Yonsei Med J.  2015 Jul;56(4):968-975. 10.3349/ymj.2015.56.4.968.

The Clinical Courses of Patients with Congenital Cystic Adenomatoid Malformation Complicated by Pneumonia

• Jhun BW
• Kim SJ
• Kim K
• Kim S
• Lee JE

• KMID: 2366336
• DOI: http://doi.org/10.3349/ymj.2015.56.4.968

Abstract

PURPOSE
We evaluated the clinical characteristics and courses of patients with congenital cystic adenomatoid malformation (CCAM) complicated by pneumonia.
MATERIALS AND METHODS
We retrospectively reviewed the records of 19 adult patients with surgically confirmed CCAM between March 2005 and July 2013.
RESULTS
Eighteen of nineteen patients presented with acute pneumonia symptoms and signs, and inflammatory markers were elevated. On chest computed tomography, all 18 patients had parenchymal infiltration around cystic lesions, 17 (94%) had an air-fluid level, and 2 (11%) had pleural effusion. After antibiotics treatment for a median of 22 days prior to surgery, all acute pneumonia symptoms and signs disappeared in 17 (94%) patients at a median of 10 days. Improvements and normalization of inflammatory marker levels, occurred in 17 (94%) and 9 (50%) patients at medians of 8 and 17 days, respectively. Radiological improvement was evident in 11 (61%) patients, at a median of 18 days, of these patients, partial radiological improvement occurred in 10 (56%) and complete radiological resolution in only 1 (6%). One patient (6%) did not improve in terms of clinical, laboratory, or radiological findings despite antibiotic treatment for 13 days. Consequently, after 17 (94%) elective and 1 (6%) emergency surgeries, all patients improved without development of complications.
CONCLUSION
We described the clinical characteristics and courses of patients with CCAM complicated by pneumonia, and showed that surgery may be performed safely after clinicolaboratory improvement is attained upon antibiotic treatment, even in the absence of complete radiological resolution.

Keyword

Antibiotic treatment; congenital cystic adenomatoid malformation; surgical resection

MeSH Terms

Adult
Cystic Adenomatoid Malformation of Lung, Congenital/*diagnosis/*surgery/therapy
Female
Humans
Male
Physical Examination
Pleural Effusion
Pneumonia/complications/*radiography
Retrospective Studies
Tomography, X-Ray Computed
Treatment Outcome

Figure

• 

  Fig. 1 Chest computed tomography (CT) of a 20-year-old male with congenital cystic adenomatoid malformation complicated by pneumonia. (A) The CT image shows parenchymal infiltration around multiple cystic lesions with an air-fluid level in the right lower lobe. (B) A CT image obtained after 27 days of broad-spectrum antibiotic treatment reveals near-disappearance of the parenchymal infiltrate around the multiple cystic lesions, and the air-fluid interface in the right lower lobe.

• 

  Fig. 2 Serial changes in clinical, laboratory, and radiological findings in response to antibiotic treatment before surgery.

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