2007-06-07-21 Heron Werner, MD; Pedro Daltro, MD Clínica de Diagnóstico por Imagem (CDPI) – Rio de Janeiro – Brazil
Cystic adenomatoid malformation of the lung is characterized by abnormal proliferation of bronchiolar-like air spaces and a lack of normal alveoli, suggesting interruption of normal cellular development. It is frequently unilateral, limited to one lobe or segment in 95% of cases. Stocker et al (1977) described three types: macrocystic (cysts 2 to 10 cm), lesions with small cysts (< 2cm), and microcystic (cysts < 0,5 cm) with solid appearance.
The differential diagnosis include congenital diaphragmatic hernia, neurenteric cyst and esophageal duplication.
We present ultrasound and MRI images of CCAM in macrocyst form at 27 week’s gestation.
|Images 1 and 2: 27th week. Image 1 shows an axial view through the area of cystic adenomatoid malformation of the left fetal lung, type I. Large anechogenic, left-sided lesion (arrow) displaces the heart to the right. Image 2 shows the axial, sagittal and coronal view of the cystic adenomatoid malformation of the left lung.|
|Images 3, 4: 3D views of the cystic adenomatoid lesion of the fetal lung (arrow).|
|Image 5: Power Doppler image; transverse scan through the chest showing cystic adenomatoid malformation of the left fetal lung with dextroposition of the heart.||Image 6: MRI (T2-weighted, axial view) shows the lesion with high signal intensity (red arrow) and the heart displaced to the right (blue arrow).|
|Images 7 and 8: MRI (sagittal view) showing the left-sided cysts representing cystic adenomatoid malformation of the lung, type I (arrows).|
|Image 9: Coronal T2-weighted view shows the high signal intensity cysts (arrow).|
Stocker JT, Madewell JE, Drake RM.: Congenital cystic adenomatoid malformation of the lung: classification and morphologic spectrum. Hum Pathol 8: 155, 1977.