Table 1.
Summary from the literature on the diagnostic work up and therapeutic strategies to antenatal suspicion of CPAM and PS in asymptomatic infants.
| Diagnostic work up | Therapeutic strategies | |||
|---|---|---|---|---|
| Procedure and timing | Operative approach and timing | Conservative approach | ||
| CPAM | ||||
| Elective surgery in all cases, within the 1st year of life (11, 12, 22, 83–86) Or In cases with large and medium-sized cysts, within the 1st year of life (14, 87) Or | Only in cases with small-sized cysts (87, 88) Or Until symptoms occur or changes in size are observed radiologically or parents/patients have concern (at which time surgery is due) (15, 16, 89) | |||
| Chest X-ray, shortly after birth (11, 12, 14, 24) | In all cases up to 18 months of age when a 2nd HRCT is made for confirming the lesion (13) | |||
| PS | ||||
| HRCT, within the first months (11, 12, 14, 24)MRI, few weeks after birth (11)2nd HRCT with contrast, at age 12–18 months (24) or at 5 years (89) | Elective surgery, within the 1st year of life (11) Or after the 1st year of life (81, 90) Or Only for intralobar PS, within the 1st year of life (14) Or In all cases up to 18 months of age when a 2nd HRCT is made for confirming the lesion (13) Or Elective embolization in case of CTM with no symptoms and no cysts (81) | Extralobar PS without significant shunting (14) Or Until symptoms occur or changes in size are observed radiologically or parents/patients have concern (at which time surgery is due) (89) | ||
| Advantages | Disadvantages | Advantages | Disadvantages | |
| 3rd HRCT, prior to transition (89) | Less risk of late complications Less risk of emergency surgery Prevention of cancer in the lesion itself More time for lung growth Short/long-term normal lung function | Potential operative morbidity and mortality No prevention of cancer in other areas of the lung | Avoidance of surgery if the lesion regresses spontaneously | Risk of complications during “wait and see” period Risk of developing high-flow heart failure Pulmonary Hypertension Abnormal lung growth Cumulative radiation risk Risk of losing patients to follow-up Greater morbidity of emergency surgery |
CPAM, Congenital Pulmonary Adenomatoid Malformation; PS, Pulmonary Sequestration; HRCT, High Resolution Computed Tomography.