Ahmed Khan Chaudhry, Muhammad Azam, Rasikh Maqsood, Bushra Naz, Abdus Salam.
Congenital Cystic Adenomatoid Malformation.
J Coll Physicians Surg Pak Jan ;13(6):345-6.

This case report presents the clinical picture, diagnostic methodology and surgical treatment of a female child who presented with chronic cough and dyspnoea due to congenital malformation of lung. A discussion of diagnosis and management is presented at the end.

Case Report: A female child, 15 months of age, was admitted in combined Military Hospital, Lahore, Cantt. with severe dyspnoea and fever of recent origin. She had history of chronic cough since birth and received periodic symptomatic treatment but no hospitalization. on examination she was tachypnoeic, acyanotic child with shifted apex beat to right side and decreased breath sound in the left side of chest. She was treated symptomatically and conservatively with antibiotic, antipyretics and oxygen inhalation in the first stage. Radiological investigations revealed shifting of trachea with absence of lung markings on right side. Ultrasound examination and CT scan chest revealed overinflated lung with multiple bullae in the left upper lobe, gross mediastinal shift and left lower lobe revealing collapse and consolidation. A provisional diagnosis of lobar emphysema / cystic lung disease was made. Laboratory profile revealed anemia and the chloride sweat test was normal. left sided chest intubation was attempted without relief. With conservative treatment child`s general condition deteriorated. Operative treatment was deemed necessary. Thoracotomy and pneumonectomy on left side was contemplated and patient recovered without any complication postoperatively. Postoperatively the child`s symptoms improved dramatically and radiological investigation revealed shifting of trachea back to central position. Histopathological examination of the lung tissue demonstrated adenoid cystic malformation of the lung. She remained asymptomatic in her follow-up.

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