Outcome of the Prenatally Diagnosed Congenital Cystic Adenomatoid Lung Malformation: A Canadian ExperienceLaberge J.M.a · Flageole H.a · Pugash D.f · Khalife S.b · Blair G.g · Filiatrault D.c · Russo P.d · Lees G.e · Wilson R.D.h
aDepartment of Surgery, Montreal Children’s Hospital, Montreal, bDepartment of Obstetrics and Gynecology, McGill University Health Centre, Montreal, Departments of cRadiology, and dPathology, Hôpital Ste-Justine, Montreal, eDivision of Pediatric Surgery, University Hospital, Edmonton, and Departments of fRadiology, gSurgery, and hObstetrics and Medical Genetics, British Columbia Women’s Hospital, University of British Columbia, Vancouver, Canada
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Congenital cystic adenomatoid malformation of the lung (CCAM) is diagnosed by prenatal ultrasonography with an increasing frequency but controversy persists as to its prognosis and prenatal management. Method: A multi-institutional study of cases of CCAM diagnosed antenatally identified by ultrasonographers and by a review of hospital charts. Results: We obtained 48 cases from five centers. We estimate the incidence of CCAM at 1:25,000 to 1:35,000 pregnancies. The incidence of voluntary abortions was 15% (7/48), of spontaneous abortions 2% (1/41) and of postnatal death 10% (4/40). One of the postnatal deaths was from trisomy 18. Of the 7 aborted fetuses, 2 had multiple malformations and 1 had severe hydrops and oligohydramnios; the other 4 had a large mass with mediastinal displacement but without hydrops. When pregnancy was allowed to continue, 56% of the lesions regressed spontaneously, even though one third of these had initial progression. In 17 cases (42%) the mediastinal shift corrected itself, sometimes by simple growth of the fetus but most often by a decrease in the size of the lung mass. In 1 fetus, repeated needle decompressions followed by double-pigtail catheter drainage of large cysts allowed regression of hydrops. Despite this, neonatal death occurred from pulmonary hypoplasia. Conclusion: CCAM can lead to fetal or neonatal demise from hydrops, lung hypoplasia, prematurity or severe associated malformations, but has a good prognosis in the majority of cases.
© 2001 S. Karger AG, Basel
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