Percutaneous fetal sclerotherapy for congenital cystic adenomatoid malformation of the lung

Objectives: Congenital cystic adenomatoid malformation (CCAM) is a rare lesion of the developing fetal lung consisting of increased cell proliferation in the bronchial structures with lack of differentiation of the alveoli. Pregnancies may be at an increased risk for perinatal loss with type III CCAM. The purpose of this paper is to present our experience with the management of complicated types II and III CCAM with a novel technique: percutaneous ultrasound-guided fetal sclerotherapy (FST). Methods: Three patients were referred with type II-III CCAM. Poor prognostic factors included hydrops, severe mediastinal shift, polyhydramnios and early gestational age (<26 weeks). Patients signed an informed consent. FST was performed with percutaneous injection of Ethamolin (ethanolamine oleate) or Polidocanol (aethoxysklerol) under ultrasound guidance using a 22-gauge needle. Results: Resolution of hydrops and of the mass effect was observed in all cases without any complications. All patients were delivered at term. Conclusions: Fetal sclerotherapy is a novel approach to the management of complicated type II-III CCAM. Further studies are indicated to assess the risks and benefits of this innovative technique.