Congenital lobar overinflation - antenatal (ultrasound and MRI)

Case contributed by Dr Ammar Haouimi

Presentation

G3P2. at 20 weeks gestation. Routine ultrasound exam.

Patient Data

Age: 35 years
Gender: Female

The ultrasound exam:

  • expanded right upper lobe with markedly increased echogenicity
  • compressed with decreased echogenicity of the right lower lobe and probably the middle lobe
  • leftward shift of the heart and mediastinal structures
  • compressed left lung with reduced volume

No other fetal anomalies were seen.

Annotated images:

  • red arrow: expanded hyperechogenic right upper lobe
  • blue arrow: compressed right lower lobe and probably the middle lobe

 The MRI sequences demonstrate:

  • increased volume with hyperintensity of the affected right upper lobe
  • compressed with decreased intensity of the right lower lobe and probably the middle lobe
  • mass effect with mediastinal shift to the left
  • preserved lung architecture
  • decreased volume with hypointensity of the normal compressed left lung

No other associated fetal malformations were seen.

Normal amount of amniotic fluid.

Placenta corporeal/fundal anterior 9 cm from the internal os.

Annotated images:

  • red arrow: expanded hyperintense right upper lobe
  • blue arrow: compressed hypointense right lower lobe and probably the middle lobe

Case Discussion

Ultrasound and MRI showing:

  • expanded right upper lobe with increased echogenicity/intensity
  • compressed with decreased echogenicity/intensity of the right lower lobe and probably the middle lobe
  • mass effect with a leftward shift of the heart
  • compressed with a reduced volume of the normal left lung.

These findings are suggestive of a congenital lobar overinflation.

On imaging, MRI is relatively superior to ultrasound to differentiate between congenital lobar overinflation from pulmonary sequestration and microcystic adenomatoid malformation 1.

 

Additional contributor: Dr: A. Ounissi, gynecologist, Khenchela, Algeria

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.