Alain Potier

Congenital lung malformation: Evaluation of prenatal and postnatal radiological findings

Background and objective:  This study evaluated the accuracy of prenatal MRI and postnatal CT imaging in the identification of congenital cystic adenomatoid malformation and bronchopulmonary sequestration by comparison with histological analysis.

Bronchogenic cyst: Clinical course from antenatal diagnosis to postnatal thoracoscopic resection

PURPOSE: The purpose of this study was to describe an approach to surgical management of bronchogenic cysts based on the natural course observed from the time of antenatal screening to surgical resection in patients treated at our institution and reported in the literature. MATERIALS AND METHODS: We retrospectively reviewed the clinical features of all children presenting bronchogenic cyst diagnosed antenatally from 2007 to 2010. A total of six children were included. RESULTS: Antenatal diagnosis was accurate in 62.5% of cases. In the first year of life, the size of the cyst remained stable in four patients, doubled in one, and increased 30% within six months in one. The indication for surgery was emphysema of the left bronchus in two patients and rapid growth in two patients. One patient is still awaiting surgery. CONCLUSION: Bronchogenic cysts grow slowly in the first months of life, but growth is exponential even in the absence of complications. We recommend complete resection before the age of two years to prevent infectious complications and facilitate surgery.

Prenatal diagnosis of complete nonrotation of fetal bowel with ultrasound and magnetic resonance imaging.

Abnormalities of intestinal rotation form a spectrum of diseases associated with aberrant rotation and fixing [1]. We wish to report herein the first case of prenatally diagnosed complete nonrotation of fetal bowel with the combined use of ultrasound and magnetic resonance imaging (MRI). A 34-year-old woman with no remarkable medical history underwent ultrasound examination at 31 weeks of gestation (WG) of an uneventful first pregnancy. Ultrasound revealed bowel dilatation of the fetus in the left flank (Fig. 1A). Findings on fetal MRI at 32 WG were consistent with complete bowel nonrotation (Fig. 1B and C). Dilatation was related to malpositioned colon that was entirely located in the left flank. The rest of the digestive tract was located in the right abdomen. After birth, abdominal ultrasound, upper gastrointestinal tract series and barium enema showed that the cecum was located to the left of L3, with a right-sided Treitz angle, confirming complete nonrotation (Fig. 1D and E). Parents were reassured and a preventive appendectomy was scheduled around the age of three years. The incidence of symptomatic bowel rotational abnormalities is about 1/6000 live births [2]. Complete mesentery nonrotation is the persistence of the embryonic position of the intestine that has not undergone the normal rotation during reintegration into the abdomen of the primitive intestinal loop around 12 WG. Thus, the whole small bowel is located in the right side of the abdomen and the entire colon is in the left flank and there is no risk of volvulus. Conversely in case of incomplete rotation, adhesions may occur that would link ileocaecal angle to posterior parietal peritoneum, thus clamping the duodenum. Incomplete rotation favors small bowel volvulus around the mesenteric axis, a life-threatening condition requiring emergency treatment, due to possibly immediate total small bowel necrosis. Prenatal diagnosis of rotational disorders would

Putative criteria for predicting spontaneous regression of prenatally diagnosed thoracoabdominal cystic lesions.

PURPOSE Cystic lesions are common findings during prenatal ultrasonography but their prenatal and postnatal prognosis is difficult to establish because of some regress spontaneously. The purpose of this study was to identify putative criteria to predict regression of partially or completely cystic lesions detected by prenatal ultrasound. METHODS Prenatal ultrasound features of thoracic or abdominal cystic lesions were retrospectively analyzed. Ovarian and urological lesions were not included in this study. RESULTS A total of 57 cystic lesions were studied. Of the 57 lesion, 36 lesions including 10 abdominal (43.5%) and 26 thoracic (76.5%) lesions required surgical resection. Of the 57 lesions, 10 persistent lesions after birth were only monitored. Eleven lesions including eight abdominal (34.7%) and three thoracic (8.8%) lesions regressed prenatally (p = 0.02). Regressing abdominal lesions consistently presented as solitary lesions with a homogenous aspect. Only one abdominal lesion showed a multilobulated aspect. Two regressing thoracic lesions were purely cystic and one lesion presented a heterogeneous aspect. CONCLUSION Regression of cystic lesions detected by prenatal ultrasound scan was more likely for lesions in abdominal (mainly adrenal or splenic lesions) than thoracic locations. The likelihood of regression was highest for purely cystic abdominal lesions.

