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case_images: Sagittal sonographic image of the left fetal thorax at 21 weeks' gestation. Note the extensive presence of cystic structures of varying sizes (mixed microcystic and macrocystic lesions) throughout the left fetal lung.
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case_images: Intrathoracic anatomy disclosed multiple cystic structures of varying sizes of the left fetal lung, consistent with extensive congenital pulmonary airway malformation (CPAM, Stocker classification type 1 or 2) (Fig. 1).
case_images: Axial sonographic image of the fetal thorax at the level of the 4-chamber heart, depicted at 21 weeks' gestation. Note the marked displacement of the fetal heart to the right - dextro-position of the fetal heart. The fetal heart essentially occupies the right hemithorax. LV, LA, RV, RA, designate the respective cardiac chambers. Note also the compressed and barely visible right fetal lung.
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case_images: The otherwise normal structured fetal heart (including normal left and right cardiac outflow tracts) was markedly displaced to the right, dextroposition (Fig. 2).
case_images: The identical axial sonographic image of the fetal thorax at the level of the four-chamber heart depicted at 21 weeks' gestation, as in Fig. 2. This figure contains lines defining the degree of displacement of the fetal heart to the right (dextroposition). The midline (solid line) in the normal-positioned heart would have traversed the right cardiac chambers (RA, RV). However, in this dextropositioned fetal heart this line has been considerably displaced to the right, and is represented by the dotted line. The angle between the two lines solid and dotted (marked with a) represents the cardiomediastinal shift angle (CMSA).
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case_images: The cardiomediastinal shift was considered severe, with the cardiomediastinal shift angle measuring approximately 20 degrees (Fig. 3).
case_images: Sagittal sonographic image of the fetal heart at 26 weeks' gestation. Note the considerably less prominent presence of cystic structures of varying sizes (mixed microcystic and macrocystic lesion) now limited to the cephalad portion of the left fetal lung (and not throughout the entire upper left lobe as depicted earlier at 21 weeks' gestation (Fig. 1).
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case_images: At 26 weeks' gestation at sonographic follow up, despite the continued presence of extensive CPAM of left fetal lung, complete spontaneous regression of the dextroposition of the fetal heart and severe cardiomediastinal shift were clearly evident (Fig. 4, Fig. 5).
case_images: Frontal radiograph of the chest and abdomen on Day 1 of life demonstrating no evidence of cystic lung lesions or dextroposition of the fetal heart.
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case_images: Chest X-ray performed on Day 1 of life demonstrated no evidence of cystic lung lesions or dextroposition of the fetal heart (Fig. 6).
case_images: Axial CT angiogram performed on Day 47 of life demonstrating predominantly cystic air-filled CPAM hybrid lesion of the left lower lobe.
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case_images: Postoperative radiograph of the neonatal chest demonstrating air-filled left lung. Note chest tube and surgical clips.
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case_images: Postoperative chest X-ray depicted an air-filled left lung (Fig. 9). Pathology examination confirmed the hybrid lesion of the lower left lobe (Fig. 10).
case_images: Postoperative left lower lobe surgical specimen. Note arrow pointing to feeding vessel of the BPS component of the hybrid lung lesion, which emanated from the thoracic aorta (see Fig. 8).
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case_images: Postoperative chest X-ray depicted an air-filled left lung (Fig. 9). Pathology examination confirmed the hybrid lesion of the lower left lobe (Fig. 10).