Pathology teach and tell: neonatal ELS.

Abstract

A2790-gs full-termmalebornby normal spontaneous vaginal delivery to a 28year-old gravida 2 para1with antenatal fetal diagnosis of cystic left lungmass associated with mediastinal shift to the right and no hydrops fetalis. The lung mass was ¢rst seen at 20 weeks gestation on ultrasound and increased in size over 9 weeks. Follow-up ultrasound at 34 weeks showed decrease in size of the mass. Karytotypewas 46XY. Apgar scores were 9 and 9 at1and 5 min, respectively. Physical examination of the infant at birth revealed tachypneawith respiratory rate 80=min min and mild lower intercostal retractions. Air entry was equal and good bilaterally. Heart soundswere heardbest to the right of themidline.Oxygen saturation remained 96^99%. Initial blood gas was within normal limits. Baby was placed on nasal CPAP 4 with F|02 0.25 due to increasing tachypnea anddesaturation. ChestX-ray showed left lower lobe density, withmediastinal shift to the right. Left diaphragmwasvisualizedwell (F|gure1).Computedtomography (CT) scanwith POcontrast con¢rmedthe cystic left lungmass (F|gure 2). Di¡erential diagnosis included bronchopulmonary sequestration and congenital cystic adenomatoid (CCAM) malformation of the lung.The baby had increased pCO2 with tachypnea needing intubation and mechanical ventilation from the 5th day. Echocardiogram showed tiny patent ductus arteriosus (PDA), large left atrial appendage, and a large £ow in left pulmonary veins.Thebabyhadelective surgeryonthe11th day. At surgery, amassmeasuring 5 4 cmwas removedandcon¢rmedtobe a left extralobar sequestrationwithblood supply fromavessel arising fromthe aorta.Thebabywas extubated uneventfully on the 3rd postoperative day and placed on nasal CPAP for1day before weaning o¡ to room air.The infant remained tachypneic intermittently with respiratory rate up to 80=min for 2 days.The baby was discharged on the10th postoperative day in stable condition.Histopathologyof themass con¢rmedthe diagnosis (F|gure 3).