Antenatal thoracoamniotic shunting in congenital cystic adenomatoid malformation

Description

This case report describes a baby who was diagnosed antenatally with a significant left-sided congenital cystic adenomatoid malformation.

Following diagnosis of a fluid-filled, macrocystic structure on the left side of the chest, the mother was referred at 27 weeks' gestation to her regional fetal medicine unit for assessment and ongoing management. Fetal MRI demonstrated a cyst measuring 6.7 mm x 4.3 mm, associated with mediastinal shift and affecting cardiac contractility. Scalp oedema and ascites noted at this time indicated evolving fetal hydrops.

At 28 weeks, thoracoamniotic shunt was inserted to drain the lesion. By 29 weeks, the cyst had decreased in size, now 5.1 mm x 3.4 mm. Cardiac function, oedema and ascites had all improved.

Subsequent scans showed that the shunt, initially placed successfully, had completely migrated into the cyst. Further drainage was completed at 37+3 weeks, with 90 mL of fluid needle aspirated.

Labour was induced, and baby was delivered at 37+4...

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