1. Re:Antenatal management of Cystic Pulmonary adenomatoid malformation

    Dear Dr Kumar,

    Thank you for your letter.

    In relation to the points raised:

    1. Much of the evidence for successful use of steroids in CPAMs relates to microcystic lesions. In this case, the lesion was a large macrocystic CPAM. The case was discussed at an antenatal MDT, and the decision not to treat with steroids was reached.

    2. We thank you for your comment on measuring baseline and subsequent cyst volume ratio, to monitor progression/resolution. That was not measured in this case.

    Conflict of Interest:

    None declared

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  2. Antenatal management of Cystic Pulmonary adenomatoid malformation

    We read case report by Cullen et al and found it very interesting. It was a successfully managed case however, I have certain queries regarding management in the index case.

    1. In a prenatally detected CPAM (previously known as CCAM) with hydrops detected prior to 32 weeks, there is a well-defined role of maternal steroids.(1) Even multiple courses of betamethasone can be tried. Whether it was thought off in index case or not.

    2. Instead of two-dimensional size, measurement of baseline, as well as subsequent Cyst volume ratio (CVR), is a good indicator of progression/ resolution of the cyst.

    References: 1. David M, Lamas-Pinheiro R, Henriques-Coelho T. Prenatal and Postnatal Management of Congenital Pulmonary Airway Malformation. Neonatology. 2016 Apr 13;110(2):101-15.

    Conflict of Interest:

    None declared

    Submit response
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