[Fetal hyperechogenic and cystic pulmonary masses: sonographic findings, antenatal management and outcome of 12 cases].

OBJECTIVE: Presentation of prenatal findings and postnatal outcome of cases with echogenic or cystic lesions of the lungs. Discussion of the prenatal diagnostic and clinical management.

PATIENTS AND METHODS: Retrospective analysis of the antenatal sonographic findings, the management and outcome of 12 cases of fetal chest masses.

RESULTS: The postnatal findings included cystic adenomatoid malformation of the lungs (CAML) (nine cases) and lung sequestration (LS) (one case). Five fetuses were observed up to term. Two of them underwent postnatal surgery and three fetuses revealed an antenatal decrease of the lesion. None of these surviving fetuses developed hydrops, but in three of them a mediastinal shift was seen. The other fetuses did not survive (termination of pregnancy: six cases, spontaneous fetal loss: one case). Four of them had bilateral solid lesions, hydrops or additional malformations.

CONCLUSIONS: 1. Ultrasound evaluation of chest masses is useful in diagnosing of the type and the extent of the lesion, recognition of secondary alterations and exclusion of additional malformations. 2. Termination of pregnancy should be recommended in cases of hydrops that develops early in gestation, bilateral lesions with expected unfavourable outcome or life-threatening additional malformations. 3. Mediastinal shift does not seem to predict a poor perinatal outcome. 4. Spontaneous decrease of the size of the lesion is associated with a favourable outcome.