Feb 082018

The surgeons at the Almazov Centre performed a successful surgery on a baby with a congenital lung malformation.

The ultrasound at 30 weeks revealed the accumulation of fluid in the left pleural cavity (intrauterine hydrothorax) in the fetus. The woman from Vologda was referred for a consult to the Perinatal Centre of the Almazov National Medical Research Centre.

Dr. Philipp Ovsyannikov, head of the Functional Diagnostics Department and ultrasound specialist, performed an intrauterine puncture of the fetal pleural cavity under ultrasound control and evacuated the fluid. The cause of its accumulation remained unclear. The doctors were concerned about the health of the future child and recommended delivery at the Perinatal Centre.

However, due to premature delivery, the mother and her baby were transferred to St. Petersburg three weeks after the delivery. A follow-up and an accurate diagnosis were required as the fluid continued to accumulate and compress the lung tissue as well as adjacent organs. This condition could ultimately lead to respiratory and circulatory failure.

Chest X-ray suggested pulmonary sequestration, a rare congenital malformation in which a mass of abnormal lung tissue is detached from the normal lung. This extra portion of lung tissue is deprived of oxygen and has no respiratory function. Unlike with other lung malformations, the sequestered tissue receives its blood supply from an isolated vessel extending directly from the aorta.

This diagnosis was confirmed by a CT scan. It is because of this unusual symptom (intrauterine fluid accumulation in the pleural cavity) that the ultrasound before delivery did not show any extra blood vessel and a large sequester.

Surgery was required to remove the abnormal mass that would otherwise be a constant site of infection leading to inflammatory processes and suppuration. The surgery was performed by Prof. Vladimir Bairov, chief visiting pediatric surgeon of the Northwestern Federal District and head of the Research Laboratory for Surgery of Congenital and Hereditary Diseases at the Almazov Centre, and Dr. Anna Sukhotskaya, head of Pediatric Surgery Department at the Perinatal Centre.

Professor Bairov said that it was the first case in his many years of practice when the intrauterine hydrothorax was a consequence of congenital pulmonary sequestration. According to the doctor, after the description in the medical literature, this case will help doctors make an accurate diagnosis and be ready to provide the necessary specialized care to newborns.

Thanks to the leading-edge technologies and high professionalism of doctors, the baby from Vologda received timely care: the abnormal tissue portion was removed before complications occurred. Soon after the life-threatening condition was repaired, the child was discharged home.