Medical Conditions

Congenital Pulmonary Airway Malformation (CPAM)

Medically reviewed by Dr. Michael Okonkwo, MD, FAAP · Board-Certified Neonatologist

Content reviewed against published AAP, ATS, NIH guidelines

Last reviewed: July 2026

If your baby has been diagnosed with or you suspect congenital pulmonary airway malformation (cpam), here is what the evidence says.

The short answer

Key takeaways

Congenital pulmonary airway malformation (CPAM, formerly called CCAM) is an abnormal mass of lung tissue that forms during fetal development. It can be cystic (fluid-filled) or solid. Many are found on prenatal ultrasound. Some cause respiratory distress at birth, while others are asymptomatic. Surgical removal is usually recommended even for asymptomatic cases due to the risk of recurrent infections and a small risk of malignancy.
Usually normal when: A small CPAM was found on prenatal ultrasound and your doctor is monitoring it with serial imaging and it is stable or shrinking
Call your doctor if: Your newborn with a known lung mass is having difficulty breathing, breathing rapidly, grunting, or appearing blue, as this may require urgent surgical intervention
Varies by age — see the age-by-age breakdown below

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— Fever and Your Child, American Academy of Pediatrics (AAP)

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What Parents Should Know

According to AAP, ATS, NIH guidelines, congenital pulmonary airway malformation (CPAM, formerly called CCAM) is an abnormal mass of lung tissue that forms during fetal development. It can be cystic (fluid-filled) or solid. Many are found on prenatal ultrasound. Some cause respiratory distress at birth, while others are asymptomatic. Surgical removal is usually recommended even for asymptomatic cases due to the risk of recurrent infections and a small risk of malignancy. At Prenatal, cPAMs are most commonly discovered on routine prenatal ultrasound, typically during the second trimester. The lesion may appear as a cystic or solid mass in the fetal lung. Many CPAMs grow during the second trimester and then stabilize or even shrink before birth. Large lesions that cause fetal hydrops (fluid accumulation) may require prenatal intervention such as thoracoamniotic shunting or fetal surgery in specialized centers. Serial ultrasounds monitor the size and any complications. Most babies with prenatally diagnosed CPAM do well after birth. It is generally considered normal when a small CPAM was found on prenatal ultrasound and your doctor is monitoring it with serial imaging and it is stable or shrinking. However, you should contact your pediatrician promptly if your newborn with a known lung mass is having difficulty breathing, breathing rapidly, grunting, or appearing blue, as this may require urgent surgical intervention.

Sources: [1], [2], [3]

Normal vs. Concerning

Usually Normal

Worth Discussing

A small CPAM was found on prenatal ultrasound and your doctor is monitoring it with serial imaging and it is stable or shrinking

Your newborn with a known lung mass is having difficulty breathing, breathing rapidly, grunting, or appearing blue, as this may require urgent surgical intervention

Your baby had a CPAM surgically removed and has recovered well with normal breathing and growth

Your baby or child with a known CPAM develops sudden onset of fever, cough, and breathing difficulty, which could indicate an infection within the malformation

A prenatal lung finding was evaluated after birth and was determined to be benign or to have resolved on its own

Your child develops sudden chest pain, difficulty breathing, or coughs up blood, which could indicate a complication of the CPAM such as hemorrhage or infection

When to Seek Immediate Care

Your newborn with a known lung mass is having difficulty breathing, breathing rapidly, grunting, or appearing blue, as this may require urgent surgical intervention
Your baby or child with a known CPAM develops sudden onset of fever, cough, and breathing difficulty, which could indicate an infection within the malformation
Your child develops sudden chest pain, difficulty breathing, or coughs up blood, which could indicate a complication of the CPAM such as hemorrhage or infection

By Age

What to expect by age

Prenatal

CPAMs are most commonly discovered on routine prenatal ultrasound, typically during the second trimester. The lesion may appear as a cystic or solid mass in the fetal lung. Many CPAMs grow during the second trimester and then stabilize or even shrink before birth. Large lesions that cause fetal hydrops (fluid accumulation) may require prenatal intervention such as thoracoamniotic shunting or fetal surgery in specialized centers. Serial ultrasounds monitor the size and any complications. Most babies with prenatally diagnosed CPAM do well after birth.

0-1 month

Babies with large CPAMs may develop respiratory distress shortly after birth with rapid breathing, grunting, or cyanosis, and may require immediate surgical intervention. Smaller lesions may cause no symptoms at birth. All newborns with a prenatally diagnosed CPAM should have a chest CT scan (typically performed around 1-3 months of age) to fully characterize the lesion and plan management, even if the baby appears well. A postnatal chest X-ray may show the lesion, though some smaller CPAMs are not visible on plain X-ray.

