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J Pediatr Surg. 2018 Jun;53(6):1092-1097. doi: 10.1016/j.jpedsurg.2018.02.065. Epub 2018 Mar 5.

Asymptomatic congenital lung malformations: Is nonoperative management a viable alternative?

Author information

1
Section of Pediatric Surgery, Department of Surgery, Michigan Medicine, C.S. Mott Children's and Von Voigtlander Women's Hospital, Ann Arbor, MI. Electronic address: cocriss@med.umich.edu.
2
Michigan State University College of Human Medicine, Lansing, MI.
3
Department of Surgery, Michigan Medicine, Ann Arbor, MI.
4
Department of Radiology, Michigan Medicine, C.S. Mott Children's and Von Voigtlander Women's Hospital, Ann Arbor, MI.
5
Section of Pediatric Surgery, Department of Surgery, Michigan Medicine, C.S. Mott Children's and Von Voigtlander Women's Hospital, Ann Arbor, MI.

Abstract

INTRODUCTION:

The purpose of this study was to evaluate clinical outcomes in children with asymptomatic congenital lung malformations (CLM) who were initially managed nonoperatively.

METHODS:

An IRB-approved retrospective review was performed on all CLMs at a single tertiary care referral center (Jan 2006-Dec 2016, n=140). Asymptomatic cases that did not undergo elective resection were evaluated for subsequent CLM-related complications based on clinical records and a telephone quality of life survey.

RESULTS:

Out of 39 (27.9%) who were initially managed nonoperatively, 13 (33%) developed CLM-related symptoms and underwent surgical intervention at a median age of 6.8years (range, 0.7-19.8years). The most common indication for conversion to operative management was pneumonia (78%). Larger lesions, as measured by CT scan, were significantly associated with the need for subsequent surgical intervention (mean maximal diameter, 5.7 vs. 2.9cm; p=0.005). Based on survey data with a median follow up of 3.9years (range, 0.2-13.2years), 17% developed chronic pulmonary symptoms, including cough (11%) and asthma requiring bronchodilators (12%).

CONCLUSION:

Although these data support nonoperative management as a viable alternative to surgical resection, at least one-third of CLM children eventually develop pneumonia or other pulmonary symptoms. Larger lesions are correlated with an increased risk for eventual surgical resection.

LEVEL OF EVIDENCE:

Level IV.

KEYWORDS:

Asymptomatic lung lesions; Bronchopulmonary sequestration; Congenital cystic adenomatoid malformation; Congenital pulmonary airway malformation; Nonoperative management

PMID:
29576400
DOI:
10.1016/j.jpedsurg.2018.02.065
[Indexed for MEDLINE]

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