Purpose or Case Report: Congenital chest lesions encompass a wide array of pathology with overlapping imaging characteristics. With prenatal ultrasound and MRI, more congenital chest lesions are being detected sooner, and it is important for radiologists to be familiar with their imaging findings for both diagnostic and prognostic purposes. This educational exhibit reviews the spectrum of pediatric congenital chest lesions and their key imaging findings.

Methods & Materials: Congenital chest lesions detailed in this exhibit are illustrated using radiography, CT, ultrasound, and MRI, including fetal imaging. The abnormalities are described with an emphasis on the key imaging features to distinguish each entity.

Results: The range of congenital chest abnormalities is broad and encompasses a spectrum of normal to abnormal vasculature with normal to abnormal lung. This pictorial review presents the most commonly encountered lesions and their imaging findings. Additional chest lesions which do not fit into the designated categories of bronchopulmonary foregut malformations or vascular anomalies will also be discussed separately.
1. Normal vasculature-abnormal lung: Pulmonary aplasia/agenesis, bronchial atresia, congenital lobar hyperinflation, bronchogenic cyst, congenital pulmonary airway malformation (types I-III), tracheoesophageal fistula, combination lesions
2. Abnormal vasculature-abnormal lung: Sequestration (intralobar and extralobar), scimitar syndrome
3. Abnormal vasculature-normal lung: Pulmonary arteriovenous malformation, pulmonary sling
4. Other chest pathology: Congenital diaphragmatic hernia

Conclusions: Neonatal chest lesions are commonly encountered by the radiologist, and an understanding of their pre- and postnatal imaging features is necessary for accurate diagnosis to guide proper treatment. By grouping these lesions using the above the categories, congenital chest lesions can be more easily approached and diagnosed by the radiologist, leading to optimal patient care.