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Pediatrics |

Congenital Lung Malformations: Cause of Respiratory Distress in Neonates

Manuela Cucerea, PhD; Marta Simon, PhD; Raluca Marian, MD; Luminita Zahiu, MD
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University of Medicine and Pharmacy, Targu Mures, Romania


Chest. 2014;145(3_MeetingAbstracts):451A. doi:10.1378/chest.1821588
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Abstract

SESSION TITLE: Pediatric Posters

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: Congenital pulmonary malformations like congenital cystic adenomatoid malformation and bronchogenic cysts are rare but potentially life-threatening anomalies. It frequently present with neonatal respiratory distress and require prompt diagnosis and treatment. Physical signs are nonspecific: grunting, tachypnea, retractions, cyanosis, pneumothorax.

METHODS: The authors present two cases of congenital pulmonary malformations (a case of cystic adenomatoid malformation and a case of bronchogenic cyst) diagnosed in the neonatal period in the Regional Center of Neonatal Intensive Care Tg. Mures, presenting the same clinical picture, but completely different evolution, a patient responding favourably to surgery, the other dying due to postoperative complications.

RESULTS: A male term newborn, birth weight of 3900 grams, presenting after one hour after birth tachypnea 70-80 breaths/minute, intercostal and subcostal retractions, oxygen desaturations in ambiental air. Serial chest radiography and computed tomography showed air cysts in the upper and lower right lobe with significant displacement of the mediastinum to the left. At the age of 7 days surgery was performed, but respiratory distress persisted, with disseminated bronchial crackles and productive cough. Computed tomography highlighted residual pulmonary cyst. The surgical partial cystectomy and tracheobronchial fistula closure were performed. Evolution was complicated by bacterial overgrowth (Pseudomonas aeruginosa, Staphylococcus epidermidis), sepsis and death. The second case is a 35-36 weeker male newborn, birth weight of 2600 grams, presenting expiratory grunting, tachypnea, subcostal and intercostal retractions, moderate cyanosis, chest bulging within 24 hours after delivery. Chest radiography and computed tomography showed right anterior basal cyst air leakage. Surgery was performed (cystectomy), with favourable outcome.

CONCLUSIONS: Congenital lung malformations require complex imaging investigations for differential diagnosis and a correct therapeutic attitude.

CLINICAL IMPLICATIONS: the treatment of choice in most congenital pulmonary malformations in neonates is surgical excision, after an adequate cardio-respiratory stabilization in neonatal intensive care unit

DISCLOSURE: The following authors have nothing to disclose: Manuela Cucerea, Marta Simon, Raluca Marian, Luminita Zahiu

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