"Congenital Bronchopulmonary Malformations" by Dr Nayha Gautam, Senior Registrar, East London, South Africa

Summary

Attend our informative on-demand teaching session titled "Congenital Bronchopulmonary Malformations," presented by N Gautam from Paediatric Surgery, East London. This session provides a comprehensive look into the classifications of congenital lung conditions and cysts, and delves into prenatal and postnatal approaches to manage these conditions. Gain an in-depth understanding of lung development, cystic lung lesions, and the fetal ultrasound approach. The session uses real case studies to enhance understanding and engages attendees with interactive questions. Furthermore, this session will cover the different surgical strategies, complications, and outcomes for congenital bronchopulmonary malformations. Stay up-to-date with the latest practices and techniques for managing congenital bronchopulmonary conditions. Boost your expertise and contribute more effectively to the delivery of care for your youngest patients.

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Description

"Congenital Bronchopulmonary Malformations" by Dr Nayha Gautam, Senior Registrar, East London, South Africa.

Learning objectives

By the end of this session, participants should be able to classify different types of congenital bronchopulmonary malformations and understand their key characteristics.
Participants should be able to demonstrate knowledge on the antenatal management of cystic lung lesions, paying particular attention to the role of prenatal ultrasound, fetal MRI, and thoracentesis.
Participants need to develop the ability to interpret and apply findings from prenatal diagnostic tools to manage the postnatal care of infants with bronchopulmonary malformations, specifically bronchopulmonary sequestration (BPS).
In relation to congenital lobar emphysema, the session seeks to help participants understand its complications, presentation, and management, with a focus on the roles of endoscopy, imaging, and surgery.
By the end, participants should be equipped with knowledge on the comparative advantages and disadvantages of thoracoscopic and open surgery for treating bronchopulmonary malformations, bearing in mind the overall conclusion that outcomes are typically good with surgical intervention.

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CONGENITAL BRONCHOPULMONARY MALFORMATIONS N Gautam Paediatric Surgery,East London 13 July 2021 TRACHEA PULMONARY AND BRONCI PARENCHYMA VASCULAR CLASSIFICATION Bronchogenic Congenital OF CONGENITAL LUNBY SITENS Cysts PulmonaryAirway Malformation Bronchopulmonary Sequestrations Congenital Lobar EmphysemaCLASSIFICATION OF CYSTS SOLID LESS DENSESPLITTING OF THE FOREGUT LUNG DEVELOPMENTANTENATAL MANAGEMENT FETAL MRI PRENATAL APPROACH TO CYSTIC LUNG LESION • A 38-year-old, • Caucasian woman • Prenatal ultrasound and fetal MRI at 23 weeks of GA • left pulmonary mass in a female fetus. • She is otherwise well. • Ultrasound and MRI mass appears to be located in the left lower lobe • M= 22.9 × 17.3 × 10.3 mm. What other information would you like to obtain from the ultrasound prior to meeting the couple? FETAL ULTRASOUND APPROACH CVR= (Length × Height ×Width × 0.52)/HC) HYDROPS MACROCY BABY DELIVERED- ON PLACENTAL SUPPORT STIC MASSES BEFORE 28 LARGE WEEKS MACROCYSTIC THOROCOTOMY LESION INTUBATED THORACENTESIS MA TERNAL STEROIDS (90% SURVIVAL)POST NATAL MANAGEMENT CT CHEST 3-4 MONTHS AGE Xray 48hrs post birth:RESOLUTION? • Progress well. CASE STUDY • CVR decreases CONTINUED... • no other complications seen. • healthy baby girl born at 39 weeks GA • No respiratory symptomsRESECTION: EARLY SURGERY 3 MONTHS SURVELLIANCE COMPLICATIONS ANTENATAL: BRONCHOPULMONARY SEQUESTRATION ( BPS) • 30 yr.F ,ultrasound 22 weeks GA • Distinct echogenic structure in thorax ( left),abutting the diaphragm • Discrete feeding vessel • Heart shift to right • No pericardial or pleura effusions • Amniotic fluid normal • Fetal survey normal Antenatal Dx → Postnatal MX BPS RONCHOGENIC CYSTS Diff CCAM/CPAM Dx TUMOUR CLE Xray CT in 6 monthslife,Asymptomatic→ BPS • Solid • Non- Fx • Blood supplyAORTA • Classified : • Extralobal • CDH/cardiac ,AVM,eventration • Asymptomatic • Shunt:hydrops • Intralobar • MX:resection early in life RESECTION • Open • Thorascopic resectionCONGENITAL LOBAR EMPHYSEMA BRONCHOPULMONARY FOREGUT MALFORMATIONS Endoscopy Gastritis seen and CASE abnormal angulation of osophagus 2 month old girl Resus CXR UGIB No improvement and CT 3 days ago Croup→ STRIDOR steroids PRESENTATION AND COMPLICATIONS Mild mass effect Mass near carina problematic Airway compromise Infection Malignancy Hemoptysis Pneumothorax HemothoraxTHORACOSCOPIC VS OPEN SURGERY CONCLUSION Rare Descriptive Imaging Management Surgery Outcomes are good REFERENCES 1. Holcomb III G,Ashcraft K.Holcomb andAshcraft’s Paediatric Surgery.7th ed.Elsevier Inc;2020. 2. Ameh E.Paediatric Surgery:A ComprehensiveText ForAfrica.1st ed.Seattle:Global HELP Organization;2011. 3. Emil S.Clinical Paediatric Surgery:A case based interactive approach;2000