Abstract Introduction / Background Congenital lung malformations (CLMs) including Congenital Pulmonary Airway Malformation (CPAM) and Bronchopulmonary Sequestration (BPS) pose significant diagnostic and management challenges, especially when prenatal imaging and postnatal findings diverge. Accurate diagnosis is essential to guide correct management decisions. We present a case of a term neonate whose prenatal imaging suggested CPAM with apparent regression, but postnatal evaluation revealed an intralobar sequestration, successfully managed with surgery. Case Presentation A female infant was delivered vaginally at 39 weeks’ gestation. A prenatal ultrasound at 28 weeks detected a 2.7 × 2.7 cm right-lung lesion consistent with CPAM. A late-gestation ultrasound showed no visible lesion, and the family was counselled that the CPAM had regressed. At birth and during initial postnatal assessment the newborn exhibited no dysmorphic features, no respiratory symptoms, and a chest X-ray (CXR) at one week was reported as normal. At 5 months a contrast-enhanced CT angiogram of the lower chest revealed intralobar pulmonary sequestration with systemic arterial supply and pulmonary venous drainage. Image (a) shows an aberrant arterial branch arising from the aorta (yellow arrow), while image (b) depicts a focal mass-like lesion in the right lower lobe with intralobar distribution and drainage into the pulmonary venous system (red arrow). The child remained clinically stable with no respiratory distress or feeding difficulties. Given the imaging findings and known risks associated with sequestration (infection, hemorrhage, rare malignant transformation) a decision was made for elective thoracoscopic wedge resection at 10 months of age. Post-operative recovery was uneventful. On follow-up the child was asymptomatic with no respiratory complaints and demonstrated improved growth. A postoperative CXR revealed no concerning residual findings. Conclusion This case underscores the evolving nature of congenital lung lesions: prenatal imaging may suggest regression of a CPAM, yet underlying pulmonary sequestration may persist (or a hybrid lesion may exist) and mimic regression on ultrasound due to echogenic similarity with adjacent lung during later gestation. Serial postnatal imaging, particularly CTA in early infancy or sooner if symptoms develop, is critical for definitive diagnosis. This lesion was not visualized on CXR due to its retrocardiac location and small size, which limit radiographic contrast and delineation against overlying mediastinal and cardiac structures. Even in asymptomatic patients, surgical intervention for sequestration is often recommended to prevent complications, and minimally invasive thoracoscopic resection can be safe and effective. The case highlights the importance of coordinated prenatal and postnatal monitoring, multidisciplinary care, and comprehensive family counselling in the management of CLMs. This abstract is funded by: None
Zafar et al. (Fri,) studied this question.