대한흉부영상의학회 Weekly Chest Cases

Case No : 135 Date 2000-05-27

Courtesy of Sun Park, MD, Chan Sup Park, MD / Inha Hospital, Korea
Age/Sex 10 / M
Chief ComplaintRecurrent cough and fever for several years

Figure 1
Figure 2

Diagnosis With Brief Discussion

Diagnosis: Congenital cystic adenomatoid malformation (CCAM), type I
Radiologic Findings: The chest PA shows ill-defined cystic mass with air-fluid level in left lower lobe. CT scan at the level of cardiac ventricle demonstrates multicystic mass in left lower lobe with consolidation.
Brief Review: CCAM occurs as adenomatous overgrowth of the terminal bronchioles, with subsequent suppression of alveolar growth. These lesions have intracystic communications and, unlike bronchogenic cysts, a connection to the tracheobronchial tree.
Stocker subclassified cystic adenomatoid malformations into three different types.

Type I malformation occurs as multiple large cysts (>2 cm in diameter), or as a single, large dominant cyst surrounded by numerous smaller cysts. Type I malformations are the most common form, accounting for up to 50% of cases.

Type II malformation makes up 42% of cases. These are described as multiple, evenly spaced cysts, mostly less than 2cm in diameter.

Type III malformation accounts for approximately 3% of the total. They are described as bulky microcystic lesions.

CCAM affects all lobes equally, and there is no right or left predominance.
Chest radiographic findings are variable and depend on the type of cyst present. Multiple air filled cysts are usually seen on the PA film. There is a depression of the ipsilateral diaphragm and a contralateral mediastinal shift. CCAM may change rapidly in size. Mucus retention or recurrent infection may lead to a granular or inhomogeneous appearance. The characteristic CT appearance consists of a localized complex cystic lesion and in the adult can be difficult to distinguish from sequestration.
Definitive treatment is removal of the affected lobe. Elective lobectomy is therefore the treatment of choice.
References
Keywords: Lung, Congenital,

No. of Applicants : 66

▶ Correct Answer : 60/66, 90.9%

- 媛理
- 嫄닿뎅
- 寃쎈 源
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- 留臾멸린
- 遺理湲곕났
- 遺二쇱
- 遺理湲곕났
- 源李ш
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- 諛李쎈
- 臾몄밴
- 源
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- 源誘쇱
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- 源
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- 沅諛곗＜
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- 源
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- 源誘쇱
- Asan Medical Center Dong Hun Kim
- Asan Medical Center Jeong Hyun Lee
- Baptist Hosp., Pusan Mi-Jeong Shin
- Dong-A University Hospital Ki-Nam Lee
- Gachon Medical School Gil Medical Center Seo Joon Beom
- Hospital General Universitario de Alicante, Spain Juan Arenas
- Matsuyama Red Cross Hospital,Matsuyama,Japan Shunya Sunami
- Samsung Medical Center Kyung Soo Lee
- Seoul National University Hospital Seong Ho Park
- Seoul national University hospital Choi Hyuck Jae
- St. Vincent Hospital, CUK Myeong Im Ahn
- Stedelijk OLV Ziekenhuis Mechelen, Belgium Ivan Pilate
- Hospital de Guipuzcoa San Sebastian Spain Gonzalo Vega - Hazas Porrua

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 135 Date 2000-05-27

Discussion

No. of Applicants : 66