Fetal MRI of Torsed Bronchopulmonary Sequestration with Tension Hydrothorax and Hydrops in a Twin Gestation

While bronchopulmonary sequestration typically has a benign course, this congenital lung malformation has a high mortality rate when associated with untreated in utero tension hydrothorax and hydrops. Hydrops related to bronchopulmonary sequestration is believed to result from torsion of the mass with compromise of the associated blood supply. The impaired venous return of the mass then leads to tension hydrothorax with compression of the heart and mediastinal vessels, impairing global venous return. To our knowledge, this scenario has only been described prenatally by ultrasound. We present the imaging findings of a dichorionic, diamniotic twin gestation with one fetus developing tension hydrothorax and hydrops from presumed intermittent torsion of a bronchopulmonary sequestration. This diagnosis was only able to be confirmed by MRI prior to the use of ultrasound-guided interstitial laser photocoagulation for the treatment of this anomaly.

Long-term outcome following interstitial laser photocoagulation of benign cold thyroid nodules

AimTo evaluate the long-term efficacy of interstitial laser photocoagulation (ILP) in solitary benign thyroid nodules.Design and methodsA total of 78 euthyroid outpatients (45 participating in randomized trials) with a benign solitary solid and scintigraphically cold thyroid nodule causing local discomfort were assigned to ILP. ILP (using one laser fiber) was performed under continuous ultrasound (US) guidance and with an output power of 1.5–3.5 W. Thyroid nodule volume was assessed by US and thyroid function determined by routine assays, before and during follow-up. Pressure symptoms and cosmetic complaints were evaluated on a visual analogue scale (0–10 cm). Of the total patients, six had thyroid surgery 6 months after ILP and three were lost to follow-up. The median follow-up for the remaining 69 patients was 67 months (range 12–114).ResultsThe overall median nodule volume decreased from 8.2 ml (range 2.0–25.9) to 4.1 ml (range 0.6–33.0; P<0.001) at the final evaluation, corresponding to a median reduction of 51% (range: −194 to 95%). This correlated with a significant decrease in pressure as well as cosmetic complaints. After 12--96 months (median 38 months) of ILP, 21 patients (29%) had thyroid surgery because of an unsatisfactory result. All had benign histology. Thyroid function was unaltered throughout and side effects were restricted to mild local pain.ConclusionUS-guided ILP results in a satisfactory long-term clinical response in the majority of patients with a benign solitary solid cold thyroid nodule. Further large-scale studies should aim at optimizing selection criteria for ILP, preferably in randomized studies.

Randomized prospective study comparing a single radioiodine dose and a single laser therapy session in autonomously functioning thyroid nodules

Objective: To compare the efficacy of interstitial laser photocoagulation (ILP) with radioiodine in hot thyroid nodules. Design: Thirty consecutive outpatients with subclinical or mild hyperthyroidism and a scintigraphically solitary hot nodule with extraglandular suppression were randomized to either one ILP session or one radioiodine (131I) dose. Methods: ILP was performed under continuous ultrasound-guidance and with an output power of 2.5–3.5 W. 131I was given as a single dose based on thyroid volume and a 24-h thyroid 131I uptake. Thyroid function and nodule volume were evaluated at inclusion and at 1, 3 and 6 months after treatment. Results: Normalization of serum TSH was achieved in 7 out of 14 patients in the ILP group and in all 15 patients in the 131I group (P=0.0025). In the ILP group, mean thyroid nodule volume reduction was 44±5% (s.e.m.; P<0.001), and in the 131I group 47±8% (P<0.001), within 6 months, without between-group difference (P=0.73). The mean reduction of total thyroid volume was 7±5% in the ILP group (P=0.20) and 26±8% (P=0.006) in the 131I group (P=0.06 between-group). Two patients in the 131I group developed hypothyroidism but no major side effects were seen. Conclusions: This first randomized study, comparing ILP with standard therapy, demonstrates that ILP and 131I therapy approximately halves thyroid nodule volume within 6 months; but in contrast to 131I, extranodular thyroid volume is unaffected by ILP and no patient developed hypothyroidism. Using the present design, ILP seems inferior to 131I therapy in normalization of serum TSH. The potential value of ILP as a non-surgical alternative to 131I needs further investigation.