Early Surgical Intervention in Congenital Pulmonary Airway Malformation: A Case Report

Ryan Prasdinar Pratama Putra^1,2, Mohamad Rizki^1,2, I Gusti Bagus Chandogya Giriastawa^1,2, Dhihintia Jiwangga Suta Winarno^1,2

Early recognition and surgical intervention in symptomatic CPAM cases prevent complications, ensuring optimal respiratory function and long-term clinical outcomes in neonates.

Abstract

Congenital Pulmonary Airway Malformation (CPAM) is a rare developmental anomaly of the bronchial tree, characterized by cystic or solid lung lesions. Early diagnosis has improved with advanced prenatal imaging, but symptomatic cases often require surgical intervention. This report presents a 2-month-old girl with respiratory distress, increased respiratory effort, and diminished breath sounds on the left side. Chest X-ray and high-resolution computed tomography (HRCT) revealed a large air-filled lesion in the left lung, causing a significant mediastinal shift. The patient underwent thoracotomy with bullectomy and wedge resection, leading to full lung expansion and symptom resolution. Postoperative recovery was uneventful, with excellent clinical improvement at follow-up. CPAM is classified into five types based on histopathologic and imaging characteristics, with Type 1 being the most common and having a favorable prognosis. Early infancy presentation often includes respiratory distress due to airway obstruction and cystic mass effect. Surgical excision remains the definitive treatment for symptomatic cases to prevent complications such as infection or malignant transformation. This case underscores the importance of early recognition, timely surgical intervention, and a multidisciplinary approach in optimizing outcomes for congenital lung anomalies.

Keywords: Bullectomy; Congenital Pulmonary Airway Malformation (CPAM); High-resolution computed tomography (HRCT); Neonatal respiratory distress; Thoracotomy.

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