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The natural history of prenatally diagnosed congenital cystic lung lesions: long-term follow-up of 119 cases
  1. James Cook1,
  2. Lyn S Chitty2,3,7,
  3. Paolo De Coppi4,6,
  4. Michael Ashworth5,
  5. Colin Wallis1
  1. 1 Department of Paediatric Respiratory Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
  2. 2 Department of Fetal Medicine, University College Hospitals NHS Foundation Trust, London, UK
  3. 3 Genetics and Genomic Medicine Section, Institute of Child Health, University College London, London, UK
  4. 4 Department of Paediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
  5. 5 Department of Pathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
  6. 6 Stem Cells and Regenerative Medicine Section, Institute of Child Health, University College London, London
  7. 7 Department of Clinical Genetics, Great Ormond Street Hospital for Children NHS Foundation Trust, London
  1. Correspondence to Dr Colin Wallis, Department of Paediatric Respiratory Medicine, Great Ormond StreetHospital for Children NHS Foundation Trust, London WC1N 3JH, UK; colin.wallis{at}gosh.nhs.uk

Abstract

Background A paucity of evidence regarding the natural history of congenital pulmonary airway malformations (CPAMs) and pulmonary sequestration (PS) has resulted in a divergence in management strategy of asymptomatic cases.

Methods We describe the long-term clinical course of 119 children diagnosed with these lesions treated at Great Ormond Street Hospital (GOSH). Cases were identified via the GOSH patient database. Study entry required the identification of a cystic lung lesion on prenatal ultrasound and confirmation of CPAM/PS on postnatal CT imaging. Patients followed up for at least 5 years were included.

Results 51 (43%) patients were managed surgically; 8 (6.7%) as an emergency during the neonatal period, 6 (5.1%) electively due to concerning features on CT scan, 20 (17%) following medical advice, 1 (0.8%) following a severe respiratory infection and in 5 (4.2%) the indication was unclear. The indication in 11 (9.2%) was recurrent respiratory infection and median age at surgery was 1.6 years (range 0.4 to 4.6 years). No cases of malignancy were identified on histological examination of resected lesions. 68 (57%) patients were managed conservatively for a median period of 9.9 years (range 5.2 years to 18 years). Seven (10%) were discharged, one was followed-up elsewhere (1.5%) and eight (11%) were lost to follow-up. In four patients (5.9%), the lesion resolved spontaneously. 52 (76%) continue to be followed-up and remain asymptomatic.

Conclusions This is one of the largest case series documenting the natural history of CPAMs and PS following a prenatal diagnosis and demonstrates that conservative management is a reasonable option in selected cases.

  • congenital
  • lung
  • cystic

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Footnotes

  • Contributors CW, LSC, PDC and JC contributed to study conception and design. JC, LSC and MA contributed to data acquisition. JC and CW drafted the manuscript. LSC, PDC and CW provided editing of the manuscript.

  • Funding LSC and PDC are partially funded by the NIHR Biomedical Research Centre at Great Ormond Street NHS Foundation Trust.

  • Competing interests None declared.

  • Ethics approval Clinical Audit Department, Great Ormond Street Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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