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Suite 210 Charlotte, NC 28207

Procedures

The board certified Pediatric Surgeons at Pediatric Surgical Associates, P.A. work closely with primary care providers and pediatric specialists to provide outstanding surgical consultation and treatment to children from birth to age 18. Pediatric Surgeons provide treatment in the areas of general, thoracic, and laparoscopic surgery, utilizing the most current, technologically advanced techniques available today. This includes minimally invasive surgery to promote quicker recovery time and quality outcomes.

The Pediatric Surgeons at PSA evaluate, diagnose, and treat a very wide range of conditions. We have provided an alphabetic listing of diagnoses below. As this is not all-inclusive, please contact our office if you have any questions and a member of our clinical staff will be happy to assist you.

Our Most Common Procedures


Other Procedures

  • Dehydration
  • Dermoid Cyst
  • Diaphragm Eventration
  • Empyema
  • Enterocolitis
  • Esophageal Atresia
  • Esophageal Foreign Body
  • Esophageal Stricture
  • Failure to Thrive
  • Fecal Impaction
  • Feeding Difficulties and Management
  • Foreign Body in Airway
  • Foreign Body in Soft Tissue
  • Ganglion Cyst
  • Gastrocutaneous Fistula
  • Gastroesophageal Reflux
  • Gastrostomy Complications
  • Gastroschisis
  • Hemangioma
  • Hematemesis
  • Hematochezia
  • Hemolytic-Uremic Syndrome
  • Hemophilia
  • Hepatoblastoma
  • Hereditary Spherocytosis
  • Hernia
  • Hirschprung’s Disease
  • Hodgkin’s Disease
  • Hydrocele
  • Hydrocephalus
  • Hypoxemia
  • Immune Thrombocytopenic Purpura (ITP)
  • Imperforate Anus
  • Ingrowing Nails
  • Intestinal Atresia
  • Intestinal Stricture
  • Intussusception
  • Ischemic Bowel
  • Jaundice
  • Labial adhesions
  • Leukemia
  • Lingual Frenulum (tongue-tie)
  • Lipoma
  • Liver Disease
  • Lymphadenitis
  • Lymphadenopathy
  • Lymphangioma
  • Lung Diseases
  • Malignant Neoplasm
  • Malnutrition
  • Malrotation
  • Meckel’s Diverticulum
  • Meconium Plug Syndrome
  • Melanoma
  • Melena
  • Minimally Invasive Surgery
  • MRSA (Methicillin-resistant staphylococcus aureus)
  • Myelodysplasia
  • Necrotizing Enterocolitis
  • Neoplasm of Uncertain Behavior
  • Neuroblastoma
  • Omphalocele
  • Osteogenesis Imperfecta
  • Osteomyelitis
  • Ovarian Teratoma
  • Ovarian Torsion
  • Ovarian Tumors
  • Patent Urachus
  • Patent Ductus Arteriosus (PDA)
  • Pelvic Abscess
  • Perirectal Abscess
  • Peritonitis
  • Phimosis
  • Pilonidal Cyst
  • Pneumonia
  • Pneumoperitoneum
  • Pneumothorax
  • Polydactyly (Extra Digits)
  • Precocious Puberty
  • Prematurity
  • Prenatal Consultation
  • Pulmonary Sequestration
  • Pyloric Stenosis
  • Pyogenic Granuloma
  • Rectal Prolapse
  • Renal Failure
  • Respiratory Arrest
  • Respiratory Distress
  • Respiratory Failure
  • Rhabdomyosarcoma
  • Sacrococcygeal Teratoma (SCT)
  • Scoliosis
  • Sepsis
  • Short Gut Syndrome
  • Sickle-cell Anemia
  • Small Bowel Obstruction
  • Thyroglossal Duct Cyst
  • Torticollis
  • Tracheoesophageal Fistula (TEF)
  • Trisomy 13
  • Ulcerative Colitis
  • Undescended Testes
  • Vascular Access Infection
  • Volvulus
  • Vomiting
  • Wilm’s Tumor
Minimally Invasive Surgery
Minimally invasive surgery (MIS) refers to a variety of techniques that limit the impact of surgical procedures on patients. This can mean less pain, less scarring, better cosmetic result, quicker recovery, or fewer complications due to infection or scar formation. Most commonly, MIS procedures involve the use of a camera passed through a small incision (3 or 5 mm), along with several other small incisions for the insertion of instruments. In the abdomen, this is called laparoscopy. In the chest, this is called thoracoscopy. MIS is relatively new, beginning in the early 1990s. MIS was initially limited in children, because the small spaces in the abdomens and chests of pediatric patients required specially made, smaller instruments and greater surgical skill. In recent years, however, Pediatric Surgeons have worked diligently to develop appropriate equipment and techniques for a wide variety of MIS applications in children.

