Cystic adenomatoid malformation of the lung: clinical evolution and management

Cystic adenomatoid malformation of the lung (CAML) is a rare pulmonary mald evelopment resulting from an abnormal growth of the terminal bronchial stru ctures. This study proposes a possible management of prenatally diagnosed C AML. A group of nine cases of CAML diagnosed prenatally between January 199 0 and December 1995 was studied retrospectively. The evolution of lesions w as followed in utero by serial ultrasound monitoring. Chest X-ray was perfo rmed at birth in all neonates and CT only in the symptomatic ones. CAML was macrocystic in three cases and microcystic in six. No polyhydramnios, hydr ops or associated malformations were seen. In four cases, CAML was confirme d at birth and required surgery. The lesion decreased in size prenatally in five fetuses, of whom only one underwent surgery. In two further cases a p renatal diagnosis of CAML was changed to diaphragmatic hernia. Conclusion Given the possible clinical disappearance or resolution of cysti c adenomatoid malformation of the lung, we believe that surgery is justifie d at birth only in symptomatic and radiologically positive neonates. It cou ld be safely delayed in those asymptomatic patients with either positive or negative chest X-ray. The former need computed tomography at birth, wherea s, in the latter, it should be performed at 6 months of age for a more defi nitive assessment of the patient.