Congenital pulmonary airway malformation (CPAM), formerly termed congenital cystic adenomatoid malformation (CCAM), comprises a heterogeneous group of developmental cystic and dysplastic lung lesions. CPAM is usually unilateral and confined to a single lobe, and it is now frequently identified during routine prenatal ultrasonography. Clinical severity ranges from an incidental antenatal finding to a large space-occupying lesion associated with mediastinal shift, fetal hydrops, neonatal respiratory compromise, or later recurrent infection [1-4]. Prenatal assessment should characterize lesion size, cystic pattern, mediastinal effect, the contralateral lung, and evidence of fetal compromise. Serial ultrasonography is central to surveillance; the CPAM volume ratio (CVR) may also assist risk stratification for hydrops when the measurements required for calculation are  available   [3,4,9]. After   birt cross-sectional imaging helps define lobar anatomy and vascular supply, particularly when pulmonary sequestration or a hybrid lesion is considered [2,4,7]. The traditional Stocker system classifies CPAM histopathologically into types 0-4. Because prenatal imaging cannot establish histologic subtype with certainty, antenatal descriptions such as “type II” should be interpreted as imaging impressions rather than definitive pathologic diagnoses [1,2,10]. This distinction is clinically important because contemporary pathology literature has refined the differential diagnosis of congenital cystic lung lesions, including the relationship of some lesions previously categorized within the Stocker framework to pleuropulmonary blastoma and other entities [10,11]. Surgical resection is accepted for symptomatic CPAM, usually by lobectomy when disease is confined to one lobe. Management of infants who are clinically stable or asymptomatic remains controversial. Elective resection during infancy and structured observation are both practiced, and a 2026 systematic review found that conservative management can be reasonable in selected asymptomatic children, although some later develop respiratory complications or ultimately undergo surgery [5-8,12]. The present report describes an antenatally detected right lower-lobe lesion managed by planned postnatal imaging and lobectomy within approximately 24 hours of birth, emphasizing the multidisciplinary pathway and the limits of inference from a single favorable case. This case is reported to illustrate how prenatal recognition of a sizable congenital lung lesion can support coordinated fetal surveillance, postnatal anatomical confirmation, and timely neonatal surgical management.

Case Presentation

Prenatal Diagnosis and Fetal Surveillance: The first prenatal detection occurred on February 28, 2026, at 17 weeks 5 days of gestation. Obstetric ultrasonography performed by Dr. Hanna Adnan Rashid demonstrated a single viable female fetus and an expanded fetal right lung containing a 41 x 27 mm lesion. Multiple cystic spaces measuring approximately 4-9 mm were present within hyperechoic parenchyma. The lesion produced inversion of the right hemidiaphragm and marked leftward displacement of the heart and mediastinum. The findings were reported as suggestive of CPAM/CCAM type II. No gross associated congenital anomaly was identified, and serial follow-up with targeted assessment of the fetal heart and kidneys was recommended Figure 1-2.

Figure 1: First obstetric ultrasound report dated February 28, 2026, documenting a 41 x 27 mm right-lung lesion with 4-9 mm cystic spaces and a prenatal impression of CPAM/CCAM type II

Figure 2: Postnatal Thoracic Imaging. A, Chest Radiograph Showing a Right-Sided Thoracic Lesion with Mild Mediastinal Displacement. B, Axial CT Image Demonstrating the Right Lower-Lobe Lesion. C, Coronal CT Image Showing the Lesion and Remaining Lung

At 31 weeks 5 days, follow-up ultrasonography demonstrated a well-defined 56 x 35 mm hyperechoic mass in the right lower lung with small internal cystic spaces. Mild leftward mediastinal shift persisted, while the left lung remained well preserved. The amniotic fluid index was 15 cm, estimated fetal weight was approximately 2100 g, and umbilical artery and middle cerebral artery Doppler parameters were within normal  limits. No fetal hydrops or significant hemodynamic compromise was reported. Pregnancy therefore continued under antenatal.

Ward Transition and Follow-up

After clinical stabilization, the infant was transferred to the Pediatric Ward on day 10. Oral feeding was introduced under observation and was tolerated without vomiting or respiratory distress. She remained stable on room air and was discharged on day 12 with oxygen saturation of 98-99% Figure 3.

Figure 3: Clinical Course After Stabilization. A, Clinical Team During Pediatric Ward Care. B, Patient at 40 Days of Age, Clinically Stable at Follow-Up; The Eyes Are Covered to Protect Identity

At follow-up approximately 2 weeks after discharge, the infant remained clinically well, with satisfactory chest expansion and no oxygen requirement. At approximately 40 days of age, she continued to feed well and had satisfactory wound healing without respiratory distress Table 1-2.