The surgeons of Pediatric Surgical Associates (PSA) continue to bring the most advanced pediatric MIS techniques to the children of the Carolinas, offering considerable benefits to patients and their families. MIS techniques have been introduced and are becoming routine in the treatment of many conditions. At PSA, we will consider MIS in any patient as long as it is safe and reasonable. We make sure our patients and their families are well-informed about the potential advantages and disadvantages of these ever-evolving surgical techniques. Below are some of the most common conditions in which we would consider MIS techniques.

Abdominal Conditions

  • Achalasia (Heller Myotomy)
  • Anorectal Malformations (Imperforate Anus)*
  • Any intestinal resection
  • Appendicitis
  • Crohn’s Disease
  • Duodenal Atresia*
  • Feeding Tube Insertion
  • Gastroesophageal Reflux (Nissen Fundoplication)*
  • Hirschsprung’s Disease*
  • Intussusceptions*
  • Malrotation of the Intestines (Ladd’s Procedure)*
  • Meckel’s Diverticulum or Intestinal Polyp*
  • Ovarian Torsion and Cyst
  • Pyloric Stenosis*
  • Splenectomy
  • Ulcerative Colitis

Chest Conditions

  • Bronchogenic Cyst*
  • Cystic Lesions of the Lung (CPAM)*
  • Congenital Diaphragmatic Hernia*
  • Diaphragmatic Eventration*
  • Empyema (infected fluid in the lung space from pneumonia)
  • Esophageal Atresia*
  • Lung Biopsies
  • Pulmonary Sequestration*

* MIS procedures performed in infants

Appendicitis
There are many causes of abdominal pain in children, most do not need surgery. However, appendicitis is the most common reason for emergency surgery in children. The appendix is an intestinal remnant that sits at the beginning of the large intestine, just past the transition from the small intestine to the large intestine. Appendicitis is an infection of the appendix, often due to a blockage from swollen immune tissue, very hard stool pellets called fecaliths, or several more rare causes. It is often manifested by diffuse abdominal pain that progresses to more focused pain in the lower right side or around the belly button over the next 1 – 3 days. Other symptoms include low-grade fever, nausea, vomiting, or loss of appetite. In the beginning, appendicitis can seem like many other conditions, such as gastroenteritis (stomach bug), food poisoning or even simple constipation. If a child’s symptoms worsen, medical evaluation is warranted, usually by the child’s primary care physician. If he or she is suspicious of appendicitis, the surgeons of Pediatric Surgical Associates (PSA) are always available for consultation. Oftentimes, appendicitis in children can be diagnosed by the story, physical exam and blood-work alone, even without further x-ray studies, such as CT scans. We work closely with our referring physicians to minimize a child’s exposure to radiation, and to expedite getting the child to the appropriate place for care. The surgeons of PSA operate at both Levine Children’s Hospital (Carolinas Health System) and Hemby Children’s Hospital (Novant Health System), and are happy to accommodate the needs of the family. The vast majority of appendices can be removed with minimally invasive surgical techniques and most children go home the next day.

Perforated appendicitis is when the appendix has been found to be ruptured at the time of operation for appendicitis, or on preoperative imaging studies. In many ways, it can be considered both distinct from, and a more severe form of, appendicitis, as the clinical courses for patients with perforated versus non-perforated appendicitis are quite different. In perforated appendicitis, the infection contained within the appendix is now freely released into the abdomen, where it can continue to spread. Left untreated, it can lead to life-threatening shock. More frequently, the infection leads to an intra-abdominal abscess, as the body attempts to wall-off and block the infection from spreading. If the perforation is identified at the time of surgery, the appendix is removed in the usual fashion (often with minimally invasive techniques) and the abscess is broken up and washed-out. Due to the severity of the infection, recovery in the hospital is generally longer, 3 – 7 days, and a period of post-operative antibiotic therapy is required to help prevent the abscess from reforming. PSA has some of the lowest rates of postoperative abscesses in the country following surgery for perforated appendicitis, and we remain actively involved in research designed to improve the care of these patients. In some situations, an abscess may be identified with imaging studies before surgery, and it becomes the discretion of the surgeon either to operate at that time, or begin a trial of antibiotics alone. Sometimes a radiographically guided drain can aid in treatment. If the child responds to antibiotics +/- drain, then appendectomy can be deferred for several months allowing the scar tissue and inflammation from the infection to subside, making the subsequent operation safer.

