Antenatal Thoracic Space–Occupying Lesions

Ashish Jain, Chetan Khare

Abstract

Antenatal care primarily involves screening for fetal abnormalities. There are diverse malformations of fetal thoracic origin. These anomalies can be detected at or before 20 weeks of gestation, and detection of anomalies in the third trimester is not uncommon. These anomalies are classified based on the site of origin, consistency, echogenicity on ultrasound scanning, laterality, or evolution over time. The sensitivity of these fetal ultrasounds for these neonatal conditions ranges from 70% to 90%. In some cases, magnetic resonance imaging is done to confirm the diagnosis. Associated anomalies often occur along with the primary condition. Antenatal management of fetal thoracic anomalies includes confirming diagnosis, assessing severity, and prognosticating and preparing the family for the course in pregnancy. Fetal interventions are unproven and not available in India, currently. The fetal outcomes also vary; often, the size of the lesion also increases as the fetus grows and occasionally resolution is seen.

The counseling in these cases is nondirective, and an option of termination of pregnancy should be reserved for the presence of severe anomalies with syndromic association. Follow-up visits are needed to assess the fetal condition and prepare the family for future surgical intervention. Neonates with congenital diaphragmatic hernia, congenital high airway obstruction syndrome, or symptomatic congenital pulmonary airway malformation need an imminent surgery after birth; other neonates may be followed up and subjected to elective surgery.