1-12 months

Many pediatric surgeons recommend elective surgical removal of CPAM during infancy, often between 3-6 months of age, even if the baby is asymptomatic. This is because leaving the lesion in place carries a risk of recurrent infections within the abnormal tissue and a small but real risk of malignancy (pleuropulmonary blastoma). Surgery typically involves removing the affected lobe of the lung (lobectomy) and is generally well tolerated in infants, with the remaining lung compensating well.

1 year+

If surgical removal was not performed in infancy, children may present later with recurrent pneumonia in the same location or with an incidentally discovered lung mass on imaging. Some centers offer observation with serial imaging for small, asymptomatic lesions, though this approach requires careful follow-up. After surgical removal, children typically have excellent lung function and can participate in normal activities. Long-term follow-up with periodic chest imaging may be recommended.

What to Tell Your Pediatrician

Describe when you first noticed congenital pulmonary airway malformation (cpam) and how it has changed over time.
Note your baby's current age and which age-specific patterns you are seeing.
Mention if a lung mass or cyst was found on your baby's prenatal ultrasound and you want to discuss what it means and the plan for after birth.
Mention if your baby has a known CPAM and you want to discuss the timing and approach for surgical removal.
Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
Bring a list of any questions or observations you want to discuss at the appointment.

What Should You Do?

When to take action

Probably normal when...

A small CPAM was found on prenatal ultrasound and your doctor is monitoring it with serial imaging and it is stable or shrinking
Your baby had a CPAM surgically removed and has recovered well with normal breathing and growth
A prenatal lung finding was evaluated after birth and was determined to be benign or to have resolved on its own

Mention at your next visit when...

A lung mass or cyst was found on your baby's prenatal ultrasound and you want to discuss what it means and the plan for after birth
Your baby has a known CPAM and you want to discuss the timing and approach for surgical removal
Your child had CPAM surgery and you have questions about follow-up care, activity restrictions, or long-term outlook
Your child has had more than one episode of pneumonia in the same area of the lung, which could suggest an undiagnosed lung malformation

Act now when...

Your newborn with a known lung mass is having difficulty breathing, breathing rapidly, grunting, or appearing blue, as this may require urgent surgical intervention
Your baby or child with a known CPAM develops sudden onset of fever, cough, and breathing difficulty, which could indicate an infection within the malformation
Your child develops sudden chest pain, difficulty breathing, or coughs up blood, which could indicate a complication of the CPAM such as hemorrhage or infection

What You Can Do at Home

Keep track of when you notice congenital pulmonary airway malformation (cpam) — noting the time of day, duration, and any triggers can help your pediatrician.
Remember that a small CPAM was found on prenatal ultrasound and your doctor is monitoring it with serial imaging and it is stable or shrinking — this is generally within the range of normal.
At Prenatal, focus on observation rather than intervention unless your pediatrician advises otherwise.
Follow any care instructions from your pediatrician. Keep a written log of symptoms to bring to appointments.
While monitoring at home, seek immediate care if your newborn with a known lung mass is having difficulty breathing, breathing rapidly, grunting, or appearing blue, as this may require urgent surgical intervention.

My Baby Is Breathing Fast

Babies normally breathe faster than adults. A normal respiratory rate for a newborn is 30-60 breaths per minute, slowing to 20-40 by age 1. Brief episodes of faster breathing during excitement, crying, or feeding are normal. However, persistently rapid breathing (tachypnea) at rest, especially with other signs of respiratory distress, may indicate a lung or heart problem that needs prompt evaluation.

Normal Noisy Breathing in Newborns

Newborns are notoriously noisy breathers. Squeaking, whistling, snorting, rattling, and gurgling sounds are very common and usually normal because babies have small, flexible airways and narrow nasal passages. As long as your baby is breathing comfortably, feeding well, and has normal skin color, noisy breathing is rarely a cause for concern.

Milestone

Month-by-Month Development

Detailed monthly development guides from birth through 24 months.

Guide

When to Call the Doctor

General guide on when to call the pediatrician, visit urgent care, or go to the ER.

Frequently asked questions

Is congenital pulmonary airway malformation (cpam) normal?

When should I call the doctor about congenital pulmonary airway malformation (cpam)?

Your newborn with a known lung mass is having difficulty breathing, breathing rapidly, grunting, or appearing blue, as this may require urgent surgical intervention Your baby or child with a known CPAM develops sudden onset of fever, cough, and breathing difficulty, which could indicate an infection within the malformation Your child develops sudden chest pain, difficulty breathing, or coughs up blood, which could indicate a complication of the CPAM such as hemorrhage or infection

When is congenital pulmonary airway malformation (cpam) normal?