Hernia

Inguinal Hernia

During fetal life in boys and girls, the testes or ovaries develop high in the abdomen near the kidneys. They are connected by a rope-like structure to the groin or scrotum, which guides them to descend into the pelvis. In girls, the ovaries settle here. In boys, the testes continue to descend through an opening in the groin, then pass through the inguinal canal and settle in the scrotum. In both boys and girls, a small opening in the groin remains, but usually closes over by itself. In about 4% of boys, the opening in the groin does not close properly, leading to inguinal hernia or a hydrocele. Girls can also develop an inguinal hernia in a similar way, but less commonly. In premature infants, failure of the hole to close is much more common, and the incidence of inguinal hernia may be as high as 40%.

What is the difference between an inguinal hernia and a hydrocele? When solid contents from inside the abdomen (usually fat or intestine) pass through the opening in the groin muscle, this is called an inguinal hernia. When fluid from the abdomen passes through the opening into the scrotum, this is called a hydrocele. An inguinal hernia manifests as a bulge or knot in the groin. This condition is usually apparent when the child is crying or straining. Most inguinal hernias are soft, painless and go in and out. However, if a hernia becomes stuck in the “out” position and becomes hard and painful, this is a condition known as incarceration. It is a dangerous situation that requires urgent evaluation by a surgeon, because the contents of the hernia (such as intestine) can become injured. A hydrocele, on the other hand, is not a bulge in the groin, but rather a bluish swelling on one side of the scrotum. It is typically apparent toward the end of the day when the child has been upright and active. In many cases, the fluid will go back into the abdomen while the child lies flat and sleeps during the night, such that the scrotum looks normal in the morning.

Inguinal hernias should be repaired within 4-6 weeks of diagnosis to avoid incarceration. Repair of inguinal hernia is one of the most common elective procedures performed by Pediatric Surgeons. The operation involves tying off the sac-like projection of abdominal wall lining that passes through the inguinal canal, preventing things from passing through in the future. Unlike adults, these hernias are generally not associated with muscle weakness, and no other reinforcing stitches or mesh are required. These operations are performed under general anesthesia and take less than an hour. Most children will be completely recovered within a week. Complications are rare for this operation but can include infection of the incision (<2%), recurrence of the hernia (<1%), or injury to the testicle in boys (<1%).

One controversial area is whether the side without a hernia should be “explored.” The chance of having a hernia on the other side is about 7%. In the past, exploration used to be routine. However, over the last decade, the indications for exploration have narrowed considerably. There are several points involved in making the decision as to whether an exploration is warranted, and these should be reviewed with your surgeon.

Umbilical Hernia

Umbilical hernias are the most common of hernias in children. Post birth, once the umbilical stalk dries up and falls off, the umbilical wound contracts and closes the abdominal wall defect where the stalk had been. If the contraction process is not complete, then a defect will persist, and the belly button will have a soft bulge that can be pushed back in. These bulges are commonly referred to as “outie” belly buttons, but really represent abdominal fat or intestines pushing up under the skin. Rarely do these hernias need surgical repair during infancy. In most children, the defect will spontaneously close over the next 2-4 years. Children with umbilical hernias that persist after 4 years of age are deemed candidates for surgical repair. Exceptions are those children who have experienced an episode of incarceration of the hernia, where intestine or abdominal fat gets stuck in the defect. Incarceration manifests as a hard, painful knot at the belly button. It represents a surgical emergency, since the intestines may be damaged in just a few hours if they remain stuck. Immediate surgical evaluation is needed. If the trapped contents of the hernia can be pushed back in, the hernia can be repaired electively in the near future. If the contents remain stuck, then emergency surgery is required. Other situations in which a hernia may be repaired prior to 4 years of age include large defects (>1.5cm) and those that are very protuberant, since neither is likely to close on its own. No matter the age of the child, the surgeons at Pediatric Surgical Associates are happy to discuss with parents their concerns regarding the presence of an umbilical hernia in their child, and if repair is indicated.

