0:01

The next case I will show you is another fetus.

0:03

You can see axial m coronal T two

0:08

images focusing on the axial.

0:10

We can see here very large

0:14

multicystic lesion occupying the left

0:18

and central portion of the chest.

0:20

As we scroll up

0:22

and down, we can see that it's causing

0:23

significant mass effect.

0:25

Here's the liver in the upper abdomen.

0:27

We can also see that there's free fluid in the abdomen

0:32

as we go superiorly, we can see

0:35

how much space it's taking up.

0:37

Similarly, on the coronal images,

0:40

we can see this large multicystic lobular lesion

0:43

occupying the left chest.

0:45

You can also see that there's fluid under the skin,

0:49

so this baby actually has hydro drops due to the fact

0:52

that this is a very large lesion

0:55

and this baby went on to have postnatal imaging

0:58

to include this radiograph.

1:02

You can see similarly this large hyper expanded

1:07

multicystic lesion in the left chest.

1:10

You can see that most of it has been replaced with air,

1:13

and so this also turned out to be a C pam.

1:17

The type one or macrocystic type

1:21

incidentally noted is A UVC going off into a

1:25

right portal vein branch.

1:27

The next case is an infant.

1:30

I'm not showing the fetal imaging in this infant,

1:33

but we have a CT scan postnatally.

1:35

We have axial coronal and sagittal images.

1:39

If we go to the axial image

1:41

and change to lung windows,

1:44

we can see in the right lower lung this

1:47

dominant cystic space

1:48

with additional smaller clustered cystic spaces around it,

1:53

as well as some adjacent opacity,

1:55

which is probably atelectasis, which fairly

1:58

discreet appearing.

2:00

We can see on the corresponding

2:03

coronal images what it looks like.

2:07

Multicystic lesion of varying sizes with the largest

2:12

being the macrocystic type.

2:14

There's a small amount of hyper aerated lung nearby,

2:19

and again, we can look at the sagittal images

2:24

as we scroll over to that side.

2:27

We see the same multicystic mass

2:29

with some adjacent ectasis nearby as well

2:32

as some hyper expansion nearby.

2:34

So this was another case of a Macrocystic CPAM,

2:38

but not nearly as large

2:41

as the prior case I showed right before this.

2:45

And the final case I will show does include a fetal MRI.

2:49

Here we have coronal and axial T two images.

2:53

These images are a bit noisy

2:55

because the baby was moving around quite a bit, but

2:58

On On both sets of images, you can appreciate that.

3:02

In the right lung, we have this large lesion that has

3:06

what I think looks a bit like a cauliflower.

3:09

We have cystic spaces centrally

3:11

and then kind of more solid borders peripherally.

3:16

And as we scroll through

3:19

and ignore the fact that the baby's moving around, we see

3:22

that occupying a large portion of that right chest.

3:26

The whole lung looks a bit

3:27

enlarged compared to the other side.

3:31

And then confirming on the axial images, that kind

3:33

of cauliflower look of central cystic spaces

3:36

with a more thickened border.

3:40

This patient went on to have a postnatal radiograph

3:42

and you can see very similar to the MRI in that right lung,

3:46

there's this large opacity

3:49

and in a central portion we can see

3:51

that there are small cystic foci.

3:53

So what's happening is that this is A-C-P-A-M,

3:57

another macrocystic CPAM,

3:59

and this was taken shortly after birth.

4:02

So some of those central cystic spaces are starting

4:05

to get replaced with air

4:06

and hence are lucid on the radiograph, whereas the periphery

4:11

are either not replaced by air yet or are more microcystic

4:15

and look solid.

4:18

This same patient went on to have a ct.

4:22

I'll start with the axial images.

4:25

We can see the large CPA

4:27

with central cystic spaces causing mass effect

4:30

onto the left side.

4:32

The mediastinal structures in the left lung, you can see

4:35

that cauliflower appearance.

4:38

And then if we look at the same lesion

4:41

in axial lung windows,

4:43

we can better appreciate those central cystic spaces

4:47

with the more thickened solid appearing rind.

4:51

Same thing on the coronal and sagittal.

4:54

We can also on this coronal,

4:56

better appreciate the mass effect on the mediastinum

5:00

and the enlargement of the entire lung,

5:03

pushing onto all the central

5:05

structures and into the left side.

5:08

And for completeness, looking at the sagittal images,

5:10

you can just get an appreciation for

5:12

how large this particular lesion is compared to

5:17

the other smaller left lung that is partially atelectatic

5:22

on all of these cases, I did not specifically point out,

5:26

but is important to know

5:27

that on the CT angiogram we did not see any

5:32

systemic arterial branches coming off of the aorta

5:36

or any of the aortic branches and feeding these lesions.

5:40

This is an important thing to note

5:42

and this is why we get CTAs as opposed to just cts

5:45

with routine IV contrast.

5:47

Because if you do see a systemic arterial branch feeding the

5:51

lesion, then you shouldn't be thinking of CPAM so much

5:54

as you should be thinking about bronchopulmonary

5:56

sequestration, which we'll be talking about in a subsequent

5:59

section.