Fetal Interventions Part II: Lung Lesions
With Dr. Jean Martin · StayCurrentMD
Cued at 9:59 · stops at 10:44 · press play
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
More about CCAM (Congenital Cystic Adenomatoid Malformation)
same diagnosisOnly a few other public items share this diagnosis — nothing to add yet.
Only a few other public items share this expert — go deeper there →
Video
Pediatric Surgical Oncology Research Collaborative (PSORC): Studying Rare Pediatric Tumors
56 s · Published May 2026
Video
Update Course Rewind 2025: Hirschsprung + ARM: Rare but Real
1 min · Published May 2026
Video
Update Course Rewind 2025: Hirschsprung + ARM: Rare but Real
1 min · Published May 2026
Video
Pooling Patients to Study Rare Pediatric Tumors: An Introduction to PSORC
56 s · Published May 2026
Video
The fetal frontier: A review of current and emerging fetal therapies for genetic diseases
44 s · Published May 2026
Video
Indocyanine green assists with sentinel lymph node mapping in pediatric and adolescent patients
1 min · Published May 2026
What the experts said
Radiofrequency ablation for vessel occlusion in fetal bronchopulmonary sequestrations was a disaster and is not recommended.
Coils were used for vessel occlusion with initial success, but the fetus died about a week later for unclear reasons.
Alcohol injection for vessel occlusion can travel through the vasculature and cause thrombosis in the systemic circulation, including thrombi in the heart chambers.
The effects of systemic alcohol injection on fetal neural development and other organ development have not been studied experimentally, even in sheep models.
Radiofrequency ablation cannot be controlled in the fetus due to 90% water content; energy can disperse unpredictably causing collateral damage.
In a laboratory study, a radiofrequency ablation probe placed in one side of a resected fetal teratoma caused the other side to boil when activated.
Probably 95% of CCAMs are now prenatally diagnosed.
Almost none of prenatally diagnosed lung lesions require prenatal intervention, and very few require intervention the day the child is born.
Only one or two centers in the world should be thinking about extreme fetal interventions for lung lesions because the numbers are so small.
Many lung lesions have been referred after a recommendation for termination by people who don't understand the natural history.
Even very large prenatal lung lesions can regress and be asymptomatic at birth, or have very good survival rates with appropriate interventions.
The garden variety postnatal CCAM is very different than some prenatal CCAMs.
Some lesions that look like CCAMs in utero, such as segmental bronchial stenosis, can be minimally apparent or non-apparent after birth.
True cystic CCAMs do not disappear; they regress but remain present and prominent on CT scan a month after birth.
Prenatal lung lesions should be called 'congenital lung lesions' (macrocystic, hyperechoic, or mixed) rather than CCAMs, since CCAM is a pathological diagnosis requiring a specimen.
Many tertiary centers have the capacity to perform EXIT procedures with a huge team approach and leadership.
Lung agenesis can be misdiagnosed as a microcystic CCAM with mediastinal shift on prenatal imaging.
EXIT procedures are more invasive than regular C-sections for the mother.
Pleuro-amniotic shunts are used specifically for macrocystic CCAMs with evidence of hydrops.
Hydrops requires pleural effusion, pericardial effusion, and skin or scalp edema; pure ascites alone is not necessarily hydrops.
Pure ascites can be related to mediastinal shift and hepatic venous return rather than true hydrops.
Pleuro-amniotic shunts are not placed prophylactically; large macrocystic lesions may be tapped just prior to delivery to improve ventilation.
A CVR cutoff of 1.6 is used; if a CCAM presents with CVR less than 1.6, the likelihood of evolving hydrops is about 3-5%.
CVR greater than 1.6 requires close watching with much higher likelihood of evolving into hydrops.
Macrocystic lesions are a wild card because the cystic component can grow very rapidly and can be worrisome even if CVR is less than 1.6.
MRI is better for some fetal anomalies and not as good for others; it depends on the specific anomaly.
There is no registry for fetal surgery or EXIT procedures similar to the ECMO registry.