Epigastric hernia

These are small holes in the abdominal musculature between the belly button and the breast bone. Small bits of internal fat from the abdomen protrude through the hole, creating a knot under the skin that is most apparent when the child is standing up. The herniated fat can go in or out, or it may remain stuck within the hernia all the time. Epigastric hernias are usually not bothersome to children, but they do not go away on their own and slowly enlarge over time. Elective repair is recommended, not just for cosmetic reasons, but to avoid long-term problems such as the intestine getting stuck in the hernia during adolescence or adulthood. These operations are performed under light general anesthesia through very small incisions and take less than 30 minutes. Most children do not require pain medication other than Tylenol and will be completely recovered within several days. Complications of any kind are exceedingly rare.

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Chest Wall Deformities

Pectus Excavatum

Pectus Excavatum is a condition the affects the sternum (breastbone) and ribs and results in an indentation in the middle of the chest. It affects approximately 1 out of every 1000 children and is more common in boys than girls. The condition has a wide range of severity from a very mild depression to a severely “sunken” chest.

Depending on the severity of the condition, patients with pectus excavatum may have no physical symptoms or may have shortness of breath with exertion. This is due to compression of the heart and lungs by more severe indentations. Patients also frequently experience psychological distress and negative body image which can have significant impact on their well being.

Treatment of pectus excavatum requires surgery. There are two accepted surgical techniques that have been used for decades to correct pectus excavatum. The modified Ravitch Procedure involves removing the abnormal cartilage attachments, elevating the sternum, and placing a stabilizing metal bar that will be removed after the cartilage has regrown (typically about a year). The Nuss Procedure involves 2 small incisions and the placement of a bar that elevates the sternum. The abnormal cartilages are not removed, but the bar bends them and allows them to remodel. The bar is then removed typically 2-4 years later. Both surgical approaches require general anesthesia and hospital stays that average 5 days. The subsequent removal of the bar is usually an outpatient procedure for both approaches. Patients may have significant discomfort which will be aggressively managed. Physical activities are limited for several months after surgery as well.

Due to the physical and emotional problems that are caused by pectus excavatum, we encourage all patients to consider consultation with us to be evaluated and discuss treatment options. The surgery is usually performed between the ages of 12 and 16, but we can evaluate the patients at any age after 6 years. The surgeons of Pediatric Surgical Associates are well versed in both surgical techniques and will help the patients and families determine which approach if any would be most appropriate for the individual patient. Typically, surgical repair is not scheduled after the initial consultation as we prefer to educate the patients and families about their options and not rush anyone into such a major decision. A follow up visit will be scheduled. This also gives us time to obtain any additional studies that are frequently required by insurance carriers.

Pectus Carinatum

Pectus Carinatum is a condition that affects the chest wall and results in the sternum and cartilage protruding. Frequently referred to as “bird chest”, pectus carinatum is less common than pectus excavatum. It is much more common in boys than girls, and typically becomes more pronounced during early adolescent growth spurts.

Most patients with pectus carinatum have mild or no physical symptoms. Many experience significant psychological distress and negative body image.

Treatment options for pectus carinatum can include both surgical and non-surgical methods. Surgical options include the Ravitch procedure in which the abnormal cartilage is removed and the sternum stabilized in the appropriate position using a metal bar. Surgical recovery involves an in-patient hospital stay for several days, a few weeks of discomfort, and restricted activities for several months. The bar is then removed about a year later as an outpatient procedure when the cartilage has re-grown in a corrected position. Many patients are also candidates for non-operative treatment with compression bracing.

At Pediatric Surgical Associates, we will meet with the patient and family to perform a thorough examination and discussion of the options. We often recommend non-operative treatment options and help make the appropriate referrals to the practice with the most experience with bracing. Typically, surgical repair is not scheduled after the initial consultation as we prefer to educate the patients and families about their options, and set up referrals for non-operative bracing options so patients can be fully informed of their options before they make any decisions.

