Menu
Materials and MethodsAll patients with clinical suspicion or provisional diagnosis of CCAM were included in the study. A clinical questionnaire was prepared to collect data.
Computed Tomography (CT) chest with High Resolution Computed Tomography (HRCT) was done for all the patients. Patients were assessed by paediatric surgeon and eligible patients were operated. The procedure conducted was usually open thoracotomy under general anaesthesia. The affected lobes were removed and specimens were sent for histopathological analysis.
All included patients were followed up prospectively to find out about their current level of health. Via telephonic interview they were asked about their overall growth, quality of life, activity, rate of respiratory infections and requirement of hospital admission.
ResultsTotal 15 patients with diagnosis of CCAM were included in the study. Of them, 8 (53.3%) were male. The commonest presentation was cough 13(86%), breathing difficulty 11(73%), fever 9(60%), recurrent pneumonia 4(26%), hypoxia requiring oxygen supplementation 6(40%), others 2(12%). Thirteen patients required surgical intervention and underwent lobectomy. There were 2 cases of type I, one each of type II and III, 3 case of type IV while 5 were intermediate type. There was no procedure related mortality. The median duration of hospital stay and all were successfully discharged with median duration of stay 11±16 days.
Premium CCcam Server full. Fast cline CCcam server. +4700 Premium CCcam channels SD-FHD-4D available. Get your Free CCcam Cline test Today! Premium CCcam&IPTV Welcome To Mycccam24. We offer CCcam and IPTV server with the best price and free support instalation ([email protected]) Only start 5 dollar Per Month. Free&Premium CCcam. 3 Months $ 18. 90 Days IPTV Server Quality SD - HD - FHD Support all devices +3000 Channels.
IntroductionCongenital Cystic Adenomatoid Malformation (CCAM) of the lung is a rare developmental abnormality with incidence rate of 1 in 11000 to 1 in 35000 live birth ,. It happens due to bronchopulmonary foregut malformations that are probably caused by an arrest in lung development between 4 th and 7 th week of fetal life –.
It does not have any genetic predisposition, gender predilection. It is not affected by maternal factors such as race, age or environmental exposures.There are reports showing that CCAM can transform into malignancies, such as bronchioloalveolar carcinoma , adenocarcinoma in aged , and pleuropulmonary blastoma. Surgical removal of the affected lobe of the lung is the best treatment for CCAM. It also prevents future complications like recurrent infections and potential risk of malignant transformation –. CCAM is an uncommon congenital disease with limited data available in the form of case reports.
It is important to identify such cases early so that early rectifying procedure can be attempted. Being a tertiary care hospital, our’s is a referral centre for treating such cases. This study was undertaken to present the experience of a tertiary care hospital in treating CCAM.
The primary objective of the present study was to assess the clinical and radiological profile of CCAM in a tertiary care hospital. Secondary objectives were to study management and outcome of surgical intervention in case of CCAM. Materials and MethodsThe study was conducted at tertiary care academic institute. It was retrospective study conducted at tertiary care teaching institute.
Patients’ data were collected from electronic medical records. All patients with either prenatal diagnosis of CCAM on antenatal ultrasound or patients having High Resolution Computed Tomography (HRCT) features suggestive of CCAM between 2006 to 2013 were included in the study. Other mimicking conditions like congenital lobar emphysema, bronchogenic cyst, bronchopulmonary sequestration, prior infection with pneumatocele and congenital diaphragmatic hernia were excluded.A clinical questionnaire was prepared to retrieve data.
It included age, gender, type and site of CCAM, symptoms at time of presentation, surgery conducted, duration of hospital stay and post-operative complication. Breathing difficulty or sucking difficulty was taken as equal. Acute respiratory distress was defined as hypoxic child with SPO 2. The most common presentation was cough 13 (86%), breathing difficulty 11 (73%), fever 9 (60%), recurrent pneumonia 4 (26%), acute respiratory distress (hypoxia requiring supplemental oxygen) 6 (40%), one patient with abdominal distension and one presented with vomiting and seizure (others) 2 (12%).There were 8 case of right sided (4 Right Upper Lobe (RUL), 3 Right Lower Lobe (RLL), 1 Right Middle Lobe (RML), 6 cases of left sided CCAM (2 Left Upper Lobe (LUL), 4 Left Lower Lobe (LLL)), and 1 case of bilateral CCAM , and. Various radiology images of study patients are depicted in.
