中孕期产前超声诊断先天性肺囊腺瘤样畸形

Prenatal ultrasound diagnosis of congenital pulmonary cystadenomatoid malformation during middle pregnancy

目的对中孕期先天性肺囊腺瘤样畸形(CCAM)的声像图特征进行分析,提高超声医师的诊断水平,为临床评估预后和产前干预提供依据。方法回顾性分析2012年1月至2020年12月在解放军联勤保障部队第九○二医院超声诊断科行中孕期产期系统超声检查的孕妇共32195人的临床和超声检查资料,发现CCAM胎儿15例,对其病灶位置、合并症及声像图特征进行分析,并随访妊娠结局。结果15例(15/32195,0.05%)均经产前超声诊断为CCAM,随访结果与超声诊断相符。其中,13例为Ⅱ型CCAM(13/15,86.67%),2例为Ⅲ型CCAM(2/15,13.33%),均为单胎妊娠,病灶均位于单侧胸腔。13例Ⅱ型CCAM肿块均表现为囊实性混合回声,囊肿直径<2 cm,其中,7例病灶位于左侧胸腔,6例病灶位于右侧胸腔;9例纵隔受压移位;2例合并腹腔积液,1例合并羊水多,1例合并其他畸形(单心室、左房发育不良、右脐静脉、单脐动脉);2例Ⅲ型CCAM肿块表现为较均匀的实质性高回声,病灶均位于左侧胸腔,纵隔均受压移位,均无合并其他畸形与并发症;CCAM肿块内均探及源于肺循环的动脉血供。结论中孕期产前超声检查能够早期且较准确地诊断CCAM,并能观察其进展和合并症,对临床评估预后和早期进行产前干预具有重要意义。

Objective To analyze the sonographic features of congenital cystic adenomatoid malformation(CCAM)of the lung in the middle pregnancy period,to improve the diagnostic level of ultrasound doctors,and to provide a basis for clinical evaluation of prognosis and prenatal intervention.Methods The clinical and ultrasonographic data of 32195 pregnant women who underwent a mid-term and puerperal ultrasonic examination in the ultrasonic diagnostic department of the 902nd Hospital of the Joint Logistics Support Force from January 2012 to December 2020 were reviewed.Fifteen CCAM fetuses were found,the location of the focus,complications and sonographic features were analyzed,and pregnancy outcomes were followed up.Results 15 cases(15/32195,0.05%)were diagnosed as CCAM by prenatal ultrasound.The follow-up results were consistent with an ultrasound diagnosis.Among them,13 cases were typeⅡCCAM(13/15,86.67%),and 2 cases were typeⅢCCAM(2/15,13.33%).All of them were a single pregnancy.In 13 cases of typeⅡCCAM,the cyst diameter was less than 2 cm,7 cases were located in the left thoracic cavity,6 cases were located in the right thoracic cavity,9 cases were translocated mediastinum,2 cases were associated with ascites,1 case was associated with polyhydramnios,one case was complicated with other malformations(single ventricle,hypoplasia of left atrium,right umbilical vein,single umbilical artery),and 2 cases with typeⅢCCAM showed homogeneous hyperechoic mass,which was located in the left thoracic cavity and mediastinum was displaced by pressure,no other malformation and complication were found,and the artery blood supply from pulmonary circulation was found in all CCAM masses.Conclusion Prenatal ultrasound examination in mid-pregnancy can diagnose CCAM early and accurately,and can observe its progress and complications.It is of profound significance for clinical evaluation of prognosis and early prenatal intervention.