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Prenatal Consultation

Having a child can be one of the most exciting but also anxiety-provoking experiences a couple will go through. The advancements in prenatal obstetrics and ultrasound have resulted in early prenatal diagnosis of many conditions. Many of these conditions ultimately will require surgical intervention for your infant. Some of the prenatally-diagnosed conditions we frequently treat are:

  • Congenital Cystic Adenomatoid Malformation (CCAM)
  • Congenital Diaphragmatic Hernia (CDH)
  • Gastroschisis
  • Giant Neck Mass
  • Pulmonary Sequestration
  • Omphalocele
  • Sacrococcygeal Teratoma (SCT)

Each of these conditions can be identified by ultrasound before the child has been born and may require treatment after birth. When the birth defect is identified we encourage you to meet with us for a prenatal consultation. A referral is frequently offered by the obstetrician, sometimes one who specializes in high-risk pregnancies. During your prenatal consultation you will meet with one of the surgeons in our group and we will explain the surgical implications of the prenatal findings. Other aspects of the prenatal visit include anticipated surgical procedures needed, expected outcomes, and what should be expected in terms of time frame of events on the day of birth and the days and weeks after. We also know that you will have several questions and we want to make sure you can get all of those answered.

Things move rapidly once you go into labor and progress toward delivery; it can be difficult to process all the events as they happen, especially with a newborn that might need immediate medical attention. By having a prenatal consultation you will have a better understanding of the process and what to expect. Many of your questions will already be answered, and you will already have met a member of the surgical team that will be caring for your child.

The surgeons of Pediatric Surgical Associates (PSA) all have a vast experience in dealing with a wide range of prenatal conditions. Many of these conditions can be treated with cutting edge minimally invasive techniques in which our surgeons are well-versed. PSA cares for patients at both Levine Children’s Hospital and Hemby Children’s Hospital. We have good working relationships with the high risk obstetricians and neonatologists serving both hospitals.

Congenital Cystic Adenomatoid Malformation (CCAM or CPAM)

This is a cystic or solid appearing non-malignant tumor of the lung. Most of these do not require immediate removal. However, extremely large masses may require more immediate intervention. Smaller lesions, or those that have regressed in size, can be followed and imaged with a CT scan at 2-3 months of age to determine if surgical resection is required. In the hands of the surgeons at PSA, these lesions are frequently amenable to minimally invasive techniques which result in minimal pain, very small scars, and short hospital stays.

Congenital Diaphragmatic Hernia (CDH)

This is a condition in which there is a hole in the diaphragm (the breathing muscle that separates the abdomen from the chest). The organs of the abdomen move into the chest and restrict the growth and development of the lung. The severity of this disease is determined by how underdeveloped the lung tissue is. In severe cases, patients may require temporary heart-lung bypass (known as ECMO or ELSO) to provide oxygen to the blood and rest the lungs. The surgeons of PSA are on the cutting edge of ECMO/ELSO techniques and technology. When the lungs are healthy the hole in the diaphragm is repaired with an operation. The repair can often be performed by PSA surgeons using minimally invasive techniques.

Gastroschisis

This condition involves a defect in the abdominal wall which results in the abdominal organs protruding through the hole and being exposed to the amniotic fluid. After birth, which can still be done with a vaginal delivery, the baby is taken urgently to the neonatal intensive care unit (ICU) and preparations are made to return the bowel to the abdominal cavity. In most instances a temporary plastic pouch called a ‘silo’ is placed to protect the intestines as they are slowly reduced back into the abdomen. When the intestines are nearly completely reduced, the final reduction of the intestines and the closure of the abdominal wall are performed in the operating room. This process typically occurs over a period of 5-7 days, although sometimes sooner. Once the abdominal wall is closed, patients still require extended stays in the ICU until their intestines have recovered and are working. It can frequently be several weeks before they are tolerating adequate oral feedings to go home.

Giant Neck Mass

This condition can be the result of many different causes. One of which is a cystic hygroma, which is a malformation of a lymphatic channel. It results in a water balloon-like mass of variable size. If the mass is large enough to affect the surrounding tissues, it may need immediate intervention. However, many of these do not end up needing surgical removal. Even if surgery is not needed, the surgeons of PSA can help guide you through the management of this complex problem.

Pulmonary Sequestration

This is an abnormal mass of lung tissue. It frequently can be confused with CCAM/CPAM on prenatal diagnosis. These lesions have abnormal blood supply connections with the normal lung tissue. They need to be removed due to the risk infection; however, they typically are not removed at birth. Rather they can be removed electively using minimally invasive techniques, typically between 3 and 12 months of age.

