from Section 3 - Classic and rare scenarios in the neonatal period
Published online by Cambridge University Press: 05 March 2012
Syndrome
Cystic adenomatoid malformation of the lung (CAML)
Definition
CCAM is a pulmonary hamartoma of the lung resulting from excessive growth of the terminal bronchioli leading to alveolar growth arrest. The lesion tends to be unilateral. The hamartoma may contain air or liquid and is connected to the bronchial system. Blood supply comes from the pulmonary circulation. In up to 20% CCAM is associated with malformations such as congenital diaphragmatic hernia (CDH), hydrocephalus, malformation of the bones, kidney, and small intestines.
Epidemiology
Incidence approx. 1:30 000 (0.33/1000)
Pathophysiology
Compression of surrounding organs, heart failure, hydrops, and lung hypoplasia are possible
Possible decrease or increase of mass
Poor prognosis in CCAM with fetal hydrops and polyhydramnios
Prenatal diagnosis
Ultrasound: macrocystic (diameter >5 mm) and microcystic (diameter <5 mm) forms
Prenatal DDx
Sequestrated lung, tumour, CDH (see pp. 404–9), lobar pulmonary emphysema, bronchogenic cyst
! A congenital cystic adenomatoid malformation (CCAM) can be diagnosed prenatally. The expectant mother must be transferred to a tertiary perinatal center prior to delivery.
Prenatal therapy
Puncture of a macrocystic malformation may be required
In specific cases thoracoamniotic shunting may be considered
Prenatal surgical treatment is not yet established
Clinical presentation
(Tachy) dyspnea
Pallor/cyanosis
O2 requirement varies
Hydrops fetalis and PPHN are possible
Postnatal DDx
Without a prenatal diagnosis: RDS, pneumothorax, aspiration, CDH, pleural effusion
Diagnosis in the delivery room
Auscultation: faint breathing sounds on the affected side
Blood gas analysis and blood glucose, laboratory work-up, and if necessary blood culture
HIV/hepatitis serology, blood type and screen/cross
To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Find out more about the Kindle Personal Document Service.
To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.
To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.