Abstract
Objective To examine the relationship between cardiomediastinal shift angle (CMSA) and adverse
perinatal outcomes and hydrops in cases of congenital pulmonary airway malformation
(CPAM).
Study Design This retrospective study evaluated CPAM cases referred to our institution from 2008
to 2015. The primary outcome was a composite score for adverse perinatal outcome.
CMSA was measured for each case and evaluated for its association with the primary
outcome. The prediction accuracy of CMSA for adverse perinatal outcome was assessed
using receiver operator characteristic (ROC) curves.
Results Eighteen (21.2%) of the 85 cases experienced an adverse perinatal outcome. Increases
in CMSA were associated with adverse perinatal outcomes and hydrops in bivariate analyses.
Adjusted analyses found each 10-degree increase in CMSA to be associated with increased
odds of an adverse perinatal outcome (adjusted odds ratio [aOR] 2.2, 95% confidence
interval [CI]: 1.4–3.3) and hydrops (aOR 3.0, 95% CI: 1.5–6.1). CMSA performed well
and was comparable to CPAM volume ratio in predicting adverse perinatal outcomes (area
under the curve 0.81 and 0.84, respectively).
Conclusion We describe a novel measurement of mediastinal shift in cases of CPAM and its relationship
with adverse perinatal outcomes and hydrops. These findings may shape the evaluation
and management of CPAMs, improve our understanding of their prognosis, and influence
patient counseling.
Keywords
cardiomediastinal shift - congenital pulmonary airway malformation - fetal lung lesion
- hydrops - mediastinal shift - perinatal outcomes
