胎儿单侧肺缺如的产前超声诊断及漏诊原因分析

Prenatal diagnosis and misdiagnosis of fetus unilateral pulmonary agenesis by ultrasonography

目的探讨胎儿肺缺如的产前超声特征与漏诊原因,提高肺缺如的产前超声诊断率。方法对2012年1月至2017年10月在本院行胎儿系统产前超声检查8例肺缺如胎儿的产前超声资料及出生后相关临床资料进行回顾性分析。结果 8例单侧肺缺如中,男婴4例,女婴4例,右肺缺如5例,左肺缺如3例,单发肺缺如3例,合并其他部位畸形5例。引产4例,4例存活婴儿行胸部CT检查证实单侧肺缺如,产前漏诊2例均为左肺缺如,其中1例产前只发现左肺动脉缺如,1例产前只发现心轴左偏并心脏增大。结论心脏移位、左或右肺动脉缺如是产前超声诊断胎儿单侧肺缺如的重要线索,产前超声是发现并诊断胎儿单侧肺缺如的首选方法。

Objective To observe the features of fetus unilateral pulmonary agenesis in antenatal ultrasonography and analyse the causes of misdiagnosed, so that fetus unilateral pulmonary agenesis can be known more deeply. Methods From January 2012 to October 2017, 8 fetuses underwent prenatal ultrasound examination of fetal system in Guangdong Maternal and Child Health Hospital. The prenatal ultrasound data and postnatal clinical data were retrospectively analyzed. Results Among 8 cases of unilateral pulmonary agenesis, there were 4 males and 4 females, 5 cases involving right lung, 3 cases involving left lung, 3 cases of single lung absence, and 5 cases combined with other deformities. There were 4 cases of induced labor , and 4 cases of surviving children were confirmed unilateral pulmonary agenesis by chest computed tomography (CT) examination. 2 cases of missed prenatal diagnosis were left pulmonary agenesis, including 1 case only found left pulmonary artery absence and 1 case only found left axis deviation and cardiac enlargement before delivery. Conclusions Cardiac displacement and absence of left or right pulmonary artery are important clues for prenatal ultrasound diagnosis of fetal unilateral pulmonary absence. Prenatal ultrasound is the preferred method to detect and diagnose fetal unilateral pulmonary absence.