Objective. Hyperechoic lung images are largely detected prenatally but their underlying etiology is still poorly defined. The aim of the study was to determine the concordance between pre and postnatal diagnosis of prenatal hyperechoic lung images. Design. Retrospective monocentric study Setting. University Hospital of Necker-Enfants malades from January 2009 to December 2018 Population. All fetuses with prenatal hyperechoeic lung images. Methods. Prenatal ultrasound evaluation was performed by a fetal medicine specialist. Postnatal diagnosis was based on CT-scan. Pre- and postnatal features were retrieved from medical charts. Main outcome measures. Accuracy of the prenatal diagnosis in the identification of the malformations and the prediction of postnatal symptoms. Results. 75 patients were included. Main prenatal diagnoses were bronchopulmonary sequestrations (BPS) (n=24-32%), pulmonary cystic malformations (PCM) (n=19-25%), congenital lobar emphysemas (CLE) (n=15-20%). Mediastinal shift was observed in 18 cases (24%); in utero intervention was required in 2. For BPS, the prenatal detection of a systemic arterial supply had a sensitivity of 96%, a specificity of 83%, a PPV of 77% and an NPV of 98%. For PCM, the prenatal detection of a cystic component had a sensitivity of 69%, a specificity of 69 %, a PPV of 67% and a NPV of 71%. All 16 neonates with prenatal isolated mediastinal shift were asymptomatic at birth. Seven neonates (CLE=5, BPS=1, BC=1) showed respiratory distress that were not predicted prenatally. Conclusions. Hyperechoic lung malformations reflect a heterogeneous group of lesions. Symptoms at birth are present in 9% and cannot be predicted by prenatal features.