Strategies for Managing Neonates with Congenital Lung Mass Presenting with Respiratory Distress

Abstract Background: Congenital lung mass is a group of entities which are usually prenatally diagnosed and not uncommon. However, patients that present with respiratory distress in neonatal period and require emergency intervention seem to be rare. Moreover, what is the best policy facing this condition has not reached a consensus in recent years. This study aims to evaluate the efficacy and safety of our strategies in managing neonates with congenital lung mass presenting with respiratory distress.Methods: We retrospectively reviewed the data of five congenital lung mass neonates presenting with respiratory distress from April 2020 to April 2022 for whom different strategies were adopted and favorable outcomes were obtained. The clinical presentations, complications, histological examination, and treatment were analyzed. Literature concerning neonates with respiratory distress undergoing emergency interventions due to large lung lesions was also reviewed.Results: All the neonatal patients were prenatally diagnosed with congenital lung mass, and among them, four neonates with cystic lung masses accepted percutaneous thoracic catheter drainage prior to surgery. One neonate with a cystic lung mass experienced prompt open lobectomy due to little alleviation of respiratory symptoms after two maneuvers. The other three patients obtained good drainage of the large air-filled cyst, thus gaining the opportunity for elective thoracoscopic surgery in median 48 d. The fifth case directly underwent emergency surgery due to the solid nature of the lung lesion. Four patients were diagnosed with congenital pulmonary airway malformation, and the fifth patient was diagnosed with a fetal lung interstitial tumor according to the pathological findings. There were no major complications, such as major bleeding, air leakage or death.Conclusions: For neonates with cystic lung masses presenting with respiratory distress due to mediastinal compression, percutaneous thoracic catheter drainage and subsequent elective thoracoscopic surgery were superior to emergency thoracotomy in terms of safety and parenchyma-sparing surgery based on the study and literature. For those with solid lung lesions whose CVR value is no less than 1.6, either EXIT surgery or emergency thoracotomy is a reliable strategy depending on the medical resources available.