Delayed diagnosis of congenital pulmonary airway malformation in an infant: diagnostic challenges and surgical implications.

Although congenital pulmonary airway malformation (CPAM) is usually diagnosed during prenatal screening, delayed presentation may increase diagnostic uncertainty and operative complexity. We report, to our knowledge, the first case of CPAM diagnosed and surgically managed in Syria in a 4-month-old infant presenting with a 1-month history of dyspnea, fever, and poor feeding in the absence of routine prenatal screening. Initial chest radiography, although technically limited, demonstrated a rounded opacity in the right hemithorax, while non-contrast chest computed tomography (CT) revealed multicystic lesions with a hyperattenuating intralesional component, raising suspicion for secondary infection or pleuropulmonary blastoma (PPB). The patient underwent right upper and middle bilobectomy, and histopathological examination confirmed CPAM and excluded PPB. This case highlights the complementary roles of postnatal CT, surgery, and histopathology in confirming CPAM and excluding PPB, particularly when delayed presentation increases operative complexity.