Introduction
Diagnostic dilemma occurs in cases of congenital lesions of lung in children simply because of wide range of spectrum which includes Congenital Cystic Adenomatoid Malformation (CCAM), Congenital Lobar Emphysema (CLE), Bronchopulmonary Sequestration (BPS) and Bronchogenic Cyst (BC). CCAM occurs with an incidence of 1 in 10,000 to 25,000 pregnancies, and is the commonest lung cyst.1 Children with congenital lung lesions may present at any age in life, from the newborn period to adulthood, and some of them may remain asymptomatic throughout life.2,3 Symptomatic lesions require surgical resection.4 The management of asymptomatic lesion is controversial, while some advocate surgical excision, others recommend resection only when symptoms occur.5,6 The study was undertaken to highlight the difficulties in diagnosis as many of them present to us with a misdiagnosis of either pulmonary tuberculosis or pneumothorax. By the time they present to us most of them have already received anti tubercular drugs or intercostals drainage which further complicate the management of such children suffering from cystic lesions of lung.
The aim of this study was to highlight the difficulty in diagnosis of congenital lesions of lung in children, and to create awareness among the physicians regarding avoiding the use of anti-tubercular treatment (ATT) and intercostal drainage (ICD) in managing these surgical conditions.
Methodology: Retrospective analysis of records of all the children diagnosed with congenital lesion of lung and treated in our department from January 2005 to December 2018. Informed consent from the parents taken at the time of admission.
Inclusion criteria included cases which received either ATT or intercostals drainage before being referred to us. Investigations included X -ray, Contrast enhanced tomography. All cases were operated after confirming the diagnosis by single experienced surgeon by Posterolateral thoracotomy. Resected specimens were sent for histopathological examination. Postoperatively children were followed up 06 monthly for first year then annually thereafter.
Results: A total of 27 cases of congenital lesions of lung were operated between Jan 2005 –Dec 2018. Out of these 27, 13 (48.1%) received either ATT or ICD and formed our study group. Out of these 13, 8(61.5%) received ATT, while 5 (38.5%) received ICD as initial management before being referred to us. There were 19 (70.3%) male and 8(29.7%) females.
The most common lesion was CCAM seen in 6 (46.1%) followed by CLE 4(30.7%), BPS in 2 (15.3%) and Bronchogenic cyst 1(7.6%). Children demographic profile, clinical presentation, site of lesions and surgical procedure done are shown in table1.