Showing HRCT images showing various types of CCAM.Thirteen patients were subjected to surgical management in the form of lobectomy. Gross appearance of CCAM is shown in.
All were confirmed to have CCAM on histopathology. There were 2 cases of type I, one each of type II and III, 3 case of type 4 while 5 were intermediate type and one was reported as CCAM with haemorrhage. Patients were followed up in post-surgery period for post-operative complications. We did not observe any post-operative complications.
There was no procedure related mortality and all were successfully discharged with median duration of stay 11±16 days. All patients had good post-operative recovery. One patient had bilateral disease and was not a candidate for surgery, so was managed conservatively and one patient was managed with medical management alone. DiscussionIn this series 15 cases of CCAM, a rare developmental, non-hereditary, hamartomatous abnormality of the lower respiratory tract were studied. Most of the population 12 (80%) were below 2 years of age. Male: Female were 1.14:1 and as described in literature we also did not find any significant gender predominance.
Now-a-days, the majority of cases are identified by prenatal ultrasound examinations. In our series there were 5 cases in which diagnosis was made on antenatal ultrasound. The median age of presentation in the study was 0.3±6 months.As per literature, patients may present with symptoms, including cough, dyspnea, haemoptysis and respiratory distress, or remain asymptomatic. The typical manifestations include progressive respiratory distress in the newborn and recurrent pulmonary infections in older children. In present series, cough and dyspnea were the commonest symptoms at time of presentation.
However, there were six patients who presented with acute respiratory distress.Recurrent or non-responding pulmonary infection is the most frequent complication of CCAM followed by haemopneumothorax, haemoptysis, and chronic cough ,.Surgical resection of the affected part of the lung is the treatment of choice and this prevents recurrent infections and malignant transformation. Present study showed that lobectomy was a procedure with few complications. It required a short hospital stay with mean duration of hospital stay of 11 days.Its occurrence is sporadic and is not related to genetic predisposition, gender predilection, or maternal factors such as race, age, or environmental exposures.
Stocker et al., suggested a new name, congenital pulmonary airway malformation and classified CCAM into five types based on the site of the defect in the tracheobronchial tree. CCAM type 0 originates from tracheal or bronchial tissue, type 1 originates from distal bronchi or proximal bronchioles, types 2 and 3 have an acinar origin; type 4 have an acinar-alveolar origin.Type 0 is the very uncommon, comprising 1 to 3% of cases. It originates from tracheal or bronchial tissue. We did not have any case having type 0 CCAM.Type 1 is the most common form of CCAM, comprising 60 to 70%. In present study 15.4% of cases were of type I CCAM.
The clinical presentation of type 1 of CCAM depends primarily on the size of the cysts. Larger cysts compressing the normal adjacent lung may be detected on prenatal ultrasound and can cause respiratory distress in the neonate, mediastinal shift to the contra-lateral side and flattening of the ipsilateral diaphragm. All two cases in our series had cough and breathing difficulty.Type II lesions comprise 15 to 20% of CCAMs as per literature. They consist of multiple cysts 0.5 to 2 cm in diameter; resemble dilated terminal bronchioles lined with ciliated cuboidal or columnar epithelium.
In present series there were 7.8% cases of CCAM type II. Extralobar pulmonary sequestrations may have a similar appearance, but unlike type II CCAM, these have a systemic blood supply. Type II CCAM is associated with other congenital abnormalities like esophageal atresia, tracheoesophageal fistula , bilateral renal agenesis or dysgenesis , intestinal atresia, other pulmonary malformations, and diaphragmatic, cardiac, central nervous system, and bony anomalies in about 60% of cases ,–. In our series the patient having CCAM type II also had Arterial Septal Defect (ASD). This association with other congenital malformations suggests that insults resulting in type 2 CCAMs occur during the third week of gestation. In many cases, the associated anomalies are the presenting feature, and the CCAM is detected as a secondary finding.Incidence of Type III CCAM is 5 to 10%. In our study it was 7.8% which correlates with reported incidence.
They have an acinar origin and are often very large involving an entire lobe or several lobes. Affected infants present in utero or at birth, with severe respiratory distress or death in the neonatal period. Our patient reported at age of 4 months.Type IV lesions comprise 10 to 15% of CCAMs.