Conduite à tenir devant une déviation médiastinale fœtale: une approche pratique

The purpose of this article is to review the technique of fetal chest ultrasound screening evaluation, the diagnostic work-up in the presence of fetal mediastinal shift and which ultrasound imaging features to look for. The first step in evaluating the fetal thorax is to confirm situs. Then, a median sagittal line is drawn from a four-chamber view to assist in spatial orientation followed by echotexture analysis of the structures of the thorax in the presence of mediastinal shift. We propose a systematic approach based on the direction of the mediastinal shift and echogenicity of the compressing hemithorax. When the hemithorax contralateral to the mediastinal shift is enlarged, which is the most frequent situation, diaphragmatic hernia and macrocystic congenital cystic adenomatoid malformation are the most likely etiologies when the mass is heterogeneous. Microcystic congenital cystic adenomatoid malformation, sometimes associated with sequestration, is the most frequent etiology when the mass is homogeneous. When the hemithorax ipsilateral to the mediastinal shift is small, which is less frequent, and the contralateral hemithorax is homogeneously isoechoic, then a diagnosis of lung hypoplasia-agenesis-aplasia should be considered.

CL161 - Kystes bronchogéniques diagnostiqués en anténatal : quelle évolution?

Objectif Connaitre l’histoire naturelle des kystes bronchogeniques (KB) depuis leur detection ante-natale (DAN) jusqu’a leur resection afin de proposer la meilleure conduite a tenir. Materiel et Methode Etude retrospective de tous les KB entre 2007 et 2009. 12 cas mais 4 exclus car pas de DAN. Resultats Un DAN correct dans 62,5 % des cas (2 faux +/1 faux-). 7 cas suivis. Diametre moyen de 14mm (entre 5 et 22). 4 sont restes stable entre DAN et Scanner a 1 mois. Pendant la premiere annee, la taille est restee stable dans 1 cas, et a ete multipliee par 1,2/1,5/ 1,73 et 2. Cinq cas ont ete operes a 4, 6, 16 (2 cas) et 22 mois. 2 sont encore surveilles. Conclusion La croissance d’un KB est probablement celle d’une sphere (4/3πr3). Compte tenu de celle-ci, nous suggerons une resection des KB de DAN avant l’âge de 2 ans en thoracoscopie afin d’eviter les complications liees a la croissance (exponentielle) ou aux lesions des structures adjacentes.

P232 - Diagnostic prénatal d’une fistule urétrorectale en H, à propos d’un cas

Les malformations ano-rectales sont repandues dans le monde, mais leur diagnostic prenatal est rarement realise. Nous rapportons le cas d’un nouveau-ne dont le diagnostic ante-natal de fistule uretro-rectale en H a permis une prise en charge adaptee. Une femme enceinte de 28 ans presente a l’echographie et l’IRM a 27 semaines d’amenorrhee (SA) une dilatation liquidienne importante du colon fœtal. A 34SA, l’IRM montre une majoration de la distension liquidienne colique sans atteinte du grele, eliminant la diarrhee fœtale et orientant vers une fistule uro-rectale. A la naissance, l’enfant ne presente aucun trouble du transit ou urinaire. Malgre cela, nous realisons une IRM a 6 jours qui retrouve une distension recto-sigmoidienne, sans fistule visible. Afin d’etayer notre hypothese, une uretro-cystographie retrograde met en evidence une fistule uretro-rectale sus-montanale. Le diagnostic est confirme lors d’une cystoscopie, et on retrouve une stenose anale. Le nouveau-ne beneficie d’une cure chirurgicale et presente un suivi a deux ans sans complication. Devant toute dilatation liquidienne colique prenatale, il faut evoquer une fistule en H conduisant a la realisation du bilan standard de malformation ano-rectale et d’une cystographie neonatale a la recherche de la fistule.

Tératome anté- et postnatal

Decouverte, chez un fœtus a 33 semaines d’amenorrhee, d’une masse mediastinale developpee au contact du cœur au cours d’une echographie fœtale.

Rhabdomyome anté- et postnatal

Decouverte de plusieurs masses cardiaques developpees dans le ventricule gauche au cours d’une echographie foetale a 32 semaines d’amenorrhee.