Review Article

Congenital Pulmonary Malformation in Children

Table 1

Common congenital pulmonary malformations.

Incidence/prevalenceFeatures and presentationTreatmentComments

CPAMIncidence is 1 per 8300 to 35,000 [3]. No sex predilection [1].Usually limited to one lobe. Many cases are detected by prenatal U/S. CPAM may present in the early neonatal period with respiratory distress. 86% of patients, who were asymptomatic at birth, had become symptomatic by 13 years of age (median age 2 years). Symptoms include pneumonia with or without infected CPAM, respiratory distress, and spontaneous pneumothorax.Surgical resection is the definitive treatment. Asymptomatic patients can be observed with serial imaging.Lesions regress antenatally in 59%. Type 4 and type 1 tend to carry a malignancy risk.

CLEPrevalence rate of 1 in 20,000 live births [12]. Males > females [13].The left upper lobe is affected in half of the cases. Lesions may be asymptomatic or present with respiratory distress in the newborn period. Those with the lesion may experience dyspnoea or recurring respiratory infection. 15% of cases may have congenital heart disease.Resection of the affected lobe in symptomatic newborn. Conservative treatment in Asymptomatic patients.Congenital cardiac anomalies often accompany CLE.

BCPrevalence rate of 1 per 68,000 [14].It can occur throughout the tracheobronchial tree. Large cyst presents with respiratory distress and cyanosis in newborns. BC may be detected as incidental findings on chest radiographs. Newborns with large cysts can develop respiratory distress, cyanosis, and feeding difficulty. Compression of the trachea and respiratory arrest has been reported. Wheeze, stridor, atelectasis of the distal lung, dysphagia, and recurrent pneumonia can occur.Surgery is recommended in all cases.Typically presented during the second decade of life.

BPSIncident is 0.29% [15]. Male > female [16].Lower lobes are mostly affected. Newborn may present with respiratory distress. Patients with ELS may remain asymptomatic. In a case series of 50 patients with ELS, 24% were diagnosed prenatally and 61% were diagnosed by three months of age. Recurrent pneumonia, chest pain, hemoptysis, and shortness of breath, respectively, can occur. The adjacent lung is frequently bronchiectatic in resected ILS specimens.Symptomatic Patients require surgical intervention. Elective resection is recommended in asymptomatic patients with ILS.Infection, heart failure, carcinoma, and bleeding can occur in sequestrated lung.

CPAM: congenital pulmonary airway malformation, CLE: congenital lobar emphysema, BC: bronchogenic cysts, BPS: bronchopulmonary sequestration, ILS: intralobar sequestration, ELS: extralobar sequestration.