Neonatal Lung Lesions with Dr. Steven Rothenberg
With Dr. Steven Rothenberg · hosted by Dr. Ian Glenn & Dr. Todd Ponsky · StayCurrentMD
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
More about congenital pulmonary airway malformation (CPAM)
same diagnosisOnly a few other public items share this diagnosis — nothing to add yet.
Video
Update Course Rewind: Pectus Excavatum 2021
Dr. Todd Ponsky · 11 min · Published Aug 2022
Podcast
Update Course Rewind: Pectus Excavatum 2021
11 min · Published Aug 2022
Video
Update Course Rewind: Thoracotomy vs VATS for Lung Metastases
Dr. Todd Ponsky · 9 min · Published Dec 2021
Video
Thoracoscopic TEF Repair, Is It Really Better Than Open? Update Course 2018
18 min · Published Aug 2018
Video
Pediatric Surgical Oncology Research Collaborative (PSORC): Studying Rare Pediatric Tumors
56 s · Published May 2026
Video
Update Course Rewind 2025: Hirschsprung + ARM: Rare but Real
1 min · Published May 2026
Video
Update Course Rewind 2025: Hirschsprung + ARM: Rare but Real
1 min · Published May 2026
Video
Pooling Patients to Study Rare Pediatric Tumors: An Introduction to PSORC
56 s · Published May 2026
Video
The fetal frontier: A review of current and emerging fetal therapies for genetic diseases
44 s · Published May 2026
Video
Indocyanine green assists with sentinel lymph node mapping in pediatric and adolescent patients
1 min · Published May 2026
What the experts said
6-40% of prenatally diagnosed lung lesions regress with time and may appear to completely disappear
Fetal intervention for lung lesions is extremely rare; CHOP performs open fetal surgery less than once every couple of years
Cyst volume ratio (CVR) greater than 2 has an extremely bad prognosis for fetal lung lesions
Hybrid lesions showing features of both CPAM and sequestration are not uncommon on pathology
Intralobar sequestration shares a common pleura with the lobe, usually the lower lobe
Extralobar sequestration has its own pleural lining and is 90% separate from the lobe
Sequestrations are defined by having a systemic artery coming directly off the aorta
Systemic vessels to sequestrations can come off the abdominal aorta and pass through the diaphragm
CPAM type 3 lesions are more solid and have the worst prognosis
Chest X-ray alone is not adequate to ensure there is no residual lung lesion after prenatal diagnosis
20-40% of untreated congenital lung lesions will develop significant infection at some point
The incidence of malignancy in untreated congenital lung lesions is over 1% in Rothenberg's series
Operating by 3 months of age avoids pneumonia or severe respiratory infection before surgery
Surgery is technically easier in younger infants because vessels are smaller and anatomy is fresh
Even asymptomatic patients often have enlarged lymph nodes and inflammation in fissures by one year of age
Hospital stay, chest tube duration, recovery, and operative time are less in patients under 5 kg compared to those under 10 kg
Most infants undergoing early lobectomy are discharged within 48 hours
By one month post-op, chest X-ray shows no evidence of prior surgery due to compensatory lung growth
Most asymptomatic infants will tolerate single lung ventilation without problem
Babies initially desaturate after lung collapse but saturations improve once they stop shunting blood to the collapsed lung
End-tidal CO2 in the mid-40s during thoracoscopy does not cause significant acidosis or deleterious effects
Standing at the patient's front provides more room from the chest wall to the hilum than standing at the back
The camera port should be anterior to the tip of the scapula in the mid-axillary line to allow working from front to back
A 4mm scope provides a more wide-angle view comparable to a 5mm scope compared to a 3mm scope
Short scopes (20cm) allow the surgeon to get close to the patient without the assistant getting in the way
3mm vessel sealing devices can seal vessels up to 5mm in diameter
Making two separate seals 4-5mm apart on vessels and cutting between them maximizes safety
Cutting partway through a sealed vessel until seeing the lumen allows detection of bleeding while maintaining control
Clips on vessels can be knocked off and are less reliable than vessel sealing
Using energy devices that seal and cut simultaneously is a mistake that sets up the surgeon for trouble
Every sealing device can fail at some point, so techniques should allow for recovery
The inferior pulmonary ligament should be taken down first to check energy source function and identify systemic vessels
Systemic vessels to sequestrations can be missed on CT scan and should be actively looked for during surgery
Incomplete fissures can be completed by working through tissue layer by layer, similar to finger fracturing in liver surgery
The bronchus sits directly underneath the pulmonary artery and can be felt to aid dissection
The pulmonary vein is directly behind the bronchus in the same plane as the fissure dissection
A 5mm stapler is inadequate for bronchus or vessels in children over 10 kg
The pulmonary vein trunk must never be taken near the pericardium because retraction into the pericardium after device failure causes fatal hemorrhage
Middle lobe vessels come off just above the right lower lobe pulmonary artery and can be damaged if dissection migrates too cephalad
Large cysts should be decompressed with the sealing device at the beginning of the procedure to improve visualization and lung manipulation
Systemic vessels to sequestrations can number up to 6 and range from small to 15mm in diameter
Using both sealing technology and clips on the same vessel risks delayed bleeding as the vessel changes nature and clips lose secure footing
Systemic vessels to sequestrations have higher pressure from the aorta compared to low-pressure pulmonary vessels
Extralobar sequestrations become infected and can cause problems even if malignant potential is uncertain
Embolization of sequestrations requires general anesthesia and significant arterial intervention with no advantage over thoracoscopic resection
Extralobar sequestration resection does not require a chest tube and patients go home the next day
Segmentectomy is feasible when disease is confined to the superior segment of lower lobe or lingula with favorable anatomy
Average length of stay for lobectomy in patients coming in the morning is about 2.5 days