In present series we found 23% cases of CCAM. Type IV CCAMs may present at birth or in childhood, often with tension pneumothorax or infection, but they may also be identified as incidental findings in asymptomatic patients. The time of presentation was 0.4 months – 3 year. The presenting symptoms were cough, fever, dyspnea, and one presented with recurrent lung infections.
As type IV CCAM has been associated with the development of malignancies, such as bronchioloalveolar carcinoma, adenocarcinoma in aged, and pleuropulmonary blastoma, we feel surgery was treatment of choice in majority of our patients.There were 5 cases of intermediate type. We did not find any significant post-operative complications and all patients had good post-operative recovery.In present series, maximum number of patients had lobectomy. As per literature, after lobectomy usually the remaining lung expands well and grows so the pulmonary function test returns to normal ,.In present study, follow-up was done of 10 cases out of 13 operated cases and their overall growth was assessed. Total 70% patients had normal overall growth and less than 1 episode of respiratory tract infection per month.
Ninety percentage patients required less than 3 times hospital admission per year. However, we were not able to do pulmonary function test for any of the patients considering their young age.English literature has multiple single case reports of CCAM with or without infections from India. One previous study from India included all kind of pulmonary malformation and was not specific for CCAM.
On literature search, one similar study from Argentina was found comprising 172 cases. Comparison of our study with quoted study is shown in. VariablePresentstudy.(n=15)Giubergia Vet al., 2012Argentina(n=172) Age at presentation0.3±6 months0.1-48 monthsMale53.350.4Prenatal diagnosis33.3314.53%Clinical presentation. Recurrent infection. Respiratory distress. Pleural effusion. Asymptomatic26.740013.340%49%8.210Surgery.
Lobectomy/ Bilobectomy. Pneumonectomy86.66098.81.2Other congenital anomalies Cardiac2010.5Lobar distribution of CCAM. RUL. RML. RLL.
Lingular lobe. Left LL. Bilateral3.3%12%38%4%24%0.58Type of CCAM. 0. 1. II.
III. IV. Intermediate015.8.5845.23.
The Better Business Bureau put out its list of 2009's Top 10 Scams Wednesday, but noted that those 'free trial offers' just keep coming, spurring rafts of complaints. A recent crack-down by the Federal Trade Commission has convinced some online marketers to at least be a touch more up-front about the fact that you might get charged if you don't cancel.But a quick look at some of the companies that caused many of last year's complaints found plenty of continuing abuses. When I Googled ' Acai'-a weight-loss supplement supposedly touted by Oprah-it touted a free trial that supposedly would only charge me a buck for shipping, for example.
But flip to the bottom of the page where you can link to the 'terms and conditions' and lo and behold. If you don't cancel within 15 days of their 'initial ship date' you'll get charged $79.90 and another $87.31 every month thereafter.
Will you know their initial ship date? Trending News.But that's not all. Lucky duck that you are, by taking this free trial, you'll also be signed up for a free-trial of a weight loss program that will cost you $9.95 per month until you discover this unauthorized charge on your credit card and cancel it.Let's say that you want to whiten your teeth. TeethWhiteningStar (a Google ad) offers a 'risk-free.
trial.' (I really like the way they put an asterisk right after 'risk-free.' Unfortunately, they lead you to believe that the asterisk refers to the shipping and handling charge, when your real risk is far, far greater.)If you click on the 'terms and conditions' (written in minuscule type at the very bottom of the page) up pops up terms for ' My Everbright Smile' saying that you have just 10 days from the time you type your credit card number into the web site to cancel your free trial. It doesn't matter that you probably haven't received the product yet. After that, they'll charge you for 'the full cost of the product' even though their terms don't spell out what that cost is.You can get an inkling of the costs by reading the online, which indicate that several British victims were charged roughly $200 U.S. Meanwhile, this teeth whitening company has thoughtfully signed you up for several more free(!) offers from third-party affiliates, who will also slam your credit card for a raft of charges.
These are called 'negative option' agreements, and you can read more about them from my colleague.Here's the good news if you're a victim. Call your credit card company. Ask them to reverse the charges. Visa recently expunged 100 companies that it cited for ' from its authorized vendor lists. If they get enough complaints like yours, they'll not only reverse the charges, they'll make it impossible for these crooks to take credit card payments.Have you been taken by a free trial offer? Please tell us about it here to help warn other consumers before they get taken too.First published on January 6, 2010 / 5:11 PM© 2010 CBS Interactive Inc.
All Rights Reserved.