Prenatal hyperechoic lung images, a common aspect for multiple
diagnoses: retrospective monocentric study
Abstract
Objective. Hyperechoic lung images are largely detected prenatally but
their underlying etiology is still poorly defined. The aim of the study
was to determine the concordance between pre and postnatal diagnosis of
prenatal hyperechoic lung images. Design. Retrospective monocentric
study Setting. University Hospital of Necker-Enfants malades from
January 2009 to December 2018 Population. All fetuses with prenatal
hyperechoeic lung images. Methods. Prenatal ultrasound evaluation was
performed by a fetal medicine specialist. Postnatal diagnosis was based
on CT-scan. Pre- and postnatal features were retrieved from medical
charts. Main outcome measures. Accuracy of the prenatal diagnosis in the
identification of the malformations and the prediction of postnatal
symptoms. Results. 75 patients were included. Main prenatal diagnoses
were bronchopulmonary sequestrations (BPS) (n=24-32%), pulmonary cystic
malformations (PCM) (n=19-25%), congenital lobar emphysemas (CLE)
(n=15-20%). Mediastinal shift was observed in 18 cases (24%); in utero
intervention was required in 2. For BPS, the prenatal detection of a
systemic arterial supply had a sensitivity of 96%, a specificity of
83%, a PPV of 77% and an NPV of 98%. For PCM, the prenatal detection
of a cystic component had a sensitivity of 69%, a specificity of 69 %,
a PPV of 67% and a NPV of 71%. All 16 neonates with prenatal isolated
mediastinal shift were asymptomatic at birth. Seven neonates (CLE=5,
BPS=1, BC=1) showed respiratory distress that were not predicted
prenatally. Conclusions. Hyperechoic lung malformations reflect a
heterogeneous group of lesions. Symptoms at birth are present in 9% and
cannot be predicted by prenatal features.