PULMONARY CYSTS IN INFANTS AND CHILDREN
Cysts may be detected in the lungs of infants or children, during an ultrasonography performed during the pregnancy or during the postpartum examinations.
These cysts might be:
- Congenital Cystic Adenomatoid Malformation (CCAM),
- Lobar Emphysema,
- Bronchogenic Cyst or
- Pulmonary sequestration.
Congenital Cystic Adenomatoid Malformations (CCAM)
These cysts are detected when the baby is in the womb. They usually appear in the lower parts of the lung. They may be in the form of small multiple cysts or a single large cyst.
The treatment is determined based on the size of the cyst and the emergent complaints from the infant or child. If there is no complaint, the condition of the cyst is determined by means of a chest X-ray taken immediately after the birth. 3 months after this procedure, a computed thorax tomography is performed to see the condition of the cyst more clearly, regardless of whether there is any complaint. If there is a growth compared to the first chest X-ray image; or if frequent infection or respiratory insufficiency symptoms appear in the child, the affected part is surgically removed. If there is not such a condition, and if the diameter of the cyst is too small, surgery is not required. However, the lung cysts should be regularly followed-up by a physician.
As for large cysts, they are surgically removed within a year after the birth, regardless of whether there is any complaint or symptom. The possibility of respiratory problems and frequent infection that the infant may encounter in the future is eliminated.
The Operation Can be Done in Two Ways:
1. Open Method – the chest is opened between the ribs, and then the affected lobe is removed. The infant needs to spend 1 night in the intensive care unit after the surgery. The hospitalization period is about 7 days.
2. Closed Method – Thoracoscopy: The chest is not opened between the ribs. Image is taken with a camera pushed forward through a 3cm-incision, and the affected part is removed through the same incision by using special instruments. This method requires a specific experience. It is applied only in advanced medical centers. In our country, surgery with single-port thoracoscopy (VATS) in children or infants is done only in Acibadem Maslak Hospital.
The operation does not require postoperative intensive care. The hospitalization period is 3 or 4 nights.
Even if the surgery is performed by thoracic surgeons, an experienced pediatric surgeon should be included in the surgical team, as well.
- Bronchogenic cysts generally do not cause clear symptoms, and they are smaller than CCAM.
- The infant or child does not need to be operated as long as the cysts do not cause frequent infections.
- Operation is required only when the cyst gets infected or inflamed.
- The surgery must be preferred to be performed with closed, i.e. thoracoscopic procedure, in order to ensure the minimum harm to the infant or child.
Congenital Lobar Emphysema
This usually appears in the upper lobe of the lung, and causes a significant respiratory problem in the infant. Therefore, sometimes the infant needs to be operated immediately after birth.
- It is a condition where a lobe of the lung cannot function due to its abnormal vascular structure.
- Because it causes frequent infections and bleeding, a surgery is needed.
- The surgery should be performed within 6 to 12 months after the birth, if any problem is not observed in the infant.
- During the surgery, the thoracoscopic (VATS) procedure should be preferred to the open surgery procedure.