gms | German Medical Science

Background: CPAM occurs approximately with an incidence of 1 in 30 000 pregnancies. Usual differential diagnosis are bronchogenic cysts, congenital diaphragmatic hernia or congenital lobar emphysema. But also cystic structures of any kind can imitate a CPAM as in this case a communicating bronchopulmonary foregut malformation.

Case history: 2 1/2 month old boy presenting with repeating episodes of tachydyspnoe and coughing. Preterm born 34 plus 4th week of pregnancy, due to insufficiency of placenta, birth weight 1800g.

Examination: Boy in reduced general condition, recapilation time 2 sec. frequence of breathing 70-80/min, suprasternal retraction, pulmo: reduced breathing apical, wet rales left and right, honchos endexpiratorally on the left

Process: X-rays and Force CT show besides a pneumonia of the upper lobe on the right a cystic structure with sedimentation with contact to the right bronchus, described as CPAM, abscess or bronchogenic cyst. An alveolar lavage shows an inflamed bronchus with a lot of pus.

In the first operation the upper lobe was resected, dark fluid was seen, middle and lower lobe seemed normal, pathology: no typical signs of C-PAM

Two days after discharge new admission with bacterial pneumonia, child has increasing dyspnoe, subcostal and suprapleural retractions, drinks worse, sonography shows cystic lesion close to the hilus of the formally upper lobe. Middle lobe shows bronchiectatic areas.

Second operation 4,5 month after the first one shows inflamed middle and lower lobe connected on a long base with each other and the pleura. Middle lobe has to be resected because of a cavernous structure. Pathology: alveolitis with eosinophil cells, not typical for C-PAM. Might be an aspiration with allergic reaction.

Child is still not better after the operation and coughs dark fluid. CT shows cystic structure paravertebral in place of the former upper and middle lobe.

5,5 month after the first operation last operation follows: mass is found dorsomedial in the area of the former upper lobe with contact to the bronchial system in the upper dome and is resected.

Pathology: Cystic tissue with stomach lining corresponding to a communicating bronchopulmonary foregut malformation.

Figure 1 [Fig. 1]