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Radiology
Bronchopulmonary Sequestration
Built from Obstetric Imaging
What’s inside
9 sections · 76 slides
Overview
- What this topic covers
What the lesion actually is
Extra lung tissue with no airway and the wrong artery
- Start with the picture, not the name
- Three features define it
- Why the word sequestration fits
- The tissue comes in two forms
- Intralobar sequestration
- Extralobar sequestration
- The two forms side by side
- Where extralobar tissue sits
How common it is and how it forms
Second only to cystic malformation, and born of a stray lung bud
- How common is it
- Why the before and after numbers differ
- How the extra lung tissue comes about
- The same story in plain words
- The blood supply is the whole story
- Where the blood goes out again
What it does to the fetus
Most shrink quietly; a few crowd the chest and cause hydrops
- Most cases are gentle
- Small masses often shrink on their own
- The dangerous minority
- How a large mass ends in hydrops
- Why fluid builds up
- Three things decide the newborn's outcome
- Size and position in more detail
- How it shows up after birth
- The commonest long-term problem
- Anomalies described alongside it
What the scans show
A bright uniform mass, and one artery that settles the diagnosis
- What it looks like on ultrasound
- Bright solid mass in the left lower lung at 27 weeks
- What to notice in that scan
- The sign that clinches the diagnosis
- Colour Doppler picks out the artery feeding the mass
- How the picture changes with time
- When the mass gets big
- Giant lung mass shifting the heart across the chest
- Three-dimensional power Doppler of the feeding vessel
- What the giant mass scan shows
- Lung mass with massive chest fluid and hydrops
- Power Doppler tracing the artery back to the aorta
- What the hydrops scan shows
- What fetal MRI adds
- How MRI changes, and where it falls short
- The two classic signs
What else looks like this
Four mimics, and the feature that separates each one
- The shortlist for a bright fetal mass
- Cystic adenomatoid malformation
- Air-filled cyst in the lung on computed tomography
- Bronchial atresia
- Scimitar syndrome
- Telling the two apart
- Masses that sit above the kidney
Treatment before birth
Watch most of them, and cut off the artery in the worst
- The fork in the road
- Watching is the default
- What each follow-up scan looks for
- Open fetal surgery is history
- Draining the chest with a shunt
- Sclerotherapy and the disappointing options
- Laser ablation of the feeding artery
- The steps of fetal management
After the baby is born
Excellent outlook, careful delivery planning, and eventual surgery
- The overall outlook
- Planning where to deliver
- Imaging the chest after birth
- Chest radiograph and tomography of a cystic lung malformation
- Computed tomography angiography
- Sequestered lower lobe and its vessels on tomography
- What that scan shows
- Surgery is the rule
- Blocking the artery from inside
Pulling it together
What to tell the referring doctor, and the points to keep
- What the referring physician needs to know
- Key points
- 2nd
- Take home
- References
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- Suggested readings
- Obstetric Imaging: Fetal Diagnosis and Care, 2nd Edition