Cory N Criss1, Ninette Musili2, Niki Matusko3, Scott Baker4, James D Geiger5, Shaun M Kunisaki5. 1. Section of Pediatric Surgery, Department of Surgery, Michigan Medicine, C.S. Mott Children's and Von Voigtlander Women's Hospital, Ann Arbor, MI. Electronic address: cocriss@med.umich.edu. 2. Michigan State University College of Human Medicine, Lansing, MI. 3. Department of Surgery, Michigan Medicine, Ann Arbor, MI. 4. Department of Radiology, Michigan Medicine, C.S. Mott Children's and Von Voigtlander Women's Hospital, Ann Arbor, MI. 5. Section of Pediatric Surgery, Department of Surgery, Michigan Medicine, C.S. Mott Children's and Von Voigtlander Women's Hospital, Ann Arbor, MI.
Abstract
INTRODUCTION: The purpose of this study was to evaluate clinical outcomes in children with asymptomatic congenital lung malformations (CLM) who were initially managed nonoperatively. METHODS: An IRB-approved retrospective review was performed on all CLMs at a single tertiary care referral center (Jan 2006-Dec 2016, n=140). Asymptomatic cases that did not undergo elective resection were evaluated for subsequent CLM-related complications based on clinical records and a telephone quality of life survey. RESULTS: Out of 39 (27.9%) who were initially managed nonoperatively, 13 (33%) developed CLM-related symptoms and underwent surgical intervention at a median age of 6.8years (range, 0.7-19.8years). The most common indication for conversion to operative management was pneumonia (78%). Larger lesions, as measured by CT scan, were significantly associated with the need for subsequent surgical intervention (mean maximal diameter, 5.7 vs. 2.9cm; p=0.005). Based on survey data with a median follow up of 3.9years (range, 0.2-13.2years), 17% developed chronic pulmonary symptoms, including cough (11%) and asthma requiring bronchodilators (12%). CONCLUSION: Although these data support nonoperative management as a viable alternative to surgical resection, at least one-third of CLM children eventually develop pneumonia or other pulmonary symptoms. Larger lesions are correlated with an increased risk for eventual surgical resection. LEVEL OF EVIDENCE: Level IV.
INTRODUCTION: The purpose of this study was to evaluate clinical outcomes in children with asymptomatic congenital lung malformations (CLM) who were initially managed nonoperatively. METHODS: An IRB-approved retrospective review was performed on all CLMs at a single tertiary care referral center (Jan 2006-Dec 2016, n=140). Asymptomatic cases that did not undergo elective resection were evaluated for subsequent CLM-related complications based on clinical records and a telephone quality of life survey. RESULTS: Out of 39 (27.9%) who were initially managed nonoperatively, 13 (33%) developed CLM-related symptoms and underwent surgical intervention at a median age of 6.8years (range, 0.7-19.8years). The most common indication for conversion to operative management was pneumonia (78%). Larger lesions, as measured by CT scan, were significantly associated with the need for subsequent surgical intervention (mean maximal diameter, 5.7 vs. 2.9cm; p=0.005). Based on survey data with a median follow up of 3.9years (range, 0.2-13.2years), 17% developed chronic pulmonary symptoms, including cough (11%) and asthma requiring bronchodilators (12%). CONCLUSION: Although these data support nonoperative management as a viable alternative to surgical resection, at least one-third of CLM children eventually develop pneumonia or other pulmonary symptoms. Larger lesions are correlated with an increased risk for eventual surgical resection. LEVEL OF EVIDENCE: Level IV.
Authors: Annelieke Hijkoop; Marloes M van Schoonhoven; Joost van Rosmalen; Dick Tibboel; Monique H M van der Cammen-van Zijp; Mariëlle W Pijnenburg; Titia E Cohen-Overbeek; Johannes M Schnater; Hanneke IJsselstijn Journal: Pediatr Pulmonol Date: 2019-04-22
Authors: Timothy Xin Zhong Tan; Andrew Yunkai Li; James Jie Sng; Mark Lim; Zhi Xiang Tan; Hope Xian'en Ang; Boon Hor Ho; David Zhiwei Law; Anne Ann Ling Hsu Journal: BMC Pulm Med Date: 2020-05-04 Impact factor: 3.317