Galea Janabel (Aberdeen Royal Infirmary/Aberdeen/Scotland), Samuel Stafrace (Royal Aberdeen Children`s Hospital/Aberdeen/Scotland), Karen Duncan (Royal Aberdeen Childrenss Hospital/Aberdeen/Scotland), Lena Crichton (Aberdeen Maternity Hospital/Aberdeen/Scotland)  

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0 Preterm  

N/A  

Thorax-Lung  

congenital  

22 week pregnant. Ultrasound shows possible abnormality involving both lung bases. MRI performed for further evaluation.  

CCAM are pulmonary lesions with abnormal proliferation of bronchiolar structures that connect to the bronchial tree. They may contain micro or macro cysts - when the later are identified, they are rather typical of the lesion.  

<- view Ultrasound 1

Ultrasound 1: Coronal image of the chest and abdomen showing hypoechoic areas in the region of the lower chest bilaterally in keeping with cysts.



<- view MRI 1

MRI 1: (Axial T2 weighted SSFSE) Shows a large high signal mass located within the lower right lung with cysts of various sizes within it with herniation of one of the cysts to the left behind the heart. Low signal flow voids represent vessels within the mass. The heart is shifted to the left and the contralateral lung is compressed by the mass.





<- view MRI 2

MRI 2: (Coronal T2 weighted SSFSE) Demonstrates the mass on the coronal plane. Note the small area of normal right lung at the apex and the compressed left lung. Both these are of slightly lower signal than the cystic mass on T2.





<- view MRI 3

MRI 3: (Coronal T1 weighted) Demonstrates the cyctic mass to be of low signal on T1. The higher signal just below the mass on this image represents the normal liver.




 

Total constellation (Consens)  

Sequestration is also part of the same spectrum and lesions can be of mixed CCAM-sequestration pathology. Sequestrations have a systemic arterial blood supply.  

Variable prognosis - mainly dependant on size. May involute during pregnancy. The larger lesions result in mediastinal shift and pulmonary hypoplasia. These can result in vascular compromise, oesophageal compression, polyhydramnios and hydrops.  

Good case showing macrocysts typically identified in CCAM  

N/A  

1. Medline:
Hubbard AM, Scott Adzick N, Crombleholme TM et al.
Congenital Chest Lesions:Diagnosis and Charecterization with Prenatal MR Imaging.
Radiology 1999;212:43-48.

2. Medline:
3. Medline:
Levine D. Barnewolt CE, Mehta TS et al.
Fetal Thoracic Abnormalities:MR Imaging.
Radiology 2003;228:379.

3. Medline:
Levine D.
Atlas of Fetal MRI.
Taylor and Francis Editors - 2005 pg 96-98.  

CCAM, Congenital Cystic Adenomatoid Malfromation, Fetal MRI, child, childhood, pediatric radiology  

Galea Janabel, Samuel Stafrace, Karen Duncan, Lena Crichton. CCAM (Congenital Cystic Adenomatoid Malformation) on fetal MRI. PedRad [serial online] vol 8, no. 12.
URL: www.PedRad.info/?search=20081204115159