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Oral Presentation - 60
The Need For Postnatal Imaging In Congenital Lung Malformations And Surgical Timing: A Retrospective Study
Gül İlayda Sarar, Ayşenur Celayir
University of Health Sciences, Turkey. İstanbul Zeynep Kamil Maternity and Children Diseases Health Training and Research Center, Department of Pediatric Surgery, İstanbul, Turkey
Purpose:This study examines the impact of surgical timing and the necessity of advanced imaging in congenital-lung-malformations(CLM).
Method: Medical records of CLM patients operated between 2008-2024 were retrospectively reviewed. Demographic data, age-at-diagnosis, associated anomalies, radiological findings, symptoms, age-at-surgery, histopathological results, complications, hospitalization duration, and follow-up were evaluated.
Results:Of forty-nine patients, 51% were female-49% male. Lesions were left-sided in 57.1%, right-sided in 42.9%. Prenatal diagnosis rate was 81.6%, median-age-at-prenatal-diagnosis was 23-weeks(Range:8-34,IQR:21-25). Fetal-magnetic-resonance-imaging(MRI) was performed in 35%. Prenatally, lesions increased in 62.1%, unchanged in 3.4%, decreased in 24.1%, and were invisible at the end in 10.3%. Postnatally, all cases underwent chest-radiographs, and 42.5% computed-tomography(CT). All had positive findings on chest-radiographs and CT. Surgery was performed in 44.9% during the neonatal period, 22.4% between 1-4 months and 32.7% 4-months onward. Lobectomy(n:19), segmentectomy(n:28), and cystectomy(n:2) were performed via thoracotomy. Intraoperative-lesion-volumes were found to be higher than prenatal-ultrasound(USG)-volumes(p<0.001). Histopathology reported CPAM(n:25,51%), BPS(n:17,34.7%), BC(n:3,6.1%), and CLE(n:4,8.2%). Imaging and histopathological diagnoses were consistent in 62.5% of prenatal-USG and 85.7% of fetal-MRI. Preoperative infection rates were higher in patients operated after 3-months(p:0.016).
Conclusion:The risk of preoperative respiratory infection is low in CLMs operated within the postnatal 3-month. Prenatal regression should be confirmed with advanced imaging postnatally. If early surgery is planned for asymptomatic CLMs with positive postnatal radiographic findings, preoperative advanced imaging should be limited to selected cases to reduce radiation exposure.