Cystic adenomatous lung malformation of type II in the newborn, problems of early diagnosis

Abstract

Introduction. Cystic adenomatous malformation (CAM) is a congenital lung malformation resulting from abnormal morphogenesis of lung branching at different stages and in different parts of the tracheobronchial tree, with formation of cysts. The incidence of CAM is one case per 8,300-35,000 live births. The modern classification distinguishes four types of CAM. The aim of the work was to analyze the features of the course of the disease and radiological signs that can help the doctor to suspect the presence of congenital lung malformations in   the newborn in the early stages of  manifestation,  justify  additional diagnostic  methods, and timely  choose an appropriate treatment tactic. Material and methods. The article presents the clinical observation of a newborn infant with type II CAM and concomitant disease «early neonatal sepsis». Medical documents are used, where the results of clinical examination, instrumental (X-ray, ultrasound, CT) and laboratory methods  of investigation are presented. Data of histological examination of biomaterial obtained intraoperatively are presented. Results. An analysis of the clinical and radiological dynamics is given. Based on the examination, congenital malformations were detected, and surgical treatment was performed. The child was discharged from the hospital on the 35th day of life in a satisfactory condition. A detailed analysis of diagnostic limitations at each stage of the child's life was conducted. Discussion. Diagnosis of CAM in the early stages was difficult not only because of the nature of the malformation, but also because of the clinic of sepsis, which was the leading one in the first days of life. The morphology of the malformation leads to problems with its prenatal diagnosis and the lack of a clear radiological and ultrasound picture in the postnatal period. Conclusion. In any case of recurrent air leak syndrome, differential diagnosis of congenital pulmonary malformations and the use of CT or MRI for accurate imaging seems reasonable.