Fetal bronchoscopy: its successful use in a case of extralobar pulmonary sequestration

Abstract

Objective: To report the performance of fetal bronchoscopy in a case of pulmonary sequestration. Materials and Methods: A 24 year-old female, Gravida 2, Para 1, was referred at 27.5 weeks with a large fetal left lung mass with marked right mediastinal shift and no visible normal left lung. Differential diagnosis included possible bronchial atresia. Results: The patient underwent fetal laryngoscopy and fetal bronchoscopy at 31.5 weeks. The right lung and a portion of the left lung expanded during surgery as a result of bronchial lavage. Bronchial atresia or bronchogenic cyst were not found. Pregnancy continued uneventfully, with continuous growth of the right lung and a small amount of left lung. The patient delivered vaginally at term. The baby underwent thoracoscopic resection of a pulmonary sequestration at 10.5 months of age and did well. Conclusion: Fetal bronchoscopy is feasible. The procedure may prove useful in the differential diagnosis and in the potential treatment of different fetal lung lesions, as well as aid in the understanding of the role of bronchial obstruction as a common pathophysiologic mechanism for different fetal lung masses. Risks and benefits of fetal bronchoscopy warrant further experience.

Keywords::

• Fetal laryngoscpy
• fetal therapy
• fetoscopy
• pulmonary sequestration
• ultrasound

Acknowledgment

We would like to thank our Fetal Therapy team, including our nurse coordinator Ms. Michaela Tregembo, our sonographers Ms. Jill Osit and Ms. Mahsomeh Haghayegh for their comprehensive sonographic evaluations and our operating room staff for their assistance in surgery. To our colleagues Dr. Gaurav Saigal from the Department of Pediatric Radiology, Dr. Juan Sola, Dr. Holly Neville and Dr. Eduardo Perez from the Department of Pediatric Surgery, Dr. Maria Rodriguez from the Department of Surgical Pathology and Dr. Eduardo Bancalari and the Division of Neonatology at the University of Miami Miller School of Medicine, Jackson Memorial Hospital. Lastly, we would like to express our gratitude to the University of Miami and Jackson Memorial Hospital for allowing us to perform this surgery.

Declaration of Interest: The authors report no conflict of interest.