A clinical guideline for structured assessment of CT-imaging in congenital lung abnormalities

• Published in: Paediatric respiratory reviews Vol. 37; pp. 80 - 88
• Main Authors: Hermelijn, Sergei M., Elders, Bernadette B.L.J., Ciet, Pierluigi, Wijnen, René M.H., Tiddens, Harm A.W.M., Schnater, J. Marco
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.03.2021
• Subjects: Computerized tomography scan; Congenital lung disease; Lung malformation; Lung surgery; Pediatric pulmonology; BC; PPB; BPS; CPAM; Lung malformation; ELS; CT; ILS; CLA; Congenital lung disease; Computerized tomography scan; Pediatric pulmonology; CLE; Lung surgery
• ISSN: 1526-0542; 1526-0550
• DOI: 10.1016/j.prrv.2019.12.004

To develop a clinical guideline for structured assessment and uniform reporting of congenital lung abnormalities (CLA) on Computed Tomography (CT)-scans. A systematic literature search was conducted for articles describing CT-scan abnormalities of congenital pulmonary airway malformation (CPAM), bronchopulmonary sequestration (BPS), congenital lobar emphysema (CLE) and bronchogenic cyst (BC). A structured report using objective features of CLA was developed after consensus between a pediatric pulmonologist, radiologist and surgeon. Of 1581 articles identified, 158 remained after title-abstract screening by two independent reviewers. After assessing full-texts, we included 28 retrospective cohort-studies. Air-containing cysts and soft tissue masses are described in both CPAM and BPS while anomalous arterial blood supply is only found in BPS. Perilesional low-attenuation areas, atelectasis and mediastinal shift may be found in all aforementioned abnormalities and can also be seen in CLE as a cause of a hyperinflated lobe. We have developed a structured report, subdivided into five sections: Location & Extent, Airway, Lesion, Vascularization and Surrounding tissue. CT-imaging findings in CLA are broad and nomenclature is variable. Overlap is seen between and within abnormalities, possibly due to definitions often being based on pathological findings, which is an unsuitable approach for CT imaging. We propose a structured assessment of CLA using objective radiological features and uniform nomenclature to improve reporting.