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Antenatal and postnatal management of congenital cystic adenomatoid lung malformation diagnosed by ultrasound and Magnetic Resonance Imaging (MRI)

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DOI: 10.4236/ojog.2012.24076    4,039 Downloads   6,513 Views   Citations

ABSTRACT

Purpose: Antenatal diagnosis of congenital cystic adenomatoid lung malformation (CCAM) is vital for disease surveillance and postnatal care. Ultrasonography (US) has been the imaging gold standard for antenatal CCAM assessment. However, one of the limitations of US is the “vanishing phenomenon” caused by isoechogenicity of CCAM tissue and adjacent normal lung parenchyma. Methods: Antenatal serial US were concurrently used with magnetic resonance imaging (MRI) to monitor macro- and microcystic lesions. Results: In both pregnant women, antenatal US and MRI confirmed the presence, in the fetus, of cystic lesions and predicted disease regression/progression as well as the need for postnatal surgical intervention. Several advantages were detected by using both—serial US and MRI (over serial US alone)—including improved signal intensity, exact volume size measurements, precise CCAM location in particular for patients with adverse ultrasound conditions. Both neonates underwent surgical resection and had an uneventful post-operative course. Conclusions: Antenatal use of MRI as well as serial US improved information regarding tissue resolution and delineation of CCAM. The information from two imaging modalities was complementary. Our literature review confirmed the emerging role of prenatal MRI for postnatal monitoring and management of CCAM.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

E. Gruessner, S. , Hertel, H. , Bültmann, E. , O. A. Omwandho, C. , Alzen, G. and Peter, C. (2012) Antenatal and postnatal management of congenital cystic adenomatoid lung malformation diagnosed by ultrasound and Magnetic Resonance Imaging (MRI). Open Journal of Obstetrics and Gynecology, 2, 367-372. doi: 10.4236/ojog.2012.24076.