A small CPAM was found on prenatal ultrasound and your doctor is monitoring it with serial imaging and it is stable or shrinking Your baby had a CPAM surgically removed and has recovered well with normal breathing and growth A prenatal lung finding was evaluated after birth and was determined to be benign or to have resolved on its own

What causes congenital pulmonary airway malformation (cpam)?

Congenital pulmonary airway malformation (CPAM, formerly called CCAM) is an abnormal mass of lung tissue that forms during fetal development. It can be cystic (fluid-filled) or solid. Many are found on prenatal ultrasound. Some cause respiratory distress at birth, while others are asymptomatic. Surgical removal is usually recommended even for asymptomatic cases due to the risk of recurrent infections and a small risk of malignancy. Common explanations include: A small CPAM was found on prenatal ultrasound and your doctor is monitoring it with serial imaging and it is stable or shrinking. Your baby had a CPAM surgically removed and has recovered well with normal breathing and growth.

What should I mention to my pediatrician about congenital pulmonary airway malformation (cpam)?

You should mention congenital pulmonary airway malformation (cpam) at your next visit if: A lung mass or cyst was found on your baby's prenatal ultrasound and you want to discuss what it means and the plan for after birth. Your baby has a known CPAM and you want to discuss the timing and approach for surgical removal. Your child had CPAM surgery and you have questions about follow-up care, activity restrictions, or long-term outlook.

Is congenital pulmonary airway malformation (cpam) normal at Prenatal?

Is congenital pulmonary airway malformation (cpam) normal at 0-1 month?

Should I go to the ER for congenital pulmonary airway malformation (cpam)?

Seek emergency care if your newborn with a known lung mass is having difficulty breathing, breathing rapidly, grunting, or appearing blue, as this may require urgent surgical intervention, or if your baby or child with a known CPAM develops sudden onset of fever, cough, and breathing difficulty, which could indicate an infection within the malformation. When in doubt, call your pediatrician's after-hours line for guidance.

Does congenital pulmonary airway malformation (cpam) go away on its own?

In many cases, congenital pulmonary airway malformation (cpam) resolves on its own, especially when a small CPAM was found on prenatal ultrasound and your doctor is monitoring it with serial imaging and it is stable or shrinking. By 1 year+, if surgical removal was not performed in infancy, children may present later with recurrent pneumonia in the same location or with an incidentally discovered lung mass on imaging. Some centers offer observation with serial imaging for small, asymptomatic lesions, though this approach requires careful follow-up. After surgical removal, children typically have excellent lung function and can participate in normal activities. Long-term follow-up with periodic chest imaging may be recommended.

AAP ATS NIH

References

[1]American Academy of Pediatrics. Congenital Lung Malformations. NeoReviews, 2019. AAP
[2]Bush A. Congenital Lung Disease: A Plea for Clear Thinking and Clear Nomenclature. Pediatric Pulmonology, 2019. ATS
[3]National Library of Medicine. Congenital Pulmonary Airway Malformation. MedlinePlus, 2024. NIH

Doctor Visit Checklist

Bring this checklist to your next pediatrician visit to discuss Congenital Pulmonary Airway Malformation (CPAM).

Things to mention

Describe when you first noticed congenital pulmonary airway malformation (cpam) and how it has changed over time.
Note your baby's current age and which age-specific patterns you are seeing.
Mention if a lung mass or cyst was found on your baby's prenatal ultrasound and you want to discuss what it means and the plan for after birth.
Mention if your baby has a known CPAM and you want to discuss the timing and approach for surgical removal.
Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
Bring a list of any questions or observations you want to discuss at the appointment.

Observations to share

A lung mass or cyst was found on your baby's prenatal ultrasound and you want to discuss what it means and the plan for after birth
Your baby has a known CPAM and you want to discuss the timing and approach for surgical removal
Your child had CPAM surgery and you have questions about follow-up care, activity restrictions, or long-term outlook

Urgent signs to report immediately

Your newborn with a known lung mass is having difficulty breathing, breathing rapidly, grunting, or appearing blue, as this may require urgent surgical intervention
Your baby or child with a known CPAM develops sudden onset of fever, cough, and breathing difficulty, which could indicate an infection within the malformation
Your child develops sudden chest pain, difficulty breathing, or coughs up blood, which could indicate a complication of the CPAM such as hemorrhage or infection

My notes

From ismybabyalright.com — free, evidence-based baby health guides

All content follows our editorial policy and is reviewed against published clinical guidelines.

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Bottom line

Most cases of congenital pulmonary airway malformation (cpam) are normal. Talk to your pediatrician if your newborn with a known lung mass is having difficulty breathing, breathing rapidly, grunting, or appearing blue, as this may require urgent surgical intervention.

Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.

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