Large fetal congenital cystic adenomatoid malformations: growth trends and patient survival

Antenatal and postnatal management of congenital cystic adenomatoid lung malformation diagnosed by ultrasound and Magnetic Resonance Imaging (MRI)

“…The disease spectrum of CCAM is quite variable. Lesions with spontaneous regression and, ultimately, complete disappearance during the third trimester have been reported; so have rapidly growing lung masses with nonimmune hydrops and in utero demise [7,16,20]. Close perinatal monitoring is essential to optimize outcome [7][8][9]16,[20][21][22].…”

“…Lesions with spontaneous regression and, ultimately, complete disappearance during the third trimester have been reported; so have rapidly growing lung masses with nonimmune hydrops and in utero demise [7,16,20]. Close perinatal monitoring is essential to optimize outcome [7][8][9]16,[20][21][22]. Serial antenatal US studies have been the imaging gold standard to characterize the features of CCAM, including the size of lesions, their appearance (macro-vs micro-cystic), and their location (lobe involvement) [13][14][15][16]23].…”

“…Close perinatal monitoring is essential to optimize outcome [7][8][9]16,[20][21][22]. Serial antenatal US studies have been the imaging gold standard to characterize the features of CCAM, including the size of lesions, their appearance (macro-vs micro-cystic), and their location (lobe involvement) [13][14][15][16]23]. However, US studies, even when done serially, have disadvantages, including less than ideal CCAM resolution and imprecise initial CCAM location, particularly in obese pregnant women [13][14][15][16].…”

“…The disadvantages of US in particular regarding unfavorable ultrasound conditions (i.e. elevated body mass [BMI] indices), however, include imprecise measurement of exact volume size, reduction in signal intensity, and need for a high number of serial imaging studies [13][14][15][16].…”

Congenital Cystic Adenomatoid Malformation

“…Therefore, a clear management plan should be instituted for the patient and her family including close ultrasound surveillance to monitor fetal well being and the early detection of fetal hydrops and polyhydramnios. Counselling by the neonatology and paediatric surgical teams provides important information regarding management issues in the postnatal period including the eventual need for surgical excision of the CCAM lesion to avoid the long term risks of morbidity from infection, pneumothorax or, more rarely, malignancy 1,5,6,8,9,10,11 .…”