Case Report: Prenatal and Postnatal Management for Fetal Bronchogenic Cysts During the COVID-19 Pandemic

Abstract

Background: A fetal bronchogenic cyst (BC) is a rare congenital anomaly with an incidence of 0.147-0.238‰. The coronavirus disease 2019 (COVID-19) pandemic, as a particular situation, hindered pregnant women from receiving periodic prenatal checkups. Case Description: Until 34⁺⁶ weeks of gestation, a fetal case of the intrathoracic cyst was found by ultrasound examination. Further, MRI examination confirmed the diagnosis of the congenital mediastinal cystic lesion, probably a BC. Genetic testing was not conducted due to the COVID-19 pandemic. At 38⁺⁵ weeks of gestation with maternal COVID-19 testing negative, a live girl was delivered by cesarean section. Five months later, the child underwent bronchocystectomy, and the postoperative pathological lesions confirmed a (right upper mediastinum) BC. Conclusion: Herein, we reported the prenatal and postnatal management for a rare case of the congenital BC by multidisciplinary approaches during the COVID-19 pandemic. Fetal MRI and screening for fetal chromosomal abnormalities are especially recommended. This case contributes to the awareness that the COVID-19 pandemic interferes with regular follow-up schedules during pregnancy and may interfere with timely performed additional tests; which leads to more accurate genetic counseling. A combination of multidisciplinary approaches, including radiology, infection control, genetic counseling, obstetrics, and pediatric surgery, is pivotal for managing fetal BC during the COVID-19 pandemic.

Keywords: COVID-19 pandemic; MRI; bronchogenic cyst; multidisciplinary approaches; prenatal and postnatal management.

Figure 1

Ultrasound at 34⁺⁶ weeks of gestation. The three-vessel trachea section of the fetus showed an anechoic area of 1.3 × 1.4 × 1.3 cm (white arrows) on the right side of the thorax, with clear boundaries and without vascular supply; the trachea was compressed and flattened.

Figure 2

Fetal MRI at 35⁺³ weeks of gestation. An ovular-like area with long T1 and long T2 signal (white arrows) was found in the upper right thoracic cavity, on the right side of the lower trachea, above the ridge of the trachea. The boundary was clear, and the size of the lesion was about 1.5 × 1.2 × 1.5 cm.

Figure 3

(A) Chest CT scan of the newborn 3 days after birth. An irregular low-density lesion with a diameter of about 16 mm was seen in the upper right mediastinum, with a slightly unclear boundary. The CT value was about 8 Hu. No abnormal thickening of the pleura was observed, and no signs of effusion were observed in the pleural cavity. (B) Postoperative pathological findings show a bronchogenic cyst.