The Clinical Courses of Patients with Congenital Cystic Adenomatoid Malformation Complicated by Pneumonia

Congenital pulmonary airway malformation in a 5 month old boy, complicated by pneumonia

Congenital cystic lesions of the lung are rare. The most common congenital anomaly among them, involving the lower respiratory tract, is congenital cystic adenomatoid malformation (CCAM), currently referred to as congenital pulmonary airway malformation (CPAM). They may be incidentally detected on prenatal or postnatal imaging. They usually present within two years of life, rarely in adults. CPAMs may be asymptomatic at birth. Some may opt for observation alone due to lack of evidence on the incidence of long-term complications. However, rarely has a CPAM remained asymptomatic throughout life and complications eventually develop. Pneumonia is most common, which is not amenable to medical treatment alone. CPAMs are notorious for their known malignant potential and they may also lead to pneumothorax, hemoptysis and hemothorax. Computed Tomography Thorax is the investigation of choice. Surgical resection is known to be safe and is the mainstay of treatment. For patients who are diagnosed prenatally, surgery is recommended at 3 to 6 months, so that compensatory lung growth can occur. A five-month old boy from Bhutan, with cough, intermittent fever, respiratory distress and a history of recurrent lower respiratory tract infections, was diagnosed with CPAM, complicated by pneumonia and underwent surgery at our centre, following optimal medical management viz. antibiotics and supplemental oxygen. The post-operative course was relatively uneventful and he was discharged from hospital in 7 days.

Congenital cystic adenomatoid malformation - diagnostic and therapeutic procedure: 8-year experience of one medical centre

Introduction

Congenital cystic adenomatoid malformation (CCAM) is a rare anomaly. The mechanisms and the time at which the abnormality develops are still unclear. The malformation is characterized by the presence of single large or multiple but smaller cysts.

Aim

To present the experience of our medical centre, the Polish Mother’s Memorial Hospital – Research Institute.

Material and methods

We analysed the medical records of 32 neonates hospitalized in 2008–2017 at the Department of Paediatric Surgery and Urology ICZMP due to pre- or postnatally diagnosed congenital cystic adenomatoid malformation.

Results

In 2008–2017 32 children were hospitalized at our department due to prenatally diagnosed CCAM. An intrauterine procedure of thoracoamniotic shunting was performed in 13 fetuses. All newborns had chest computed tomography. Surgery had been performed in 21 children. Histopathological analysis of specimens prepared from the resected lung tissue confirmed type 1 CCAM in 4 cases, type 2 CCAM in 11 cases and type 3 CCAM in 1 case. Four patients were diagnosed with a bronchogenic cyst and one with extralobar pulmonary sequestration.

Conclusions

Postnatal management of CCAM depends on the clinical status of the newborn. Newborns without clinical symptoms require radiological diagnostics to confirm the presence of malformation. Surgical treatment is recommended before the age of 10 months. Resection of the malformed lung fragment in patients with CCAM is the first-line treatment. It should be emphasized that despite the tremendous advances in diagnostic imaging, the final diagnosis of CCAM is made based on histopathological findings.

Congenital pulmonary airway malformation: advances and controversies

Advances in antenatal screening have provided evidence that the prevalence of congenital pulmonary airway malformation is higher than previously thought. This means that, on a global scale, more congenital pulmonary airway malformations will be diagnosed and seen by clinicians across many different specialties. This increase poses new controversies and challenges for clinicians in terms of prenatal and postnatal management. Important and exciting research has begun to emerge in the past decade. This Review describes current understanding of the disease, the latest surgical developments, and highlights management issues and controversies, including the rationale and timing of surgical intervention, the choice of surgical approach, and long-term functional outcomes. In doing so, we attempt to provide a balanced management algorithm for readers.

Ultrasound as a screening tool in the follow-up of asymptomatic congenital cystic adenomatoid malformation

Congenital cystic adenomatoid malformation accounts for the vast majority of congenital cystic lung pathologies. The clinical spectrum of congenital cystic adenomatoid malformation is wide and ranges from silent incidental lesions to severe congenital respiratory distress or stillbirths. Management of clinically silent lesions is still a matter of debate, with conservative follow-up being a popular approach during the last decade. However, an optimal methodology of follow-up is yet to be determined. In this study, ultrasound is proposed as a follow-up tool for clinically silent lesions based on the findings in a case with known congenital cystic adenomatoid malformation from the antenatal period, which has been followed up for four years.