E-Mail karger@karger.com Novel Insights from Clinical Practice Fetal Diagn Ther 2015;37:75–80 DOI: 10.1159/000361015 Fetal Bronchoscopy as a Useful Procedure in a Case with Prenatal Diagnosis of Congenital Microcystic Adenomatoid Malformation Rogelio Cruz-Martinez   a–c Antonio Méndez   a, c Oscar Perez-Garcilita   c Araceli Monroy   c Karla Aguilar-Vidales   c Miriam Alejandra Cruz-Martinez   c Cecilia Martinez-Morales   b a  Department of Fetal Medicine and Surgery, Children’s and Women’s Specialty Hospital of Querétaro, and b  Unidad de Investigación en Neurodesarrollo ‘Dr. Augusto Fernández Guardiola’, Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM) Campus Juriquilla, Querétaro, and c  Fetal Medicine Research Group Fetal Medicine Mexico, Mexico City, Mexico to improve prognosis. Therapeutic options include open fetal surgery with pulmonary resection, fetal sclerotherapy and fe- toscopy. We present a case with a severely enlarged left lung without ultrasound signs of dilated airways compatible with the diagnosis of microcystic CCAM, hydrops and severe con- tralateral lung hypoplasia that was treated successfully at 30 weeks of gestation by fetal bronchoscopy, through which bronchial atresia was identified at the end of the left mainstem bronchi and permeabilized by laser ablation. After fetal sur- gery, weekly follow-up showed a progressive decrease in the Key Words Fetal surgery · Fetal bronchoscopy · Congenital cystic adenomatoid malformation · Bronchial atresia Abstract Massive microcystic congenital cystic adenomatoid malfor- mation (CCAM) and bronchial atresia are associated with a high perinatal mortality secondary to lung hypoplasia and car- diac dysfunction, and fetal intervention should be considered Received: September 8, 2013 Accepted: February 28, 2014 Published online: August 14, 2014 Rogelio Cruz-Martinez Department of Fetal Medicine, Children’s and Women’s Speciality Hospital Unidad de Investigación en Neurodesarrollo Instituto de Neurobiología, UNAM–Juriquilla, Querétaro 76230 (Mexico) E-Mail cruz-martinezr  @  hotmail.com © 2014 S. Karger AG, Basel 1015–3837/14/0371–0075$39.50/0 www.karger.com/fdt Established Facts • Differential diagnosis between congenital cystic adenomatoid malformation (CCAM) and bronchial atresia is very challenging during fetal life. While microcystic CCAM is never associated with ultra- sound signs of dilated airways, fetal diagnosis of main bronchial atresia is established by the presence of a cystic tubular image at the level of the lung hilum as the intrapulmonary continuation of the inter- rupted main bronchi. Novel Insights • We describe a novel use of fetal bronchoscopy to refine the fetal diagnosis of bronchial atresia in cases with prenatal ultrasound diagnosis of a large microcystic adenomatoid malformation without ultra- sound signs of dilated fetal airways. Downloaded by: E. Gratacos - 76750 189.177.24.74 - 2/11/2015 4:20:21 AM