References

[1] Stocker, J.T., Madewell, J.E. and Drake, R.M. (1977) Congenital cystic adenomatoid malformation of the lung: Classification and morphologic spectrum. Human Pathology, 8, 155-171. doi:10.1016/S0046-8177(77)80078-6
[2] Ch’in, K.Y. and Tang, M.Y. (1949) Congenital cystic adenomatoid malformation of one lobe of a lung with general anasarca. Archives of Pathology, 48, 221-229.
[3] Calvert, J.K. and Lakhoo, K. (2007) Antenatally suspected congenital cystic adenomatoid malformation of the lung: Postnatal investigation and timing of surgery. Journal of Pediatric Surgery, 42, 411-414. doi:10.1016/j.jpedsurg.2006.10.015
[4] Gornall, A.S., Budd, J.L., Draper, E.S., et al. (2003) Congenital cystic adenomatoid malformation: Accuracy of prenatal diagnosis, prevalence and outcome in a general population. Prenatal Diagnosis, 23, 997-1002. doi:10.1002/pd.739
[5] Wilson, R.D., et al. (2006) Cystic adenomatoid malformation of the lung: Review of genetics, prenatal diagnosis, and in utero treatment. American Journal of Medical Genetics, A140, 151-155. doi:10.1002/ajmg.a.31031
[6] Volpe, M.V., Pham, L., Lessin, M., et al.. (2003) Expression of Hoxb-5 during human lung development and in congenital lung malformations. Birth Defects Research. Part A, Clinical and Molecular Teratology, 67, 550-556. doi:10.1002/bdra.10086
[7] Azizkhan, R.G. and Crombleholme, T.M. (2008) Congenital cystic lung disease: Contemporary antenatal and postnatal management. Pediatric Surgery International, 24, 643-657. doi:10.1007/s00383-008-2139-3
[8] Davenport, M., Warne, S.A., Cacciaguerra, S., Patel, S., Greenough, A. and Nicolaides, K. (2004) Current outcome of antenatally diagnosed cystic lung disease. Journal of Pediatric Surgery, 39, 549-556. doi:10.1016/j.jpedsurg.2003.12.021
[9] Eber, E. (2007) Antenatal diagnosis of congenital thoracic malformations: Early surgery, late surgery, or no surgery? Seminars in Respiratory and Critical Care Medicine, 28, 355-366. doi:10.1055/s-2007-981656
[10] Mann, S., Wilson, R.D., Bebbington, M.W., Adzick, N.S. and Johnson, M.P. (2007) Antenatal diagnosis and management of congenital cystic adenomatoid malformation. Seminars in Fetal and Neonatal Medicine, 12, 477-481. doi:10.1016/j.siny.2007.06.009,
[11] Garrett, W.J., Kossoff, G. and Lawrence, R. (1975) Grey scale echocardiography in the diagnosis of hydrops due to fetal lung tumor. Journal of Clinical Ultrasound, 3, 45-50. doi:10.1002/jcu.1870030109
[12] Adzick, N.S., Harrison, M.R., Glick, P.L., Golbus, M.S., Anderson, R.L., Mahoney, B.S., Callen, P.W., Hirsch, J.H., Luthy, D.A. and Filly, R.A. (1985) Fetal cystic adenomatoid malformation: Prenatal diagnosis and natural history. Journal of Pediatric Surgery, 20, 483-488. doi:10.1016/S0022-3468(85)80470-X,
[13] Cavoretto, P., Molina, F., Poggi, S., Davenport, M. and Nicolaides, K.H. (2008) Prenatal diagnosis and outcome of echogenic fetal lung lesions. Ultrasound in Obstetrics & Gynecology, 32, 769-783. doi:10.1002/uog.6218
[14] Chen, W.S., Yeh, G.P., Tsai, H.D. and Hsieh, C.T. (2009) Prenatal diagnosis of congenital cystic adenomatoid malformations: Evolution and outcome. Taiwanese Journal of Obstetrics and Gynecology, 48, 278-281. doi:10.1016/S1028-4559(09)60304-1
[15] Illanes, S., Hunter, A., Evans, M., Cusick, E. and Soothill, P. (2005) Prenatal diagnosis of echogenic lung: Evolution and outcome. Ultrasound in Obstetrics & Gynecology, 26, 145-149. doi:10.1002/uog.1921
[16] Kunisaki, S.M., Barnewolt, C.E., Estroff, J.A., Ward, V.L., Nemes, L.P., Fauza, D.O. and Jennings, R.W. (2007) Large fetal congenital cystic adenomatoid malformations: Growth trends and patient survival. Journal of Pediatric Surgery, 42, 404-410. doi:10.1016/j.jpedsurg.2006.10.014
[17] Epelman, M., Kreiger, P.A., Servaes, S., Victoria, T. and Hellinger, J.C. (2010) Current imaging of prenatally diagnosed congenital lesions. Seminars in Ultrasound, CT, and MRI, 31, 141-145.
[18] Liu, Y.-P., Chen, C.-P., Shih, S.-L., Chen, Y.-F., Yang, F.-S. and Chen, S.-C. (2010) Fetal cystic lung lesions: Evaluation with magnetic resonance imaging. Pediatr Pulmonol, 45, 592-600.
[19] Matsushita, M., Ishii, K., Tamura, M., Takahashi, Y., Kamura, T., Takakuwa, K. and Tanaka, K. (2008) Perinatal magnetic resonance fetal lung volumetry and fetal lung-to-liver signal intensity ratio for predicting short outcome in isolated congenital diaphragmatic hernia and cystic adenomatoid malformation of the lung. Journal of Obstetrics and Gynaecology Research, 34, 162-167. doi:10.1111/j.1447-0756.2008.00754.x
[20] Rocha, G., Fernandes, P.C., Proenca, E., Quintas, C., Martins, T., Azevedo, I. and Guimaraes, H. (2007) Congenital cystic adenomatoid malformation of the lung—The experience of five medical centres. Revista Portuguesa de Pneumologia, 13, 511-523.
[21] Calvert, J.K., Boyd, P.A., Chamberlain, P.C., Syed, S. and Lakhoo, K. (2006) Outcome of antenatally suspected congenital cystic adenomatoid malformation of the lung: 10 years’ experience 1991-2001. Archives of Disease in Chilhood, Fetal and Neonatal Edition, 91, F26-28. doi:10.1136/adc.2004.068866
[22] Chow, P.C., Lee, S.L., Tang, M.H., Chan, K.L., Lee, C.P., Lam, B.C. and Tsoi, N.S. (2007) Management and outcome of antenatally diagnosed congenital cystic adenomatoid malformation of the lung. Hong Kong Medical Journal, 13, 31-39.
[23] Stocker, J.T. (2001) The respiratory tract. In: Stocker, J.T. and Dehner, L.P., Eds., Pediatric Pathology, 2nd Edition, Lippincott/Williams & Wilkins, Philadelphia, pp. 445- 517.
[24] Farrugia, M.K., Raza, S.A., Gould, S. and Lakhoo, K. (2008) Congenital lung lesions: Classification and concordance of radiological appearance and surgical pathology. Pediatric Surgery International, 24, 987-991. doi:10.1007/s00383-008-2201-1
[25] Stanton, M., Njere, I., Ade-Ajayi, N., Patel, S. and Davenport, M. (2009) Systematic review and meta-analysis of the postnatal management of congenital cystic lung lesions. Journal of Pediatric Surgery, 44, 1027-1033. doi:10.1016/j.jpedsurg.2008.10.118
[26] Hammond, P.J., Devdas, J.M., Ray, B., Ward-Platt, M., Barrett, A.M. and McKean, M. (2010) The outcome of expectant management of congenital cystic adenomatoid malformations (CCAM) of the lung. European Journal of Pediatric Surgery, 20, 145-149. doi:10.1055/s-0030-1249047
[27] Pelizzo, G., Barbi, E., Codrich, D., Lembo, M.A., Zennaro, F., Bussani, R. and Schleef, J. (2009) Chronic inflammation in congenital cystic adenomatoid malformations, An underestimated risk factor? Journal of Pediatric Surgery, 44, 616-619. doi:10.1016/j.jpedsurg.2008.10.064
[28] Tran, H., Fink, M.A., Crameri, J. and Culminane, F. (2008) Congenital cystic adenomatoid malformation: Monitoring the antenatal and short-term neonatal outcome. Australian and New Zealand Journal of Obstetrics and Gynaecology, 48, 462-466. doi:10.1111/j.1479-828X.2008.00887.x
[29] Diniz, E.M.A., Viera, R.A., Silvia, F.L.V.F., Ceccon, M.E.J., Krebs, V.L.J. and Vaz, F.A.C. (2006) Diffuse congenital cystic lung disease with spontaneous regression. Journal of Maternal-Fetal and Neonatal Medicine, 19, 745-748. doi:10.1080/14767050600964174
[30] Ozcan, C., Celik, A., Ural, Z., Veral, A., et al. (2001) Primary pulmonary rhabdomyosarcoma arising within cystic adenomatoid malformation: A case report and review of literature. Journal of Pediatric Surgery, 36, 1062-1065. doi:10.1053/jpsu.2001.24747
[31] Bush, A. (2009) Prenatal presentation and postnatal management of congenital thoracic malformations. Early Human Development, 85, 679-684. doi:10.1016/j.earlhumdev.2009.08.056

  
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