We are back with another Update Course Rewind video! This time we are presenting you "Congenital Lung Lesions" with Dr. Charles Snyder from APSA Professional Development Committee.
Host: Brittany Levy
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Type: video · 4 min · posted 2023-08-17 Canonical: https://library.globalcastmd.com/watch/update-course-rewind-congenital-lung-lesions-2022-6996 ## Chapters - [0:15](https://library.globalcastmd.com/watch/update-course-rewind-congenital-lung-lesions-2022-6996?t=15) Malignancy Risk Factors in Congenital Lung Lesions - [1:46](https://library.globalcastmd.com/watch/update-course-rewind-congenital-lung-lesions-2022-6996?t=106) Prenatal Diagnosis and PPB Risk - [2:37](https://library.globalcastmd.com/watch/update-course-rewind-congenital-lung-lesions-2022-6996?t=157) Indications for Resection and Timing Considerations ## Statements - "The incidence of congenital lung lesions has increased over the past decades because more prenatal screening has been occurring worldwide" (epidemiological) [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) [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) [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) [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) [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) [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) [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) [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) [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) [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) [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) [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) [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) [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) [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) [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) [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) [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) [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) [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) [4:12](https://library.globalcastmd.com/watch/update-course-rewind-congenital-lung-lesions-2022-6996?t=252) ## Transcript The incidence of congenital lung lesions has increased over the past decades because more prenatal screening has been occurring, really worldwide. These lesions can often lead to malignancy or recurrent infections, both of which may require surgical workup and management. In today's update course rewind, we welcome Doctor Chuck Snyder to discuss the best practices for the workup and, Management of children with congenital lung lesions. A 6 month old boy had a chest X-ray due to chronic cough and right lower lobe cystic lung mass was seen. Subsequent chest CT scan demonstrated a macrocystic 4 centimeter lesion in the right lower lobe with a question of a feeding vessel. Mother had serial prenatal ultrasounds for. Central position and no lesion was ever seen, which factor is most concerning for possible malignancy in this child? In 2021, the Midwest Pediatric Surgery Consortium reviewed 521 primary lung lesions from 11 children's hospitals, and they aimed to identify specific risk factors associated with malignancy. In that series, no prenatally diagnosed lesions were malignant. Roughly 10% of them that were diagnosed postnatally were malignant, and then about half of the malignant lesions were associated with the DE 1 mutation. There was no malignant lesion that had a systemic feeding vessel. Overall, CT scan had poured sensitivity and specificity for malignancy. However, suspicion for malignancy by a CT scan and bilateral disease were predictive. We looked at the same module. Actually, this series has like I think 400 cystic lesions and there was not a single patient who had antenatal diagnosis who was found to have a PPB. If you have prenatal diagnosis, the chances of being PPB it's close to 0. I'm saying that as a prenatal diagnosis is before you know if they're symptomatic or not. I take them all out. Some would argue that look, if you diagnose this prenatally. And they don't ever get symptoms, you don't have to take these out. I think that's the argument because the numbers are so low. Maybe it could be near 0, but it's not 0. That's the thing. Asymptomatic or one is not symptomatic, it's not zero. So at the end of the day, at some point you have a patient with a malignant tumor undiagnosed that you're keeping the thing inside forever. Ultrasound technology is so good and then these moms then get a fetal MRI and then they get all these consultations and then we see them and they get a CT scan after birth and a lot. A lot of these turn out to be nothing. Either it's not there, it's some sort of mucus plug that's gone away. CPAm becomes a general bucket for these lesions in the fetal world. And as the ability to identify specific lesions gets better with technological advances, our management needs to change too. 4, 56789 years old that have had recurrent pneumonias, and it's, all of us have probably been there. It is a mess. And the chances of them having a successful thoracoscopic resection are much lower in that age group than they are in the perinatal period or in that first year of life. So I think my reason for taking them out is to prevent that. When I counsel parents, I say it's not the cancer. I worry about these recurrent pneumonias and real problems with bronchiectasis. I agree with that. Just one last thing, but remembering that the range of anomalies, sometimes these are trivial little cysts. And probably don't make much difference one way or the other. Other times they are actually multilobar, and what it's gonna mean if you're gonna take them out is that you're gonna do a pneumonectomy, and that doesn't seem sensible either. So, I think as pediatric surgeons, we're all, we've got to tailor ours to what that actual pathology is. I think it's opening our eyes that we don't know it yet. Every year we're learning a little more. We're tailoring. I think that's the best phrase. This probably doesn't solidify any new practice plan for anyone, but I think it's, we're getting more information with each year, so. It was a good discussion. So basically, reasons to resect the lesion include infection and risk of malignancy, and really malignancy risk might be a more minor reason for most people. Thanks for joining Doctor Snyder along with the rest of the ABSA Professional Development Committee for this update course rewind. Remember to check out the Stay Current app for more content related to pediatric surgery and more. --- Not medical advice · citation policy: https://library.globalcastmd.com/ai