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Fetal lung lesion

Case contributed by Maulik S Patel
Diagnosis certain

Presentation

An asymptomatic 2nd gradiva with 21 weeks of amenorrhea presented for an anomaly scan. The first child is normal.

Patient Data

Age: 25 years
Gender: Female
ultrasound

There is a single live intrauterine fetus with growth corresponding to the period of amenorrhea. There is a mixed solid-cystic lesion replacing most of the left lung of the fetus causing the mediastinal shift to the right side. Solid areas of the lesion show hyperechogenicity in comparison to the contralateral right lung. There are multiple anechoic cysts in the lesion measuring up to 4 mm. Thoracic aorta supplies feeding artery to the lesion. 

Rest of anatomical survey of the fetus is normal. There is no polyhydramnios/ hydrops fetalis.

Case Discussion

2nd gravida female presented for anomaly scan which shows a single live fetus with growth corresponding to the period of amenorrhea. There is a left lung lesion in the fetus, with solid echogenic areas along with the presence of multiple anechoic cysts. There is a systemic arterial supply to the lesion from the thoracic aorta.

Differentials for a fetal echogenic lung lesion include pulmonary sequestration, congenital pulmonary airway malformation, lobar emphysema, bronchial atresia. Among these; sequestration has systemic arterial supply. Other lesions are supplied by the pulmonary artery.

The lesion, in this case, shows greyscale features more like congenital cystic airway malformations (CPAM). On the Doppler study, systemic arterial supply favors pulmonary sequestration. It can also be a hybrid lesion.

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