Prenatal Diagnosis of Congenital Cystic Adenomatoid Malformations: Evolution and Outcome

Summary 

Objective

The aim of this study was to describe the natural history and outcomes of fetal congenital cystic adenomatoid malformation (CCAM) of the lung in three antenatally diagnosed cases.

Case Report

Three women whose fetuses had CCAM of the lung between 2004 and 2006 chose to continue their pregnancies. We followed up these fetuses every 2 weeks and observed whether there were CCAM-related complications, such as polyhydramnios, mediastinal shifting, and even hydrops fetalis. We also used three- dimensional ultrasound using the VOCAL (Virtual Organ Computer-aided Analysis) rotational technique to calculate CCAM volume serially until delivery. At presentation, the three cases of fetal CCAM were all unilateral and microcystic. Two were complicated by mediastinal shift, but none had hydrops fetalis. Serial ultrasound volumetry demonstrated a trend toward a decreasing CCAM volume, despite an initial increase in volume. Complete resolution was noted in two cases by antenatal sonography. However, persistent lung lesions were found in two cases by postnatal chest radiography and in all cases by postnatal computed tomography scans.

Conclusion

The outcomes of the prenatally detected CCAMs were good in our cases. If the CCAM is not complicated by hydrops fetalis, maintaining the pregnancy with continuing management seems to be a reasonable recommendation. Despite antenatal resolution of CCAM on ultrasound, postnatal examination with chest radiography and computed tomography scan is necessary.

Key Words:  congenital cystic adenomatoid malformation , fetal monitoring , pregnancy outcome

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