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Hepatic Pulmonary Fusion in Neonates

Thomas L. Slovis1, Diana L. Farmer2, Walter E. Berdon3, Raja Rabah4, John B. Campbell5 and Arvin I. Philippart2

1 Department of Pediatric Imaging, Children's Hospital of Michigan, 3901 Beaubien Blvd., Detroit, MI 48201.
2 Department of Pediatric Surgery, Children's Hospital of Michigan, Detroit, MI 48201.
3 Department of Radiology, Babies and Children's Hospital of New York, 3975 Broadway, Rm. 3-318, New York, NY 10032.
4 Department of Pathology, Children's Hospital of Michigan, Detroit, MI 48201.
5 Department of Radiology, Arnold Palmer Hospital for Children and Women, 92 W. Miller St., Orlando, FL 32806.



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  		Fig. 1. —4-day-old boy with hepatic pulmonary fusion and moderate respiratory distress. Frontal chest radiograph shows right shift of mediastinum, minimal liver opacity in abdomen, and mass within right hemithorax. Right lung is hypoplastic.

 


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  		Fig. 2. —2-day-old girl with hepatic pulmonary fusion and respiratory distress. Frontal chest radiograph shows hypoplasia of right lung and mass within right hemithorax. Mediastinum has not shifted. Note liver is seen in abdomen.

 


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  		Fig. 3. —1-day-old boy with hepatic pulmonary fusion and mild retractions.

A, Frontal chest radiograph shows small posterior paraspinal mass on right side (arrow). Small mass has not affected mediastinal position.

 


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  		Fig. 3. —1-day-old boy with hepatic pulmonary fusion and mild retractions.

B, Lateral chest radiograph shows small posterior paraspinal mass (arrow).

 


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  		Fig. 4. —6-hour-old girl with hepatic pulmonary fusion and severe respiratory distress.

A, Frontal chest radiograph shows large mass in right chest (right diaphragmatic hernia). Mediastinum shifted away from lesion; image does not show reason for fusion.

 


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  		Fig. 4. —6-hour-old girl with hepatic pulmonary fusion and severe respiratory distress.

B, Histology of postmortem specimen reveals lung in upper field in continuity with liver in lower field. Membranous tissue separates lung and liver (arrowheads) with no pleura or liver capsule.

 


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  		Fig. 5. —1-day-old girl with hepatic pulmonary fusion and mild retractions of intercostal muscles.

A, Frontal chest radiograph shows two masses in right hemithorax (arrow on smaller mass) with small shift of mediastinum.

 


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  		Fig. 5. —1-day-old girl with hepatic pulmonary fusion and mild retractions of intercostal muscles.

B, Follow-up frontal chest radiograph (at 5 weeks old) reveals liver almost filling right hemithorax with mediastinal shift away from lesion.

 


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  		Fig. 5. —1-day-old girl with hepatic pulmonary fusion and mild retractions of intercostal muscles.

C, Histology reveals nodule of liver (arrowheads) embedded in lung tissue (sequestration). Fused lung-liver interface was separated but not resected.

 

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