Computed tomography (CT)-based classification and management pathways for hybrid lesions in children: a comparative analysis of congenital pulmonary airway malformation (CPAM) and bronchopulmonary sequestration (BPS).

AIM: To establish a CT-based classification system for hybrid lesions in children, elucidate misdiagnosis mechanisms, and propose optimized clinical management pathways through comparative analysis with isolated CPAM and BPS.

MATERIALS AND

METHODS

This retrospective study analyzed 393 children with surgically confirmed congenital lesions (87 hybrids, 218 CPAMs, 88 BPS) from two centers (2010-2022). Hybrid lesions were classified preoperatively: Type A: cystic lesion + systemic arterial supply; Type B: solid lesion + systemic arterial supply; Type C: solid lesion - systemic arterial supply. Comparative analysis of clinical and imaging features was performed.

RESULTS

Type A(51 cases, 58.6%): Predominantly Type 2 CPAMs (cyst diameter <2.85 cm, AUC = 0.963) with intralobar BPS (88.2%). Prenatal detection rate: 70.6% (36/51); symptomatic rate: 37.3% (19/51). Type B (33 cases, 37.9%): Solid lesions with extralobar BPS (78.8%). Prenatal detection rate: 84.8% (28/33); symptomatic rate: 24.2% (8/33). Type C (3 cases, 3.4%): 100% misdiagnosis due to absent systemic arterial supply. Hybrid lesions demonstrated significantly higher prenatal detection rates than isolated CPAMs and BPS (75.9% vs. 51.4% vs. 56.8%, P<0.001) but lower symptomatic rates (31.0% vs. 62.4% vs. 48.9%, P<0.001). Radiologically, hybrid lesions predominantly involved the left lower lobe (66.7% vs. 28.0% in CPAMs, P<0.001).

CONCLUSIONS

CT demonstrated 54.1% diagnostic accuracy for hybrid lesions. The proposed A/B/C classification clarifies misdiagnosis mechanisms, with left lower lobe predominance (66.7%) and systemic arterial supply (95.4%) as hallmark features. Microcystic Type 2 CPAMs (<2.85 cm) and extralobar BPS anatomical isolation synergistically reduce complication risks, providing an imaging-guided framework for risk-stratified management.