Congenital diaphragmatic hernia and neonatal lung lesions.

Increasingly, the diagnoses of chest lesions in infants are made not by symptoms of respiratory distress but by prenatal imaging. Because the availability and quality of prenatal imaging have increased, so has the frequency of prenatal diagnoses that include symptomatic and asymptomatic lesions. Early prenatal diagnosis of life-threatening lesions, such as congenital diaphragmatic hernia (CDH) and congenital cystic adenomatoid malformation (CAM or CCAM), allows detailed evaluation and subspecialty referral but may lead to decisions for pregnancy termination. It is imperative that counseling physicians have accurate and up-to-date information about prognosis in these difficult situations. Improved prenatal imaging also identifies lesions that may resolve spontaneously or may otherwise remain asymptomatic. As we gain in understanding of the natural history of these lesions, the advisability of routine surgical resection of asymptomatic lesions can be evaluated better. This article discusses the embryologic development, diagnosis, treatment, and outcome of CDH and lung lesions of infancy. The focus is primarily on recent developments in the last decade and addresses areas of evolving controversy. Earlier writings are cited as needed to illustrate important historical points, identify concept development, and re-evaluate outdated thinking.