod Gerardo and Ellen Ancisco (host_summary) [Ep 19 · 24:40](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1480) - "The main reasons for operating on asymptomatic CPAMs are: risk of malignancy both at resection and from malignant transformation later, risk of infection that will make surgery more difficult, and better compensatory lung growth if operating sooner in life." — Rod Gerardo and Ellen Ancisco (host_summary) [Ep 19 · 25:29](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1529) - "Thoracoscopic lobectomy risks include bleeding, prolonged post-op mechanical ventilation, infections, air leak, pneumothorax, nerve injury, and mortality." — Rod Gerardo and Ellen Ancisco (host_summary) [Ep 19 · 26:03](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1563) - "The particular malignancy associated with CPAM is pleuropulmonary blastoma (PPB), with risk that the lesion at birth already has malignancy and risk of malignant transformation over a person's life." — Rod Gerardo and Ellen Ancisco (host_summary) [Ep 19 · 27:47](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1667) - "Features suggesting higher risk of PPB include: lesion in more than one lobe, in more than one lung, associated pneumothorax, and DICER1 genetic mutation." — Jack Langer (clinical) [Ep 19 · 28:25](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1705) - "Features suggesting very low risk of PPB are a feeding vessel and prenatal diagnosis." — Jack Langer (clinical) [Ep 19 · 28:59](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1739) - "A recent study published in April 2021 found that no prenatally diagnosed lesions had malignancy, but 10% of patients diagnosed postnatally had malignancy in their resected mass." — Rod Gerardo and Ellen Ancisco (host_summary) [Ep 19 · 30:17](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1817) - "Dr. Langer follows observed CPAM patients with regular chest X-rays for the first 2 years, expecting to see changes on serial X-rays if a PPB is developing from type 1 to type 2, then follows clinically after that." — Jack Langer (clinical) [Ep 19 · 30:56](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1856) - "If a CPAM becomes infected, it should be treated with IV antibiotics, allowed to settle down, then removed, as infected CPAMs make surgery more difficult with more blood loss and complications." — Jack Langer (clinical) [Ep 19 · 31:51](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1911) - "Single lung ventilation for thoracoscopic lobectomy is obtained by mainstem intubation of the contralateral bronchus, preventing the lung from overinflating during dissection of key vessels or structures." — Steven Rothenberg (clinical) [Ep 19 · 36:43](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=2203) - "For thoracoscopic lobectomy, the scope port should be placed over the major fissure in the mid-axillary line, anterior to the tip of the scapula, to allow working from front to back and avoid working in paradox." — Steven Rothenberg (clinical) [Ep 19 · 39:02](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=2342) - "When completing an incomplete fissure during lobectomy, work through it layer at a time like finger fracturing during liver lobectomy, starting at the front and working posteriorly until exposing the pulmonary artery." — Steven Rothenberg (clinical) [Ep 19 · 41:39](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=2499) - "Vascular control in thoracoscopic lobectomy is everything; dissect out vessels to get enough length to make a seal proximally and distally, then cut partway between seals to check for bleeding before completing division." — Steven Rothenberg (clinical) [Ep 19 · 43:09](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=2589) - "The bronchus sits right underneath the pulmonary artery and can be felt to help dissect behind the artery during lobectomy." — Steven Rothenberg (clinical) [Ep 19 · 44:13](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=2653) - "When dissecting behind the bronchus during lobectomy, stay hard on the backside of the bronchus and be aware that the pulmonary vein is right behind it." — Steven Rothenberg (clinical) [Ep 19 · 46:57](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=2817) - "Do not take the pulmonary vein trunk near the pericardium during lobectomy, because if the device fails, the vessel will retract into the pericardium and the child will bleed to death before you can do anything; ensure enough length away from pericardium for proximal control." — Steven Rothenberg (clinical) [Ep 19 · 48:44](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=2924) - "The incidence of CPAMs is estimated to be about 1 in every 8,000 to 35,000 births." — Rod Gerardo and Ellen Ancisco (host_summary) [Ep 19 · 52:39](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=3159) - "60% of prenatally diagnosed lung lesions are CPAMs, making them the most common prenatal lung lesion." — Rod Gerardo and Ellen Ancisco (host_summary) [Ep 19 · 52:53](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=3173) - "Most children with prenatally diagnosed CPAM are born asymptomatic" (clinical) [Ep 20 · 1:44](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=104) - "A 2017 prospective study in Archives of Disease in Childhood followed 119 prenatally diagnosed congenital cystic lung lesions for a median of 10 years" — Rod Gerardo (host_summary) [Ep 20 · 2:00](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=120) - "57% (68 patients) of the 119 cases were managed conservatively, and none of those who could be followed up became symptomatic" — Ellen Encisco (host_summary) [Ep 20 · 2:38](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=158) - "Respiratory compromise at birth in CPAM is very unusual; the speaker has not seen it in 20 years" (clinical) [Ep 20 · 2:49](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=169) - "The 2017 study is the only completely prospective study on CPAM natural