Aspects diagnostiques et thérapeutiques des malformations pulmonaires congénitales symptomatiques de l’enfant au Mali

Abstract

Symptomatic congenital pulmonary malformations (CPM) in child are rare. The diagnosis is based on clinical, radiological and histopathological confrontation. The aim of this study is to derterminate the diagnostic, therapeutic and evolutionary profile of CPM in a poor ressources country. This was a retrospective study over a period of 8 years (from January 2012 to March 2020), including 13 cases treated for CPM in the thoracic surgery department of a teaching hospital in Mali. Among patients, we found 5 cases of congenital lobar emphysema (38.8%), 4 cases of pulmoary cyst (30.8%), 3 cases of cystic adenomatoid malformation of the lung (23%) and 1 case of pulmonary sequestration(7,7%). The sex ratio was 2,2. All patients were symptomatic with an average age of 8,5 months. The symptoms were dominated by respiratory infection (38,4%), dyspnea (30,8%), dyspnea with cyanosis(7,7), dyspnea with thoracic pain (7,7%), respiratory distress (7,7%) and hemoptysis (7,7%). The chest X-ray has allowed to orient the diagnosis in most cases and the thoracic scan set it in 100% of the cases. All the patients underwent surgery by thoracotomy. Lobectomy was done for 53,8 % followed by cystectomy in 30,8%, segmentectomy (7,7%) and pneumonectomy (7,7%) of patients. Histopathological examination confirmed the diagnosis of malformation in all cases. The postoperative outcome was uneventful for all the patients. Clinical manifestations evoks the diagnosis of symptomatic CPM, the chest X-ray allowed to orient it and the thoracic scan set it in all cases. The treatment is mainly surgical.

Keywords: Pulmonary malformation, diagnosis, treatment, child, Mali.