대한흉부영상의학회 Weekly Chest Cases

Case No : 1335 Date 2023-05-22

Courtesy of Sung Ho Hwang / Korea University Anam Hospital
Age/Sex 65 / F
Chief ComplaintCough and sputum

Figure 1
Figure 2
Figure 3

Diagnosis With Brief Discussion

Diagnosis: Congenital Pulmonary Airway Malformation
Radiologic Findings: Fig. 1 Chest radiography shows a mass-like opacity with irregular contours (arrow) behind heart in left lower lung field.
Fig. 2 A transverse image of contrast-enhanced chest CT shows a 4-cm sized heterogeneous lesion including small vessel structures inside in the left lower lobe of left lung.
Fig. 3 A sagittal image of contrast-enhanced chest CT shows a wedge-shaped lesion along left lung bronchovascular bundle.
Brief Review: CPAM is A heterogeneous, complex congenital malformation, typically cystic, containing smooth muscle but generally no cartilage. The majority of cases are detected in the setting of neonatal respiratory distress. In adults, CPAM may be an incidental finding or may be accompanied by symptoms related to recurrent respiratory infections, such as cough and fever. Type II CPAM contains more uniform small cysts, less than 2 cm in diameter of bronchial origin. Radiographs usually show a cystic or solid mass in the lower lobe that consists of numerous air-containing cysts. CT findings in adults typically consist of multiple thin-walled, complex cystic masses, ranging from 4 to 12 cm in diameter. The main differential diagnoses are lung abscess, bronchogenic cyst, sequestration, and cystic lung cancer. Because the majority of cases are associated with recurrent infection and risk for the development of carcinoma, CPAMs are usually removed surgically.
References: 1. Lee EY, Dorkin H, Vargas SO. Congenital pulmonary malformations in pediatric patients: review and update on etiology, classification, and imaging findings. Radiol Clin North Am. 2011 Sep;49(5):921-48. doi: 10.1016/j.rcl.2011.06.009. PMID: 21889015.
2. 8DR Biyyam, T Chapman, MR Ferguson, G Deutsch, MK Dighe: Congenital lung abnormalities: embryologic features, prenatal diagnosis, and postnatal radiologic-pathologic correlation 1. Radiographics. 30:1721-1738 2010
Keywords

No. of Applicants : 95

▶ Correct Answer : 10/95, 10.5%

- Chonnam National University Hwasun Hospital , Korea (South) SEONGWOO CHO
- Seoul National University Hospital , Korea (South) HYUNGIN PARK
- Yonsei University College of Medicine , Korea (South) INSUNG CHO
- Korea University Ansan Hospital , Korea (South) HYO YOUNG KIM
- Chungbuk National University Hospital , Korea (South) MIHYEON PARK
- Korea University Guro Hospital , Korea (South) LEE DAKYONG
- Korea University Guro Hospital , Korea (South) SANGSEOK OH
- Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
- Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
- Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY

▶ Correct Answer as Differential Diagnosis : 17/95, 17.9%

- , Japan SUZUNE TSUKAMOTO
- , Japan HIROAKI ARAKAWA
- McGill University Health Center , Canada ALEXANDRE SEMIONOV
- , Japan CHIAKI SATO
- Oita University, Faculty of Medicine , Japan FUMITO OKADA
- Hanyang University Hospital , Korea (South) HYEJIN PARK
- Soonchunhyang University Hospital Bucheon , Korea (South) HYEJOO PARK
- Inje University Pusan Paik Hospital , Korea (South) JIYEON HAN
- Kyoto University Hospital , Japan YASUHISA KURATA
- Ajou University Hospital , Korea (South) YOU NA KIM
- University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
- Osaka metropolitan university Hospital , Japan TATSUSHI OURA
- Seoul National University Hospital , Korea (South) SUNGHO HONG
- , Taiwan SHIHHAN PAN
- Nerimahikarigaoka hospital , Japan TAKANA HAYASHI
- The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
- Other , Korea (South) YONG HO JANG

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1335 Date 2023-05-22

Discussion

No. of Applicants : 95