Congenital cystic adenomatoid malformation: Impact of prenatal diagnosis and changing strategies in the treatment of the asymptomatic patient

OBJECTIVE. This study was designed to assess the effect of prenatal sonogra phic diagnosis on the treatment of congenital cystic adenomatoid malformati on of the lung. MATERIALS AND METHODS. The medical records of 27 patients with pathological ly proven congenital cystic adenomatoid malformations were retrospectively reviewed. Patients were divided into four groups based on mode of presentat ion: with or without abnormal findings on prenatal sonography and with or w ithout symptoms at birth. Age at diagnosis, age at surgical intervention, c omplications, and length of hospital stay were recorded for each group. RESULTS. Twenty-seven patients with 31 proven congenital cystic adenomatoid malformations were included. Eleven patients underwent prenatal sonography establishing the diagnosis (6 asymptomatic at birth, 5 symptomatic), and 1 6 did nut have a prenatal diagnosis (10 asymptomatic at birth, 6 symptomati c). In the symptomatic populations, prenatal diagnosis had no impact on age at surgery, length of stay, or surgical complication rate (p = 0.78-0.83), In the asymptomatic population, prenatal diagnosis allowed early diagnosis (p < 0.001) and resection in the asymptomatic period. It was also associat ed with a shorter length of stay at the time of surgical resection (mean ti me, 4.2 days for patients with prenatal diagnosis versus 12.9 days for thos e without it; p < 0.001) and with a trend toward lower serious complication rate (3 patients without prenatal diagnosis versus 1 patient with it). CONCLUSION. Prenatal sonography provides the radiologist a means to identif y congenital cystic adenomatoid malformations in a population of infants wh o are asymptomatic at birth. Surgical intervention in the asymptomatic infa nt is associated with a shorter length of stay, a trend toward Fewer compli cations, and decreased medical cost compared with intervening after symptom s develop.