Omphalocele

This is a rare abdominal wall defect in which the intestines and liver protrude into the widened base of the umbilical cord. Surgical repair is sometimes able to be performed early after birth; however, most cases involve a staged closure over many months or even years. Babies with omphalocele have a high rate of associated problems that can involve their lung development, heart function, ability to feed, and overall development. The surgeons of PSA help guide you through the ongoing treatment.

Sacrococcygeal Teratoma (SCT)

This is the most common tumor of the newborn, but still only occurs in 1 out of every 35,000 live births. The tumor is located in the area of the tailbone (coccyx) and can vary greatly in size. Extremely large tumors can put stress on the fetal heart as they take a large volume of the blood flow. In cases of large tumors these infants often need to be delivered early to protect the health of the infant and mother. Smaller tumors are less dangerous. However, no matter the size, these tumors need to be removed. Although many are not malignant, they can become malignant over time. The prognosis after early resection is very favorable.

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Congenital Cystic Adenomatoid Malformation (CCAM or CPAM)

This is a cystic or solid appearing non-malignant tumor of the lung. Most of these do not require immediate removal. However, extremely large masses may require more immediate intervention. Smaller lesions, or those that have regressed in size, can be followed and imaged with a CT scan at 2-3 months of age to determine if surgical resection is required. In the hands of the surgeons at PSA, these lesions are frequently amenable to minimally invasive techniques which result in minimal pain, very small scars, and short hospital stays.

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Congenital Diaphragmatic Hernia (CDH)

This is a condition in which there is a hole in the diaphragm (the breathing muscle that separates the abdomen from the chest). The organs of the abdomen move into the chest and restrict the growth and development of the lung. The severity of this disease is determined by how underdeveloped the lung tissue is. In severe cases, patients may require ECMO (extracorporeal membrane oxygenation) which is a temporary lung bypass technique to provide oxygen to the blood and rest the lungs. The surgeons of Pediatric Surgical Associates are on the cutting edge of ECMO techniques and technology. When the lungs are healthy the hole in the diaphragm is repaired with an operation. The repair can often be performed by PSA surgeons using minimally invasive techniques.

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Gastroschisis

This condition involves a defect in the abdominal wall which results in the abdominal organs protruding through the hole and being exposed to the amniotic fluid. After birth, which can still be done with a vaginal delivery, the baby is taken urgently to the neonatal ICU and the bowel is returned to the abdominal cavity. In most instances a temporary plastic pouch called a silo is placed to protect the intestines and slowly the intestines are returned to the abdominal cavity at which time the muscles of the abdominal wall can be closed. This process typically occurs over a period of 5-7 days. Occasionally the bowel can be returned to the abdominal cavity immediately after birth and the muscles closed. Once the abdominal wall is closed, patients still require extended stays in the ICU until their intestines have recovered and are working. This can frequently be several weeks before they are tolerating adequate oral feedings to go home.

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Omphalocele
This is a rare abdominal wall defect in which the intestines and liver protrude into the widened base of the umbilical cord. Surgical repair is sometimes able to be performed early after birth, however, most cases involve a staged closure over many months or even years. Babies with omphalocele have a high rate of associated problems that can involve their lung development, heart function, ability to feed, and overall development. The surgeons of PSA help guide you through the ongoing treatment.

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Pulmonary Sequestration

This is an abnormal mass of lung tissue. It frequently can be confused with CCAM/CPAM on prenatal diagnosis. These lesions have abnormal blood supply connections with the normal lung tissue. They need to be removed due to the risk infection; however, they typically are not removed at birth. Rather they can be removed electively using minimally invasive techniques, typically between 3 and 12 months of age.

Back to List

Sacrococcygeal Teratoma (SCT)

This is the most common tumor of the newborn, but still only occurs in 1 out of every 35,000 live births. The tumor is located in the area of the tailbone (coccyx) and can vary greatly in size. Extremely large tumors can put stress on the fetal heart as they take a large volume of the blood flow. In cases of large tumors these infants often need to be delivered early to protect the health of the infant and mother. Smaller tumors are less dangerous. However, no matter the size, these tumors need to be removed. Although many are not malignant, they can become malignant over time. The prognosis after early resection is very favorable.

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