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The postnatal management of congenital cystic adenomatoid malformation
S Keidar1, L Ben-Sira, M Weinberg
1Department of Pediatric Surgery, Dana Children's Hospital, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Israel.
Insights
Prenatal ultrasound detects more congenital cystic lung anomalies. Surgery is recommended between 6-12 months, with complete lobe removal being the preferred treatment for optimal outcomes.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Neonatal Care
Background:
- Prenatal ultrasound has increased the detection of congenital cystic lung malformations.
- Common types include congenital adenomatoid malformation, pulmonary sequestration, lobar emphysema, and bronchogenic cysts.
Purpose of the Study:
- Evaluate postnatal diagnostic methods for congenital lung cysts.
- Determine optimal surgical timing and extent of lung resection.
- Assess outcomes of surgical intervention in infants and children.
Main Methods:
- Retrospective review of 11 patients with congenital lung cysts undergoing surgical resection.
- Procedures included 8 lobectomies and 3 segmentectomies.
- Diagnosis confirmed by computed tomography (CT) scan.
Main Results:
- Prenatal diagnosis in 9 of 11 patients; CT confirmed diagnosis in all.
- Postnatal chest X-ray normal except in 2 with recurrent pneumonia.
- Excellent recovery in most; complete resection showed no residual disease, while limited resection had some residual lesions.
Conclusions:
- Congenital cystic lung anomalies are more frequent than previously thought.
- Postnatal CT is crucial for diagnosis; surgery is indicated for all cases.
- Complete lobectomy is recommended over segmental resection; early surgery (6-12 months) is well-tolerated.
Background:
Routine prenatal ultrasound has increased the frequency of prenatal diagnosis of congenital cystic lung malformation, such as cystic adenomatoid malformation, pulmonary sequestration, congenital lobar emphysema, and bronchogenic cyst.
Objectives:
To evaluate the methods of postnatal diagnosis, the optimal age for operation since surgery is always required, and the optimal extent of lung resection.
Methods:
The clinical courses of 11 patients with congenital lung cysts who underwent surgical lung resection (8 lobectomies and 3 segmentectomies) were reviewed.
Results:
The diagnosis was confirmed by computed tomography scan in all. In nine patients the diagnosis was made prenatally. Chest X-ray was normal postnatally in all patients except for two who had recurrent pneumonia. Postoperative follow-up showed excellent recovery in all operated children. One patient who underwent surgery for CCAM following episodes of severe pneumonia died from another cause 5 months later. Postoperative chest CT scan showed no residual disease in eight patients. In two who had undergone limited resection, tomography showed a small segment of residual disease in one and a suspected residual lesion in the other.
Conclusion:
With prenatal ultrasound the true frequency of congenital cystic lung anomaly appears to be higher than previously reported. Postnatal CT is mandatory to confirm or to rule out the diagnosis. The mere presence of cystic lung malformation is an indication for surgery. Complete removal of the affected lung lobe is recommended. Segmental resection may be inadequate. Early operation is tolerated well by infants and small children and we recommend that surgery be performed in children between 6 and 12 months of age.