CONGENITAL ADENOMATOID MALFORMATION OF THE LUNG - WHEN IS ACTIVE FETAL THERAPY INDICATED

OBJECTIVE: Although aggressive fetal therapies such as thoracoamniotic shunting can be applied to cystic adenomatoid malformations of the lu ng diagnosed in utero, there is no clear consensus regarding their ind ications. Our purpose was to evaluate a management policy in which agg ressive fetal therapy was restricted to those cases complicated by maj or polyhydramnios or hydrops; all other cases were managed conservativ ely. STUDY DESIGN: A prospective cohort study of 33 cases with a prena tal diagnosis of cystic adenomatoid malformations of the lung was perf ormed. Thoracoamniotic shunting was offered only in nine macrocystic c ases with acute polyhydramnios or hydrops. RESULTS: Four cases were di agnosed postnatally as sequestrations. Of 12 cases complicated by acut e polyhydramnios or hydrops, 5 survived (1 type III with spontaneous i ncomplete resolution in utero, 4 type I with substantial volume reduct ion after shunting). The 17 cases without acute polyhydramnios or hydr ops were managed conservatively and survived. CONCLUSION: Conservative management is indicated in cases of cystic adenomatoid malformations of the lung without acute polyhydramnios or hydrops.