The Use of Fetal Bronchoscopy in the Diagnosis and Management of a Suspected Obstructive Lung Mass

Andrew H. Chon; James E. Stein; Tammy Gerstenfeld; Larry Wang; Walter D. Vazquez; Ramen H. Chmait

doi:10.1055/s-0038-1673378

American Journal of Perinatology Reports, Table of Contents

CC BY-NC-ND 4.0 · AJP Rep 2018; 08(03): e195-e200
DOI: 10.1055/s-0038-1673378

Case Report

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Use of Fetal Bronchoscopy in the Diagnosis and Management of a Suspected Obstructive Lung Mass

Authors

Andrew H. Chon

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
James E. Stein

²Department of Pediatric Surgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
Tammy Gerstenfeld

³Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Kaiser Permanente San Diego, San Diego, California
Larry Wang

⁴Department of Pathology and Laboratory Medicine, Keck School of Medicine, University of Southern California, Children's Hospital Los Angeles, Los Angeles, California
Walter D. Vazquez

⁵Department of General Surgery, Kaiser Permanente San Diego, San Diego, California
Ramen H. Chmait

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California

Abstract

Etiologies of fetal lung anomalies include congenital pulmonary airway malformation (CPAM), intra- or extralobar pulmonary sequestration, congenital high airway obstruction syndrome (CHAOS), bronchogenic cyst, and bronchial atresia. Fetal tracheobronchoscopy has been reported both as a diagnostic and therapeutic procedure in the setting of severe congenital lung lesions. In this case report, prenatal imaging of a fetus with a large chest mass was suspicious for an obstructive bronchial lesion. The absence of visible normal lung tissue on the right side and mass effect on the left side raised the concern for pulmonary hypoplasia. After antenatal betamethasone and a period observation, hydropic changes developed. Fetal tracheobronchoscopy was then performed in an effort to identify and decompress the suspected obstructive bronchial lesion. Other than release of bronchial debris, no anatomical abnormalities were visualized. However, the right lung lesion and mediastinal shift both decreased after the fetal bronchoscopy. The newborn underwent postnatal resection of a CPAM Type II and is doing well. We hypothesize that fetal tracheobronchoscopy provided the following potential diagnostic and therapeutic benefits: (1) exclusion of an obstructive bronchial lesion; (2) disimpaction of bronchial debris from the saline lavage that we posit may have contributed to the rapid reduction in CPAM size.

Keywords

CPAM - congenital lung mass - fetal bronchoscopy

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References

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