Resolution of hydrops fetalis in congenital cystic adenomatoid malformation after prenatal steroid therapy☆,☆☆
Section snippets
Materials and methods
The fetal treatment and diagnosis database for the Fetal Treatment Center at the University of California, San Francisco was reviewed for all mothers carrying fetuses with CCAM. Between 1997 and 2000, 3 women carrying fetuses with prenatally diagnosed CCAM were identified. All 3 fetuses exhibited signs of nonimmune hydrops fetalis based on antenatal sonograms at time of referral. Each woman was given a standard regimen of prenatal steroids (betamethasone, 12 mg intramuscularly for 2 doses, 24
Results
Patient 1 presented with a right-sided CCAM. Prenatal sonograms showed the lesion to be large and predominantly solid. At 23 3/7 weeks' gestation, the fetus exhibited sign of NIHF including severe mediastinal shift, mild pleural effusion, small ascites, mild scalp edema, and inverted diaphragm. A prenatal course of betamethasone was administered at 24 weeks' gestation. Follow-up sonograms showed resolution of ascites, pleural effusion, and diaphragmatic inversion by 27 4/7 weeks' gestation. The
Discussion
Advances in prenatal imaging have elucidated the natural progression of CCAM.7 However, the embryo- and pathogenesis of CCAM are unknown. CCAM represents an abnormality in lung development characterized by the lack of normal alveoli and the abnormal proliferation of terminal respiratory bronchioles.12 Some have speculated that CCAM represents an arrested state of normal lung development which has been characterized by increased cell proliferation and decreased apoptosis.13
Lung development is a
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Cited by (0)
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This study was partially funded by the Sean P. Nicholson Foundation.
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Address reprint requests to Hanmin Lee, MD, The Fetal Treatment Center, University of California, San Francisco, 513 Parnassus Ave, HSW-1601, San Francisco, CA 94143-0570.