Name the malformation from its content and blood supply: cystic lung (CPAM), a systemic artery from the aorta (sequestration), a hyperinflated lobe (congenital lobar emphysema), a fluid cyst beside the airway (bronchogenic) — CT angiography answers the surgical question.
Orient first
- Many are diagnosed antenatally; postnatal CT is usually done at a few months before resection (verify local timing).
- Hybrid lesions (CPAM with systemic supply) are common.
- CLE in the neonate may be fluid-filled and opaque, later hyperlucent.
Acquire the study
- Arterial phase CT angiography, thin slices, MIP and volume rendering; lung window.
The manoeuvre
- Lung window: cysts — size of the largest in cm, number, walls.
- Arterial phase: systemic feeding artery from the thoracic or abdominal aorta — its origin and calibre.
- Venous drainage: pulmonary (intralobar) vs systemic (extralobar).
- Hyperinflated lobe with attenuated vessels (CLE); mediastinal shift.
- Fluid-attenuation cyst adjacent to the carina (bronchogenic).
What confirms it
- Typical cystic or vascular anatomy on CT angiography.
What licenses you to exclude it
- Normal CT angiography after an antenatal diagnosis may mean regression — a small residual lesion can still be present.
The classic misread
- Missing the feeding artery below the diaphragm by not scanning the upper abdomen.