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Congenital Chest Lesions: Diagnosis and Characterization with Prenatal MR Imaging¹

¹ From the Departments of Radiology (A.M.H., J.C.H., S.M.) and Surgery (N.S.A., T.M.C., L.J.H.), Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104, and the Department of Radiology, University of Pennsylvania Medical Center, Philadelphia (B.G.C.). Received March 25, 1998; revision requested June 18; revision received September 8; accepted December 21. Address reprint requests to A.M.H. (e-mail: Hubbard@email.chop.edu).

View larger version (143K): [in a new window]   Figure 1. Axial RARE MR image (4.4/64 [effective], 120° flip angle, 6-mm section thickness) through the level of the heart (large straight arrow) shows a normal chest in a fetus at 30 weeks gestational age. The spinal canal (small straight arrow) is shown posteriorly. The lungs (curved arrows) are homogeneous and high in signal intensity.

View larger version (139K): [in a new window]   Figure 2. CCAM in a fetus of 23 weeks gestational age. Sagittal RARE MR image (4.4/64 [effective], 120° flip angle, 6-mm section thickness) through the left side of the chest. A well-defined, slightly heterogeneous high-signal-intensity mass (solid white arrow) is shown originating from the left lower lobe. The normal lung (straight black arrow) is visible in the anterior portion of the chest and is notably lower in signal intensity than the CCAM. The left lobe of the liver (curved arrow) has very low signal intensity, and the fluid-filled stomach (open arrow) has high signal intensity.

View larger version (180K): [in a new window]   Figure 3a. CCAM in a fetus of 29 weeks gestational age. (a) Sagittal US image through the fetus with the spine (small straight arrows) directed toward the transducer. There is a large hyperechoic mass (curved arrows) in the right side of the chest. A large, dominant cyst (long straight arrow) is present within the hyperechoic lesion. The lung lesion is substantially more echogenic than the liver (L). (b) Axial RARE MR image (4.4/64 [effective], 120° flip angle, 6-mm section thickness) through the chest at the level of the heart (H) shows a large high-signal-intensity heterogeneous mass (curved arrows) arising from the right lung and crossing the midline. A small amount of normal right lung (black arrow) can be seen anterior to the heart, which is shifted to the left. The left lung (open arrow) can be seen posterior to the heart. There also is marked subcutaneous edema (arrowhead), consistent with hydrops. (c) Axial RARE MR image (4.4/64 [effective], 120° flip angle, 6-mm section thickness) obtained through the chest at the level of the heart (H) at gestational age of 32 weeks, 3 weeks after in utero removal of the CCAM lesion, shows marked growth of both lungs (long arrows). A small amount of right-sided pleural fluid (short arrow) is present.

View larger version (114K): [in a new window]   Figure 3b. CCAM in a fetus of 29 weeks gestational age. (a) Sagittal US image through the fetus with the spine (small straight arrows) directed toward the transducer. There is a large hyperechoic mass (curved arrows) in the right side of the chest. A large, dominant cyst (long straight arrow) is present within the hyperechoic lesion. The lung lesion is substantially more echogenic than the liver (L). (b) Axial RARE MR image (4.4/64 [effective], 120° flip angle, 6-mm section thickness) through the chest at the level of the heart (H) shows a large high-signal-intensity heterogeneous mass (curved arrows) arising from the right lung and crossing the midline. A small amount of normal right lung (black arrow) can be seen anterior to the heart, which is shifted to the left. The left lung (open arrow) can be seen posterior to the heart. There also is marked subcutaneous edema (arrowhead), consistent with hydrops. (c) Axial RARE MR image (4.4/64 [effective], 120° flip angle, 6-mm section thickness) obtained through the chest at the level of the heart (H) at gestational age of 32 weeks, 3 weeks after in utero removal of the CCAM lesion, shows marked growth of both lungs (long arrows). A small amount of right-sided pleural fluid (short arrow) is present.

