Key Points

• Many congenital lung lesions are diagnosed antenatally.
• Most lung lesions have a benign prenatal course, with peak size in mid-gestation followed by slowed growth or regression.
• Indications for fetal surgical resection are fetal hydrops with evolving fetal heart failure.
• Indications for postnatal resection include: symptomatic lesions, or asymptomatic lesions that affect a significant portion of a lung lobe, or those that may be increasing in size or show suspicious radiologic features concerning for possible malignancy.
• Long-term results following resection are excellent.

Congenital lung abnormalities include the broad category of bronchopulmonary foregut anomalies, simple cysts, hypoplasia, and agenesis of the lung. Prenatal ultrasonography is able to diagnose most of these lesions during the second trimester of pregnancy and has thus improved our understanding of their natural history and optimized perinatal management. The clinical presentation of infants with these abnormalities varies from critically ill to asymptomatic. Many of these infants will require surgical therapy for their lesion, sometimes on an emergency basis.