CYSTIC ADENOMATOID MALFORMATIONS

Cystic adenomatoid malformation
Cystic adenomatoid malformations of the lung are masses that may cause a spectrum of symptoms, from massive mediastinal shifts in the fetus (resulting in pulmonary hypoplasia) to isolated subsegmental lobar masses in the newborn (or adult) with minimal associated symptoms.

Severe lesions also may cause fetal cardiac compromise and result in hydrops.

If the infant requires positive pressure ventilation, extreme caution must be used because the distending pressure may inflate the cystic malformation.

An inflated cystic malformation is capable of massive expansion, causing respiratory embarrassment because of the prevention of ventilation of other normal lung tissue.

Cystic hygromas
This condition is the result of a congenital deformity of the lymphatic channels. Lymph accumulates and may compress the airway, depending on the size and location of the lymph accumulation.

Approximately 80% of these lymphatic cystic accumulations occur in the neck and may compress the trachea.

These infants may present with significant respiratory distress and require immediate intubation with deep positioning of the ETT to relieve the obstruction by stinting open the airway.

However, most of these lesions expand outward from the neck and do not cause significant airway compromise in the delivery room.