Can CPAM Go Undiagnosed Until Adulthood?
Yes, congenital pulmonary airway malformation (CPAM) can absolutely remain undiagnosed until adulthood, despite being a congenital anomaly typically detected prenatally or in early childhood.
Clinical Reality of Late CPAM Diagnosis
While CPAM is most commonly identified on prenatal ultrasound or presents with respiratory distress in the neonatal period, a subset of patients with asymptomatic or minimally symptomatic lesions can evade diagnosis for years or even decades 1, 2. The literature documents multiple cases of CPAM first diagnosed in adolescence and adulthood, with patients presenting anywhere from teenage years into their twenties and beyond 1, 2, 3.
Why Diagnosis Is Delayed
Several factors contribute to delayed diagnosis:
- Asymptomatic presentation: Small CPAMs may not cause respiratory compromise sufficient to prompt imaging during childhood 4
- Misattribution of symptoms: Recurrent respiratory infections in childhood may be treated as simple pneumonia without further investigation 2
- Lack of clinical suspicion: Without a history of prenatal diagnosis or neonatal respiratory distress, clinicians may not consider congenital malformations in adults presenting with respiratory symptoms 3
- Incidental discovery: Some cases are only identified when imaging is performed for unrelated reasons 1
Typical Adult Presentations
When CPAM finally manifests in adulthood, patients commonly present with:
- Hemoptysis (frank bleeding from the airway) 1
- Recurrent pneumonia in the same anatomical location 2, 4
- Spontaneous pneumothorax 5, 4
- Persistent cough and wheeze 2
- Chest pain and breathlessness 3
A critical clinical pearl: a history of frequent lower respiratory tract infections during childhood should raise suspicion for underlying structural abnormalities like CPAM 2.
Diagnostic Approach in Adults
When CPAM is suspected in an adult patient:
- High-resolution CT imaging is essential and will typically reveal cystic lesions, often with ground glass opacities and interlobular septal thickening 2
- Bronchoscopy can help localize the lesion and exclude other pathology 1
- Chest radiography may show diffuse opacity, volume loss, or cystic changes but is less specific than CT 2
Management Implications
Surgical resection is recommended for all symptomatic adult CPAM cases at the time of diagnosis 1, 5, 4. The rationale is compelling:
- Risk of malignant transformation: CPAMs carry a definitive risk of developing into carcinomas or pleuropulmonary blastomas 4
- Recurrent infections: Medical management alone is insufficient, as complications will eventually develop in virtually all patients 4
- Additional complications: Including pneumothorax, hemoptysis, and hemothorax 4
Video-assisted thoracoscopic surgery (VATS) with lobectomy or wedge resection is the preferred surgical approach and has proven safe and effective 1, 5, 3.
Critical Pitfall to Avoid
The most dangerous error is misdiagnosing CPAM as simple pneumothorax or infected bullae and treating with chest tube insertion alone 3. This delays definitive treatment and exposes the patient to ongoing risks of infection, bleeding, and malignancy. When imaging suggests cystic lung disease in a young adult, particularly with a history of recurrent infections, CPAM must be in the differential diagnosis 2, 3.
Post-Surgical Surveillance
Even after surgical resection, close monitoring is advocated given the mild but definitive risk of malignancy 5. The specific surveillance protocol should include periodic clinical assessment and imaging, though optimal intervals are not well-established in the literature.