Late referral of fetal congenital cystic adenomatoid malformation in COVID-19 pregnant women: Diagnostic and management dilemma from limited resource setting country: Case report

Abstract

we reported a case of late congenital cystic malformation (CCAM) diagnosis with problematic COVID-19 infected condition during delivery and dilemmatic neonatal management. A 24-year-old pregnant woman, second pregnancy, came very late in pregnancy (38 weeks gestational age), misdiagnosed with congenital diaphragmatic hernia. Our ultrasound examination revealed congenital cystic malformation type-1 in the right lung, with some of the normal lung lobes. The Left side lung was normal. CCAM volume ratio (CVR) 2,79 cm. Due to COVID-19 infection, our multidisciplinary team decided to perform quick chest tube insertion during the ex-utero intrapartum therapy (EXIT) procedure to avoid pneumothorax complications continued with intubation for the newborn. Neonatal middle right lung lobectomy was done after optimal condition at 20 days old with pathology anatomic result of CCAM type 1. The diagnosis, type, and prognosis of CCAM should be established earlier to make enough time for the better-prepared multidisciplinary management of the newborn.