Update Course Rewind: Congenital Lung Lesions 2022
With Dr. Dr. Chuck Snyder · StayCurrentMD
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
The incidence of congenital lung lesions has increased over the past decades because more prenatal screening has been occurring worldwide
Congenital lung lesions can often lead to malignancy or recurrent infections, both of which may require surgical workup and management
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
In the Midwest Pediatric Surgery Consortium series, no prenatally diagnosed lesions were malignant
Roughly 10% of postnatally diagnosed congenital lung lesions were malignant
About half of the malignant lesions were associated with the DICER1 mutation
There was no malignant lesion that had a systemic feeding vessel
CT scan had poor sensitivity and specificity for malignancy
Suspicion for malignancy by a CT scan and bilateral disease were predictive of malignancy
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)
If you have prenatal diagnosis, the chances of being PPB are close to 0
For asymptomatic prenatally diagnosed lesions, the malignancy risk is not zero
Many prenatally suspected lesions turn out to be nothing after birth, either not present or representing a mucus plug that has resolved
CPAM becomes a general bucket for these lesions in the fetal world
As the ability to identify specific lesions gets better with technological advances, management needs to change
Children aged 4-9 years old with recurrent pneumonias from congenital lung lesions present a surgical challenge
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
The primary concern for resection is preventing recurrent pneumonias and bronchiectasis rather than cancer
The range of congenital lung anomalies varies from trivial little cysts to multilobar lesions that would require pneumonectomy
Management must be tailored to the actual pathology of each individual lesion
Reasons to resect congenital lung lesions include infection and risk of malignancy, with malignancy risk being a more minor reason for most surgeons