Congenital pulmonary malformations: clinical, radiological and treatment features

##plugins.themes.academic_pro.article.main##

Rabiaa Ben Abdallah
Habib Bouthour
Youssef Hellal
Mohamed Riadh Ben Malek
Youssef Gharbi
Nejib Kaabar

Abstract

Background: Congenital broncho-pulmonary malformations (CBM) are rare, essentially presented by congenital lobar emphysema, bronchogenic cysts, pulmonary sequestrations and cystic adenomatoid malformations. The diagnosis can be in prenatal. In postnatal, symptoms are variable. Radiological investigations lead to diagnosis in all cases.
Aim: To study the principal clinic, radiologic and therapeutic of the congenital broncho-pulmonary malformations through ten cases.
Methods: Retrospective study of 10 cases of congenital bronchopulmonary malformations diagnosed between 2003 and 2010 in our institution.
Results: The mean ages at the time of diagnosis is 2months (4 days to 16months). The sex ratio is 1. The symptoms consisted of recurrent pneumonia in 4cases, respiratory distress in 2cases,bronchiolite in 2 cases and 2cases of antenatal diagnosis. All patients have a chest X-ray, night patients have a chest computerized tomography and one patient has a bronchial endoscopy. Ten cases of BPM have been investigated: five congenitals lobar emphysema, tow pulmonary sequestrations, tow cystic adénomatoid malformation and one bronchogenic cyst. Eight patients required surgical treatment involving pneumonectomy (1case), lobectomy (5 cases),segmentectomy (1 case) and in 1 case the pulmonary sequestration was treated by ligature of the anomalous artery with pulmonary resection. The histopathological examination confirmed the diagnosis in all cases. The postoperative period was uneventful in 8 cases with a mean of follow-up of 2 years (5 months to 5years). Tow patient died after surgical treatment.
Conclusion: The diagnosis of BPM malformations can be clinical, confirmed by radiological investigations. The improvement in prenatal ultrasound diagnosis modified the management strategy. The treatment varies frome attitude conservatrice to pneumonectomy.

Keywords:

Broncho-pulmonary malformations -lobectomy-pneumonectomy

##plugins.themes.academic_pro.article.details##

References

  1. C. Stoll, B. Dott, Y. Alembik et al . Malformations congénitales observées dans une série de 131760 naissances consécutives pendant dix ans. Arch Fr Pediatr 1991 ; 48 :549-54.
  2. F Kieffer, A Ferrière, JF Magny, Y Coatantiec, Y Revillon, M Voyer : Malformation kystique adénomatoide du poumon révélée chez un nouveau-né par une image d'un abcès pulmonaire. Arch Pédiatr 1996 ; 3: 470-72.
  3. H. Lahbabi, H.Sadiki, B. Slaoui et al. Kyste bronchogénique du nourrisson relevé par une dyspnée sifflante récidivante. Arch Pédiatr 2010; 7: 87.
  4. N. Aloui-Kasbi, I. Bellagha, A. Hammou et al. Séquestration pulmonaire. Aspects cliniques et radiologiques particuliers. Arch Pédiatr 2004; 11: 394-96.
  5. R. Konan Blé, K. Coste, P. Blanc et al. Une étiologie rare de poumon hyperéchogéne: Arare etiology of hyperechoic lung. Gynécol Obstét Fertil 2008 ;36 :529-31.
  6. O. Olutoye, BG. Coleman, AM. Hubbard. Prenatal diagnosis and management of congenital lobar emphysema. J Pediatr Surg 2000; 35:792- 5.
  7. MZ. Schwartz, P. Ramachandran. Congenital malformation of the lung and mediastinum, a quarter century of experience from a single institution. J Pediatr Surg 1997; 32:44-7.
  8. Bailey PV, Tracy T Jr, Connors RH, deMello D, Lewis JE, Weber TR. Congenital bronchopulmonary malformations. Dignostic and therapeutic considerations. J Thorac Cardiovasc Surg. 1990; 99: 597-603.
  9. Lacy DE, Shaw NJ, Pilling DW, Walkinshaw S. Outcome of congenital lung abnormalities detected antenatally. Acta Paediatr 1999; 88: 454.
  10. K. Bousetta, N. Aloui-Kasbi, Z. Fitouri et al. Malformations pulmonaires congénitales. Apport de l'imagerie. J Pédiatr Puéric 2004; 17: 370-79.
  11. M .Salles, A .Deschildre, C.Bonnel et al. Diagnostic et traitement des malformations broncho-pulmonaires congénitales : analyse de 32 observations. Arch Pédiatr 2005 ;12 : 1703-8.
  12. TS. Kim, KS. Lee, JS. Park et al. Systemic arteral supply to normal basilar segments of the lower lobe: radiographic and CT findings in11patients. J Thorac Imaging 2002; 17: 34-9.
  13. T. Kuga, I. Tnoue, H. Sakano et al. Congenital cyctic adenomatoid malformation of the lung with and oesophageal cyst: report of case. J Peditr Surg 2001; 36:4.
  14. Karnack, ME. Senocak, AO. Ciftic. Congenital lobar emphysema diagnostic and therapeutic considerations. J Pediatr Surg 1999, 1: 131-2.
  15. V. Bunduki, R. Ruano, M. Marqus Da Silvia et al. Prognostic factors associated with congenital cystic adenomatoid malformation of the lung. Prenat Diagn 2000; 20: 459-64.
  16. A. AL Bassam, A .AL Rabeeach, S. AL Nassar et al. Congenital cystic disease of the lung in infants and children (experience with 57cases). EurJ Pediatr Surg 1999; 9: 364- 8.
  17. CT. Albanese, RM. Sydorak, K. Tsao et al. Thoracoscopic lobectomy for prenatally diagnosed lung lesions. J Pediatr Surg 2003;38:553-5.
  18. EH. Kabiri, F. Atoini, A. Zidane et al. Séquestration du segment postérobasal du lobe pulmonaire inférieur droit. Ann Chir 2006 ;131: 547- 49.
  19. C. Granata, C. Gambini, T. Balducci et al. Bronchioloalvealor carcinoma in child with congenital cystic adenomatoid malformation in a child: a case report and review on malignancies originintig in congenital cystic adenomatoid malformation. Pediatr Pulmonol 1998; 25:62-6.