Introduction
Diagnostic dilemma occurs in cases of congenital lesions of lung in
children simply because of wide range of spectrum which includes
Congenital Cystic Adenomatoid Malformation (CCAM), Congenital Lobar
Emphysema (CLE), Bronchopulmonary Sequestration (BPS) and Bronchogenic
Cyst (BC). CCAM occurs with an incidence of 1 in 10,000 to 25,000
pregnancies, and is the commonest lung cyst.1 Children
with congenital lung lesions may present at any age in life, from the
newborn period to adulthood, and some of them may remain asymptomatic
throughout life.2,3 Symptomatic lesions require
surgical resection.4 The management of asymptomatic
lesion is controversial, while some advocate surgical excision, others
recommend resection only when symptoms occur.5,6 The
study was undertaken to highlight the difficulties in diagnosis as many
of them present to us with a misdiagnosis of either pulmonary
tuberculosis or pneumothorax. By the time they present to us most of
them have already received anti tubercular drugs or intercostals
drainage which further complicate the management of such children
suffering from cystic lesions of lung.
The aim of this study was to highlight the difficulty in diagnosis of
congenital lesions of lung in children, and to create awareness among
the physicians regarding avoiding the use of anti-tubercular treatment
(ATT) and intercostal drainage (ICD) in managing these surgical
conditions.
Methodology: Retrospective analysis of records of all the
children diagnosed with congenital lesion of lung and treated in our
department from January 2005 to December 2018. Informed consent from the
parents taken at the time of admission.
Inclusion criteria included cases which received either ATT or
intercostals drainage before being referred to us. Investigations
included X -ray, Contrast enhanced tomography. All cases were operated
after confirming the diagnosis by single experienced surgeon by
Posterolateral thoracotomy. Resected specimens were sent for
histopathological examination. Postoperatively children were followed up
06 monthly for first year then annually thereafter.
Results: A total of 27 cases of congenital lesions of lung were
operated between Jan 2005 –Dec 2018. Out of these 27, 13 (48.1%)
received either ATT or ICD and formed our study group. Out of these 13,
8(61.5%) received ATT, while 5 (38.5%) received ICD as initial
management before being referred to us. There were 19 (70.3%) male and
8(29.7%) females.
The most common lesion was CCAM seen in 6 (46.1%) followed by CLE
4(30.7%), BPS in 2 (15.3%) and Bronchogenic cyst 1(7.6%). Children
demographic profile, clinical presentation, site of lesions and surgical
procedure done are shown in table1.