Congenital adenomatoid malformation of the lung: when is active fetal therapy indicated?
OBJECTIVE
Although aggressive fetal therapies such as thoracoamniotic shunting can be applied to cystic adenomatoid malformations of the lung diagnosed in utero, there is no clear consensus regarding their indications. Our purpose was to evaluate a management policy in which aggressive fetal therapy was restricted to those cases complicated by major polyhydramnios or hydrops; all other cases were managed conservatively.


METHODS
A prospective cohort study of 33 cases with a prenatal diagnosis of cystic adenomatoid malformations of the lung was performed. Thoracoamniotic shunting was offered only in nine macrocystic cases with acute polyhydramnios or hydrops.


RESULTS
Four cases were diagnosed postnatally as sequestrations. Of 12 cases complicated by acute polyhydramnios or hydrops, 5 survived (1 type III with spontaneous incomplete resolution in utero, 4 type I with substantial volume reduction after shunting). The 17 cases without acute polyhydramnios or hydrops were managed conservatively and survived.


CONCLUSIONS
Conservative management is indicated in cases of cystic adenomatoid malformations of the lung without acute polyhydramnios or hydrops.
Dommergues
M
M
Maternité Port-Royal, Paris, France.
Louis-Sylvestre
C
C
Mandelbrot
L
L
Aubry
M C
MC
Révillon
Y
Y
Jarreau
P H
PH
Dumez
Y
Y
D015331:Cohort Studies; D015615:Cystic Adenomatoid Malformation of Lung, Congenital / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging* / Q000628:therapy*; D005865:Gestational Age; D006801:Humans; D015160:Hydrops Fetalis / Q000628:therapy; D007231:Infant, Newborn; D006831:Polyhydramnios / Q000628:therapy; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012127:Respiratory Distress Syndrome, Newborn / Q000209:etiology; D013909:Thorax / Q000000981:diagnostic imaging; D016216:Ultrasonography, Prenatal