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Radiology
Congenital Pulmonary Airway Malformation
Built from Obstetric Imaging
What’s inside
10 sections · 72 slides
Overview
- The road ahead
What this lesion is
Start with the plain idea, then the formal words
- A patch of lung that never finished building
- The formal definition
- How the malformation forms
- Two names for one condition
- Who it affects
- 50-75%
How common it is
Why prenatal and postnatal counts do not match
- The commonest bright lung lesion in the fetus
- Why the counts disagree
How it is classified
One system from the microscope, one from the scan
- Why bother with types at all
- Stocker's five types
- Type I in detail
- Type II in detail
- Type III in detail
- What the types tell you about where it started
- The two rare extra types
- The classification you actually use on the scan
- The split that changes management
- Two systems side by side
What you see and what it does
Appearance on the scan, natural course, and the harm a big mass causes
- How it appears on the scan
- Large macrocystic lesion in the left lung
- What to notice in that image
- How it behaves over the pregnancy
- Mostly solid mass with two medium cysts
- Uniformly bright solid mass filling the left chest
- What a large mass does to the fetus
- From growing mass to hydrops
- Chromosomes and other birth defects
Predicting the outcome
Size, lung reserve, and a simple ratio
- What decides the prognosis
- Measuring the mass: the CPAM volume ratio
- > 1.6
- How to use the CVR in the clinic
Imaging the lesion
What ultrasound must answer, and where MRI fits
- What the ultrasound must answer
- How each type looks on the screen
- Blood supply: the deciding feature
- Solid-cystic mass fed by an artery from the aorta
- Tracing the feeding vessel
- The rest of the workup
- Early warning signs of heart strain
- How often to rescan
- Where magnetic resonance imaging fits
- Bright cystic lesions of the right lung on fetal MRI
- The transverse view up close
- Classic signs
What else it could be
Four lesions that mimic CPAM on the fetal scan
- Intralobar bronchopulmonary sequestration
- Congenital lobar emphysema
- Bronchial atresia and bronchogenic cyst
- Congenital diaphragmatic hernia
- The look-alikes at a glance
Treatment before birth
Who needs nothing, who needs a drain, and what is still experimental
- Most cases need nothing at all
- Who might need treatment in the womb
- The grey zone: high risk but no hydrops yet
- The spectrum of fetal interventions
- Open fetal surgery
- Thoracoamniotic shunt: first choice for big cysts
- What the shunt achieves
- Which treatment for which lesion
- Hydrops diagnosed after 34 weeks
- Microcystic lesions: what can be tried
- What parents must be told
- Steroids: the medical option
- Why steroids come first
After birth, and the take-home
Surgery is the rule, and what the referring clinician needs
- Surgery after birth
- What the referring clinician needs to know
- Key points
- Key points
- References
- References (continued)
- References (continued)
- References (continued)
- Suggested readings
- Obstetric Imaging: Fetal Diagnosis and Care, 2nd Edition