Conservative management of antenatally diagnosed cystic lung malformations

Abstract

This retrospective cohort study of 74 consecutive CLMs diagnosed antenatally over a 10-year period demonstrates that most of these lesions will remain asymptomatic throughout childhood. Although the natural history of CLMs in later years remains to be elucidated, we hope that this report on medium-term outcomes will be useful to clinicians who undertake antenatal counselling and may inform the discussion on how best to manage these children.

Surgical treatment of congenital cystic adenomatoid malformation: a retrospective study of single tertiary center experience

“…Conforti et al [6] support early surgical treatment for asymptomatic congenital adenomatoid malformation and suggest the best surgery timing is between 3 and 6 months of age. Ng et al [7] conducted a retrospective analysis and follow-up of 74 consecutive CLMs over a 10-year period demonstrated that those lesions can be safely left in situ and observed clinically. Finally, others recommend surgery for ''significant'' lesions but may observe smaller ones [8].…”

The natural history of prenatally diagnosed congenital cystic lung lesions: long-term follow-up of 119 cases

“…For asymptomatic lesions the decision is less clear. Advocates of an expectant approach suggest that prior to the introduction of fetal anomaly scanning these lesions had rarely been identified as pathogenic, the risk of complication in the majority is low9 and postnatal spontaneous resolution is possible 10. However, doubt regarding the safety of this approach due to the potential for malignant transformation and recurrent infection has resulted in approximately 70% of lesions being resected worldwide 11…”

Surgical intervention strategies for pediatric congenital cystic lesions of the lungs: A 20-year single-institution experience

“…Peters et al [9] reported that 20% of surgeons in the UK and Ireland never resect an asymptomatic lesion. Ng et al [1] reported that 5% of asymptomatic infants (3/60) developed symptoms associated with CCAM after a median follow-up period of 5 years.…”

“…It is well known that, the majority of the patients with CCL do not present complications, which include respiratory failure, pneumonia and lung abscess, immediately after birth or for the first few months of life. Some authors report that there should be no indication of surgical intervention for babies with no symptoms [1,2]. Conversely, other authors recommend elective surgery, even on asymptomatic babies with CCL, because the spontaneous regression of the cystic lesion after birth is reported to be unlikely [3], and because the wait-and-see strategy might only increase the risk of abscess formation or the development of severe lung infections [4][5][6].…”