Table 1: Postoperative Laboratory Findings

Table 2: Clinical Timeline

The most important feature of this case was the early antenatal recognition of a sizable right-lung lesion with mediastinal displacement. Serial ultrasonography documented enlargement from 41 x 27 mm at 17 weeks 5 days to 56 x 35 mm at 31 weeks 5 days, while the contralateral lung remained preserved and no hydrops or Doppler evidence of fetal compromise was reported. Prenatal detection of congenital lung malformations is clinically valuable because it permits serial risk assessment, parental counseling, delivery planning, and immediate postnatal evaluation rather than waiting for unexpected respiratory deterioration [2-4,7,9]. Postnatal imaging localized the lesion to the right lower lobe and demonstrated no aberrant systemic arterial supply. This vascular information is particularly useful when distinguishing CPAM from pulmonary sequestration or a hybrid lesion [2,7]. The prenatal label of “type II” in this case should remain an imaging impression: Stocker subtyping is fundamentally histopathologic, and definitive subtype assignment requires examination of the resected specimen. Contemporary pathology literature has also refined the classification and differential diagnosis of congenital cystic lung lesions, reinforcing the need to avoid overinterpreting prenatal cyst size alone [10,11]. The timing of surgery deserves careful interpretation. Resection is generally accepted when CPAM is symptomatic, but practice varies for clinically stable or asymptomatic infants [5-8,12]. The APSA systematic review highlighted persistent uncertainty regarding optimal management of asymptomatic lesions [5], and a more recent 2026 systematic review of conservatively managed asymptomatic children found that observation can be a viable strategy in selected patients, although approximately 16% developed complications and 20% ultimately underwent surgery during reported follow-up [12]. These data do not directly answer whether surgery in the first day of life is preferable to later elective resection. Therefore, the present case should not be used to advocate routine immediate neonatal lobectomy for all stable infants. In this infant, lobectomy within approximately 24 hours of birth was technically feasible after prenatal recognition and rapid postnatal anatomical confirmation. The favorable short-term course likely reflects the entire multidisciplinary pathway rather than the timing of surgery alone: antenatal surveillance, planned neonatal admission, cardiopulmonary assessment, definitive imaging, surgical resection, respiratory monitoring, chest-tube management, wound and infection surveillance, and supervised transition to oral feeding. The absence of aberrant systemic arterial supply also simplified the vascular differential before operation. Several limitations should be acknowledged. This is a single case with short follow-up and cannot establish comparative safety, optimal operative timing, or long-term pulmonary benefit. The available record does not provide a calculated CPAM volume ratio, detailed perioperative respiratory-support parameters, operative blood loss, histopathologic report, or long-term imaging and pulmonary follow-up; these data should not be inferred. In addition, the prenatal designation of type II cannot substitute for histologic classification. Longer follow-up is warranted to document respiratory growth, recurrent symptoms, chest-wall or scar outcomes, and any late complications.

Prenatal recognition of CPAM enabled serial fetal assessment, planned postnatal imaging, and coordinated neonatal management. In this selected infant, open right lower lobectomy within approximately 24 hours of birth was feasible and was followed by an uncomplicated short-term recovery and satisfactory early follow-up. The case supports the value of multidisciplinary perinatal planning but does not establish that immediate neonatal surgery is superior to delayed elective resection in clinically stable CPAM.

Consent and Ethical Considerations

Written informed consent was obtained from the patient's parent or legal guardian for publication of this case    report     and    the    accompanying  clinical  and radiological images. Identifying information was minimized, and the infant's eyes were covered in the follow-up photograph to protect identity. Institutional ethical approval or waiver status should be added here if required by the target journal and according to the hospital's policy.

1. Langston, C. “New Concepts in the Pathology of Congenital Lung Malformations.” Seminars in Pediatric Surgery, vol. 12, no. 1, 2003, pp. 17–37.
2. Biyyam, D.R. et al. “Congenital Lung Abnormalities: Embryologic Features, Prenatal Diagnosis, and Postnatal Radiologic-Pathologic Correlation.” Radiographics, vol. 30, no. 6, 2010, pp. 1721–1738. https://doi.org/10.1148/rg.306105508.
3. David, M. et al. “Prenatal and Postnatal Management of Congenital Pulmonary Airway Malformation.” Neonatology, vol. 110, no. 2, 2016, pp. 101–115.
4. Leblanc, C. et al. “Congenital Pulmonary Airway Malformations: State-of-the-Art Review for Pediatrician’s Use.” European Journal of Pediatrics, vol. 176, no. 12, 2017, pp. 1559–1571.
5. Downard, C.D. et al. “Treatment of Congenital Pulmonary Airway Malformations: A Systematic Review from the APSA Outcomes and Evidence-Based Practice Committee.” Pediatric Surgery International, vol. 33, no. 9, 2017, pp. 939–953.
6. Kapralik, J. et al. “Surgical versus Conservative Management of Congenital Pulmonary Airway Malformation in Children: A Systematic Review and Meta-Analysis.” Journal of Pediatric Surgery, vol. 51, no. 3, 2016, pp. 508–512.
7. Hegde, B.N. et al. “Management of Congenital Lung Malformations.” Clinics in Perinatology, vol. 49, no. 4, 2022, pp. 907–926. https://doi.org/10.1016/j.clp.2022.08.003.
8. Bisht, S. and A. Pal. “Congenital Pulmonary Airway Malformation.” StatPearls. StatPearls Publishing, 2026.
9. Zhu, P. et al. “Diagnostic Value of Congenital Pulmonary Airway Malformation Volume Ratio for Fetal Hydrops Due to Congenital Lung Malformations: A Systematic Review and Meta-Analysis.” Orphanet Journal of Rare Diseases, vol. 17, 2022, article 213. https://doi.org/10.1186/s13023-022-02347-0.
10. Dehner, L.P. et al. “Congenital Pulmonary Airway Malformations with a Reconsideration and Current Perspective on the Stocker Classification.” Pediatric and Developmental Pathology, 2023. https://doi.org/10.1177/10935266221146823.
11. Dias, J.F. et al. “Congenital Lung Malformations: A Comprehensive Overview of Current Knowledge—Narrative Review.” Archivos de Bronconeumología, vol. 62, 2026. https://doi.org/10.1016/j.arbres.2025.09.021.
12. Thorburn, C. et al. “The Safety of Conservative Management of Asymptomatic Congenital Pulmonary Airway Malformations (CPAMs) in Children: A Systematic Review.” Journal of Pediatric Surgery, vol. 61, no. 6, 2026, article 162954. https://doi.org/10.1016/j.jpedsurg.2026.162954.