View larger version (103K): [in a new window]   Figure 3c. CCAM in a fetus of 29 weeks gestational age. (a) Sagittal US image through the fetus with the spine (small straight arrows) directed toward the transducer. There is a large hyperechoic mass (curved arrows) in the right side of the chest. A large, dominant cyst (long straight arrow) is present within the hyperechoic lesion. The lung lesion is substantially more echogenic than the liver (L). (b) Axial RARE MR image (4.4/64 [effective], 120° flip angle, 6-mm section thickness) through the chest at the level of the heart (H) shows a large high-signal-intensity heterogeneous mass (curved arrows) arising from the right lung and crossing the midline. A small amount of normal right lung (black arrow) can be seen anterior to the heart, which is shifted to the left. The left lung (open arrow) can be seen posterior to the heart. There also is marked subcutaneous edema (arrowhead), consistent with hydrops. (c) Axial RARE MR image (4.4/64 [effective], 120° flip angle, 6-mm section thickness) obtained through the chest at the level of the heart (H) at gestational age of 32 weeks, 3 weeks after in utero removal of the CCAM lesion, shows marked growth of both lungs (long arrows). A small amount of right-sided pleural fluid (short arrow) is present.

View larger version (131K): [in a new window]   Figure 4a. BPS in a fetus of 23 weeks gestational age. (a) Transverse US image through the lower portion of the chest demonstrates a hyperechoic lesion (large arrow) in the region of the left lower lobe. This lesion is more hyperechoic than the normal right lower lobe (small arrow). (b) Axial RARE MR image (4.4/64 [effective], 120° flip angle, 6-mm section thickness) through the chest at the level of the heart (H) demonstrates a well-defined lesion (solid arrow) with homogeneously high signal intensity involving the left lower lobe. The normal right and left lungs (open arrows) are shown.

View larger version (139K): [in a new window]   Figure 4b. BPS in a fetus of 23 weeks gestational age. (a) Transverse US image through the lower portion of the chest demonstrates a hyperechoic lesion (large arrow) in the region of the left lower lobe. This lesion is more hyperechoic than the normal right lower lobe (small arrow). (b) Axial RARE MR image (4.4/64 [effective], 120° flip angle, 6-mm section thickness) through the chest at the level of the heart (H) demonstrates a well-defined lesion (solid arrow) with homogeneously high signal intensity involving the left lower lobe. The normal right and left lungs (open arrows) are shown.

View larger version (156K): [in a new window]   Figure 5. Bronchial stenosis of the right middle lobe in a fetus of 23 weeks gestational age. Axial RARE MR image (4.4/64 [effective], 120° flip angle, 6-mm section thickness) through the chest at the level of the heart (H) shows shift of the heart to the left side of the chest. The right middle lobe (curved arrow) is enlarged. A normal vessel can be seen coursing through the right lung (arrowhead). The markedly enlarged right middle lobe has homogeneous signal intensity that is only minimally higher than that of the left lung (straight arrow).

View larger version (148K): [in a new window]   Figure 6. Foregut cyst in a fetus of 23 weeks gestational age. Axial RARE MR image (4.4/64 [effective], 120° flip angle, 6-mm section thickness) through the chest at the level of the heart (small arrow) shows marked shift of the heart to the right side of the chest. There is a large, homogeneous unilocular cyst (large arrow) occupying the left side of the chest and extending anterior to the spine (S) and posterior to the heart.

View larger version (89K): [in a new window]   Figure 7. Left-sided congenital diaphragmatic hernia in a fetus of 22 weeks gestational age. Coronal T1-weighted fast low-angle shot MR image (174/4.1, 80° flip angle, 6-mm section thickness) shows the high-signal-intensity liver (straight arrows) extending into the chest above the diaphragmatic ridge (curved arrow). The meconium-filled bowel (arrowhead) has high signal intensity and extends to the apex of the chest.