Radiology/Pathology Correlation

Unknown 17

The patient is a newborn female infant with respiratory distress.

 

 

 

Figure 1: Sonogram

Axial prenatal sonogram shows a complex mass with mixed echogenicity within the posterior left thorax. It displaces the heart anteriorly and somewhat to the right. Cystic areas are present within the mass.

Identify the complex mass and heart.

 

 

 

Figure 2: Sonogram

Oblique sagittal prenatal sonogram shows a posteriorly-located complex mass consisting of areas of increased echogenicity and cystic change. The rounded foci of increased echogencity located posteriorly (toward the top of the image) represent ribs. The longitudinally-oriented, posteriorly-located tubular hypoechoic structure is the thoracoabdominal aorta. Tissue anterior to the aorta represents the fetal lung. Fetal head is to the left.

Identify the complex mass.

Figure 3: Doppler Image

Oblique sagittal prenatal sonogram using power Doppler shows color throughout the aorta without evidence of an aberrant vessel supplying the left thoracic mass.

The foci of power Doppler signal anterior to the aorta represent cardiac chambers. Small foci of power Doppler signal posterior to the thoracoabdominal aorta mark the location of intercostal and lumbar arteries.

Identify the complex mass.

Identify the aorta in Figure 2.

Figure 4. Chest Radiograph

Digital frontal radiograph shows a complex cystic lesion in the medial left lower lobe.

Figure 5: Postnatal CT

Axial CT through the lower thorax shows a complex cystic lesion within the medial left lower lobe.

What is the differential diagnosis?

Answer

Histologic Findings

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Differential diagnosis: The differential diagnosis of a space-occupying lesion within the neonatal thorax includes sequestration (more commonly extralobar than intralobar in the early neonatal period), congenital pulmonary airway malformation, infantile lobar hyperinflation, and congenital diaphragmatic hernia.

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