To shunt or not to shunt a pulmonary adenomatoid cystic malformation after 33 weeks of gestation: a case report.
BACKGROUND
Macrocystic adenomatoid malformation of the lung can cause severe mediastinal shift, hydrops and polyhydramnios, thereby increasing the risk of perinatal deaths. After 33 weeks of gestation, repeated puncturing of the cyst is recommended. We present a case in which a cyst-amniotic shunt was placed instead of performing this procedure.


METHODS
A cyst-amniotic shunt was placed at 33 weeks of gestation because of a large macrocystic adenomatoid malformation of the lung associated with severe mediastinal shift and polyhydramnios. Although it was confirmed that the catheter was in the correct place, the cyst increased in size again two weeks later, associated with repetition of polyhydramnios. It was postulated that the catheter was blocked, and we chose to place another catheter instead of performing repeated punctures. The cystic volume, polyhydramnios and mediastinal shift regressed progressively. At 38.5 weeks, a 3,310/g male infant was delivered without presenting any respiratory distress. The infant underwent thoracotomy on the 15th day of life. Thus, in the present study, we discuss the possibility of placing a cyst-amniotic shunt instead of performing repeated cystic punctures, even at a gestational age close to full term.
Department of Obstetrics, Fetal Medicine Unit, Faculdade de Medicina, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil. rodrigoruano@usp.br
Rodrigo
R
Ruano
Paula Beatriz Tavares
PB
Fettback
Vinicius Lima
VL
Ribeiro
Marcus Marques
MM
Silva
João Gilberto
JG
Maksoud
Marcelo
M
Zugaib
D000328:Adult; D002408:Catheters, Indwelling; D015615:Cystic Adenomatoid Malformation of Lung, Congenital / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis / Q000628:therapy*; D046128:Fetal Therapies / Q000379:methods; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D006831:Polyhydramnios; D011247:Pregnancy; D011256:Pregnancy Outcome