1 / 39

Pulmonary Mass in a Neonate

Pulmonary Mass in a Neonate. Filomena Hazel R. Villa, MD PL 1- Pediatrics. Objective. To present a case of a neonate with pulmonary mass, its management and differential diagnoses. History. Boy M, 5 hours old Born term (40 weeks), LGA (3732 g) 21 y/o G1P1 Prenatal History: unremarkable

Download Presentation

Pulmonary Mass in a Neonate

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Pulmonary Mass in a Neonate Filomena Hazel R. Villa, MD PL 1- Pediatrics

  2. Objective • To present a case of a neonate with pulmonary mass, its management and differential diagnoses

  3. History • Boy M, 5 hours old • Born term (40 weeks), LGA (3732 g) • 21 y/o G1P1 • Prenatal History: unremarkable • Natal History: Born at CDN SROM - clear amniotic fluid, unknown amount NSVD, vertex presentation, APGAR 9,9

  4. History • 2nd hour: feeding was started, + vomiting, tachypnea • 5th hour of life: persistence of tachypnea • Transferred to Thomason via EMS

  5. Physical Examination • VS: T- 99.4; HR- 140; RR-89 BP - 57/33 (MAP 43-47) O2 Sat: 82-92% • Alert, and active • No icterus, no rashes • Open flat fontanelle • Eyes, normal shape and size with equal red reflex

  6. Physical Examination • Ears: normally set, no gross anomalies • Nose: nares are patent, intact palate • Lungs and Chest: anteriorly - clear and equal breath sounds; posteriorly - slightly decreased breath sounds on the left hemithorax, ICS retractions, mild tachypnea

  7. Physical Examination • Chest: normal rate and rhythm, pulses equal on all extremities, no murmur • Abdomen: umbilical stump: clean, with 3 vessels, soft, non tender, no organomegaly, no masses, normal bowel sounds • Genitalia: normal male genitalia

  8. Physical Examination • Back and spine: no gross defects • Limbs and hips: no hip clicks, 10 fingers and toes, symmetric movements, capillary refill < 3 seconds • Neurologic: normal suck, tone, grasp, cry, Moro, root

  9. Assessment and Plan • Term male infant • Suspected sepsis secondary to respiratory distress and desaturations • TTN vs Pneumonia • Plan: Sepsis work up, CXR • NPO, Isolette, Oxygen • Ampicillin and Gentamicin

  10. Course in the NICU • Initial CXR: density in the left retrocardiac area • Unlikely pneumonia or atelectasis • Differential diagnoses: • Intra or Extra lobar sequestration • Mediastinal neuroblastoma • Broncho foregut malformation • Neuroenteric malformation • Intrathoracic kidneys

  11. Course in the NICU • Case discussed with Radiologist • CT scan of the thorax • Ultrasound of abdomen and thorax • Echocardiogram: normal

  12. Course in the NICU • CT scan of the thorax: • Soft tissue mass with no calcifications • No diaphragmatic eventration, no evidence of hernia • Differentials: Teratoma, Neuroblastoma

  13. Course in the NICU • Sonogram of the abdomen: normal gas pattern, liver pancreas and kidneys-within the cavity • Sonogram of the thorax: • Left hemithorax mass • Arterial supply from the aorta • Vein drainage-origin not established • Consider: Extralobar Sequestration

  14. Course in the NICU • 4th hospital day: referral to pediatric surgery • Images were reviewed • Plan: removal of the pulmonary mass

  15. Course in the NICU • 5th hospital day: Surgery (Thoracotomy) • Intra-op findings: • Pulmonary sequestrum • Arterial aspect supplying the mass emerges from the thoracic aorta • Venous drainage into the intercostal vein • Resection of pulmonary sequestration

  16. Chext X-ray Post-op

  17. Post- operative Course • Uncomplicated recovery • Patient was discharged on 6th post-op day

  18. Pathological Findings • It consists of a 6.5 x 4.5 x 3.0 cm lower lobe of lung tissue. It has an attached purple tan cystic structure filled with hemorrhagic serous fluid and air. This cystic structure measures 1.5 cm in greatest diameter. • Diagnosis: pulmonary sequestration with minimal interstitial lymphocytic inflammation dilated congested blood vessels and focal parenchymal hemorrhage.

  19. Differential diagnoses • Pneumonia • Diaphragmatic hernia • Teratoma • Neuroblastoma • CCAM

  20. Extralobar Pulmonary Sequestration • Non-functioning lung tissue • Aberrant blood supply- systemic circulation • Has its own pleura • Associated with other anomalies • Congenital

  21. Extra vs Intralobar INTRALOBAR • Acquired/ congenital • Systemic blood supply • Pulmonary venous drainage • Pleura shared with adjacent normal lung EXTRALOBAR • Congenital • Systemic blood supply • Systemic venous drainage • Own pleura

  22. Extra vs Intralobar

  23. Epidemiology • Incidence: 0.15-1.7% • 15-25%- extralobar • 75-85%- intralobar • 4:1 male to female • 60%- first 6 months of life

  24. Embryology

  25. Prenatal Diagnosis and Treatment • No hydrops- follow closely with ultrasound • With hydrops- thoracoamniotic shunt • Postnatally- resection

  26. Diagnosis • Plain x-ray- triangular or oval shape opacity • CT- cystic component • Color Doppler ultrasound- anomalous vessels • MRI- venous drainage

  27. Treatment • Surgical resection • Thoracoscopy • Arterial embolization

  28. Hemorrhage Empyema Hemothorax Hemoperitoneum Air leak Bronchopleural fistula Wound infection Atelectasis Infections Secretions management Respiratory failure Complications

  29. Prognosis • With hydrops fetalis- dismal • Without hydrops - excellent

  30. Baby boy M is presently being followed in our high risk clinic, growing and developing without significant pulmonary residuals.

More Related