Pulmonary Sequestration (BPS) Fetal MRI

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Feeding artery + size/effusion/hydrops
   Feeding artery + size / effusion / hydrops? (Pulmonary sequestration = non-functioning lung tissue, not communicating with the tracheobronchial tree, with systemic arterial supply. Color Doppler showing a feeding artery from the aorta is characteristic; fetal MRI confirms the mass + feeding vessel + characterization. Intralobar (75%) vs extralobar (25%, can be infradiaphragmatic, often with CDH). Differentiate from CPAM (pulmonary circulation supply), neuroblastoma (infradiaphragmatic).)
   • Well-defined echogenic/T2-high mass + aortic supply, no effusion/hydrops (most cases) → Typical sequestration · good prognosis
   • Large mass causing mediastinal shift / pleural effusion / hydrops, or a hybrid lesion → Large/effusion/hydrops → fetal intervention
2. [End] Typical sequestration · good prognosis
   Typical sequestration (echogenic/T2-high solid mass + feeding artery from the aorta, no effusion/hydrops): good prognosis, often shrinks prenatally; serial ultrasound follow-up, MRI if needed; postnatal contrast CT to confirm the feeding artery, resect if symptomatic.
3. [End] Large/effusion/hydrops → fetal intervention
   Large mass causing mediastinal shift/pleural effusion/hydrops, or a hybrid lesion (CPAM + sequestration features): can cause high-output/hydrops; fetal therapy — pleural effusion → thoraco-amniotic shunt, feeding vessel → laser/radiofrequency ablation, microcystic CPAM component → maternal steroids; multidisciplinary + serial monitoring.

Source guidelines & references

• Fetal pulmonary sequestration MRI and Doppler feeding artery (intralobar/extralobar, hybrid lesions)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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