Rising detection of congenital pulmonary airway malformations and a pragmatic institutional algorithm: a four-patient...

Congenital pulmonary airway malformations (CPAM) are rare lung anomalies increasingly detected through prenatal imaging. Management of asymptomatic patients remains controversial, particularly regarding imaging strategy, timing of surgery, and malignancy risk. We report a four-patient case series treated at a regional pediatric surgical center between February and June 2025, representing an increased local incidence. All patients were asymptomatic postnatally and underwent thoracic computed tomography at a mean age of 13 months. Elective thoracoscopic lower lobectomy was performed in all cases at a mean age of 18.3 months. Histopathology revealed CPAM type 2 in three patients and CPAM type 4 in one asymptomatic child. Two postoperative pneumothoraces required temporary drainage; no long-term complications occurred. Our findings support elective thoracoscopic resection for confirmed CPAM. The detection of CPAM type 4 highlights the limitations of radiologic subtype differentiation, supporting early surgery in asymptomatic patients. We propose a management algorithm applicable to secondary centers.