IMFH | Fetal Therapy | Fetal Conditions Treated | Fetal Cystic Lung Masses
Cystic lung masses are a group of fetal disorders that are amenable to needle drainage and/or shunting. Space-occupying lesions in the fetal chest, whether fluid or solid, may cause underdevelopment of the lung tissue and lethal pulmonary hypoplasia, as well as compression of cardiovascular structures and eventual fetal hydrops (heart failure) and death.
One example of intrathoracic space-occupying pathology is a fetal pleural effusion. Fetal pleural effusion is an accumulation of fluid in the pleural space (around the lung) caused by a variety of etiologies, such as malformation of the thoracic duct, pulmonary lymphangectasis, and a variety of genetic syndromes. Pleural effusions may have a variable course from complete spontaneous resolution to fetal hydrops and death. Improved perinatal survival has been shown in fetuses with persistent pleural effusions with hydrops or impending hydrops treated by thoracocentesis or thoracoamniotic shunting.
The two common chest masses that can also cause fetal hydrops are congenital cystic adenomatoid malformation (CCAM) and pulmonary sequestrations (PS). CCAM is an overgrowth of terminal respiratory bronchioles that form cysts of various diameters. On the other hand, PS consists of non-functioning lung tissue that is supported by an anomalous arterial blood supply. Fetal treatment is indicated in those cases with fetal hydrops remote from term gestation. In macrocystic CCAM’s, thoracoamniotic shunt placement will reverse fetal hydrops. Preliminary reports have shown that microcystic CCAM’S and in PS’s can be successfully treated using either sclerotherapy or laser energy delivered via a needle.
