Prenatal detection and urgent surgical resection of a mesenchymal hamartoma of the chest wall in a neonate

Abstract

Mesenchymal hamartomas of the chest wall are rare lesions usually detected incidentally in the neonatal and pediatric populations. Despite having a rather alarming appearance on imaging, these lesions are generally benign and carry virtually no risk of malignant transformation. Thus, management is primarily conservative for asymptomatic lesions while surgical resection is reserved for the more severe and symptomatic cases. Herein, we report our experience in the prenatal detection of a large mesenchymal hamartoma of the chest wall at gestational week 33 and the subsequent emergent resection of the lesion after the neonate was delivered prematurely due to spontaneous rupture of membranes. The patient was found to be in respiratory failure and a CT chest confirmed the presence of a large intrathoracic mass on the right side causing pulmonary hypoplasia due to mass effect. The patient underwent excision of the mass just five hours after birth, after which he had a prolonged course in the neonatal intensive care unit. In this case report and literature review, we demonstrate our prenatal findings and discuss the pathology, clinical presentation, radiologic findings, management and possible complications of this clinical entity. © 2022