title: Long-term outcome of asymptomatic patients with congenital cystic adenomatoid malformation.
abstract: OBJECTIVE
  Congenital cystic adenomatoid malformation (CCAM) represents a rare congenital anomaly of the lung. It remains controversial whether patients with asymptomatic lesions warrant early surgical intervention. Our aim was to review the outcome of asymptomatic CCAM patients at a paediatric tertiary centre.
  
  
  METHODS
  The medical case notes of all children with CCAM presenting to our institution between 1986 and 2007 were reviewed. Data on pre- and post-natal investigations, clinical presentation, lesion site, type of surgical procedure, timing, and outcomes of surgery were reviewed.
  
  
  RESULTS
  A total of 35 patients were diagnosed with CCAM during the 21-year study period (1986-2007). Sixty percent (n = 21) were asymptomatic at birth including eight patients with prenatal ultrasound scan confirming CCAM. In this group, 18 patients (86%) subsequently developed symptoms (median age 2 years, range 1 month-13 years) and required surgery. Symptoms included pneumonia with or without infected CCAM (43%), respiratory distress (14%) and spontaneous pneumothorax (14%). Eight patients underwent multiple hospital presentations with complications related to CCAM. Of the 21 initially asymptomatic patients, 17 (81%) underwent surgical resection. Only one of these patients was completely asymptomatic prior to surgery. There were eight post-operative complications and no mortality. One patient underwent a second thoracotomy for residual CCAM. The median length of hospital stay was 9 days (range 3-32 days).
  
  
  CONCLUSIONS
  This study suggests patients who present with asymptomatic CCAM will subsequently become symptomatic. Early surgical referral and intervention may be beneficial to avoid the development of complications.
authors.affiliation: Department of Academic Surgery, The Children's Hospital at Westmead, The University of Sydney, Locked Bay 4001, Westmead, NSW, 2145, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Wong
authors.forename: D
authors.initials: D
authors.lastname: Vieten
authors.forename: S
authors.initials: S
authors.lastname: Singh
authors.forename: J G
authors.initials: JG
authors.lastname: Harvey
authors.forename: Andrew J A
authors.initials: AJ
authors.lastname: Holland
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015615:Cystic Adenomatoid Malformation of Lung, Congenital / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016896:Treatment Outcome