history and the only one dealing with long-term follow-up" — Jose Campos (clinical) [Ep 20 · 3:13](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=193) - "Retrospective studies show a huge range of 3-85% for risk of becoming symptomatic, but systematic reviews narrow this to 3.2% in one review and 25% in another" — Jose Campos (host_summary) [Ep 20 · 3:32](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=212) - "A 2021 Pediatrics study by the Midwest Pediatric Surgery Consortium retrospectively examined histology of 521 lung lesions resected across 11 children's hospitals" — Rod Gerardo (host_summary) [Ep 20 · 4:04](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=244) - "Out of 344 prenatally diagnosed lesions, none had malignant pathology when resected" — Ellen Encisco (host_summary) [Ep 20 · 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" — Rod Gerardo (host_summary) [Ep 20 · 4:47](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=287) - "The risk of malignancy approached 10% for lung masses diagnosed postnatally" — Ellen Encisco (host_summary) [Ep 20 · 5:03](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=303) - "For prenatally diagnosed asymptomatic CPAM, Dr. Campos would find it very difficult to recommend operation; for postnatally diagnosed lesions, very difficult not to operate" — Jose Campos (opinion) [Ep 20 · 5:21](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=321) - "Prenatal CPAM (0% malignancy) and postnatal CPAM (10% malignancy) represent two different populations or diseases" (clinical) [Ep 20 · 5:37](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=337) - "The International Pleuropulmonary Blastoma Registry has 350 cases reported worldwide and has found only 9 cases of prenatally diagnosed lesions that turned out to be pleuropulmonary blastoma" — Jose Campos (host_summary) [Ep 20 · 5:49](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=349) - "Common practice in Chile is to resect prenatally diagnosed CPAMs, but after reviewing the literature, the academic discussion at Dr. Campos's hospital now leans toward not operating" — Jose Campos (clinical) [Ep 20 · 6:16](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=376) - "A 2021 Journal of Pediatric Surgery study examined whether previous infection matters for thoracoscopic surgery outcomes in congenital lung malformations" — Rod Gerardo (host_summary) [Ep 20 · 6:53](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=413) - "The study was retrospective and looked at about 90 patients undergoing thoracoscopic lung resections" — Ellen Encisco (host_summary) [Ep 20 · 7:08](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=428) - "Patients without prior pulmonary infection had shorter operative time, fewer postoperative fevers, less need for postoperative antibiotics, but no significant difference in postoperative complications or conversion rates" — Rod Gerardo (host_summary) [Ep 20 · 7:18](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=438) - "After infection, there is a higher rate of conversion from thoracoscopy to open surgery" — Jose Campos (host_summary) [Ep 20 · 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 in all cases" — Jose Campos (opinion) [Ep 20 · 8:25](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=505) - "If you only operate on lesions that get infected, you will miss those that develop pleuropulmonary blastoma without a pre-existing infection" (clinical) [Ep 20 · 8:38](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=518) - "Screening everyone and removing every lung lesion results in many unnecessary lobectomies in a group with very low rate of problems" (opinion) [Ep 20 · 8:44](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=524) - "A 2018 Journal of Pediatric Surgery study examined optimal timing for elective resection of asymptomatic CPAM, dividing patients under 1 year into three groups: 1-3 months, 4-6 months, and 6-12 months" — Rod Gerardo (host_summary) [Ep 20 · 9:12](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=552) - "Operative time increased with each increase in age; at younger ages the tissue planes are easier to dissect" — Rod Gerardo (host_summary) [Ep 20 · 9:39](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=579) - "The 1-3 month group had the shortest operative time at 115 minutes compared to 163 minutes in the 6-12 month group" — Rod Gerardo (host_summary) [Ep 20 · 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 the three age groups" — Ellen Encisco (host_summary) [Ep 20 · 10:07](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=607) - "The 1-3 month group had a 40% thoracotomy rate, suggesting the outcome depends on surgeon expertise in performing safe thoracoscopy" — Jose Campos (clinical) [Ep 20 · 10:25](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=625) - "Kansas City showed that complication rate of operating on perforated appendix with abscess is the same as interval appendectomy, analogous to the CPAM timing question" (host_summary) [Ep 20 · 10:42](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=642) - "Even if complication rates are the same, surgeons generally prefer to do cases that are easier and less stressful" (opinion) [Ep 20 · 10:54](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=654) - "Elective preventive resection should be easy and have nearly zero complications; prophylactic operations should be close to zero complications" — Jose Campos (opinion) [Ep 20 · 11:06](https://library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=666) ## Changelog - Sep 9: 1 item added automatically - Sep 7: 18 items added automatically - Sep 7: 2 items added automatically - Sep 7: 7 items no longer name CPAM - Sep 7: Audit reverted — short clips unhidden - Sep 7: 9 items added automatically --- Educational content from recorded physician discussions — not medical advice. Cite the canonical URL or the ?t= deep link. Policy: https://library.globalcastmd.com/ai