A Study of the Clinical Features of Benign Convulsions with Acute Gastroenteritis in Children

PURPOSE: We investigated the complexities of benign convulsions associated with gastroenteritis in children. METHODS: We selected children diagnosed as afebrile convulsion with acute gastroenteritis from June 2006 to May 2008 who had been admitted to the Kwandong Medical College Myongji Hospital. We investigated clinical features, EEGs, and brain imaging results for patients exhibiting complex-type seizures (Group B) and compared the data with that from patients with simple seizures (Group A). The statistical significance between the two groups was subsequently examined. RESULTS: A total of 43 patients showed afebrile benign convulsions with acute gastroenteritis, and 18 patients were diagnosed as CwG (benign convulsions with acute gastroenteritis). The median age of Group B was 26.3 month which was significantly higher than that of Group A (P < 0.05). The gender ratio was 3.5 times more in higher female of Group A compared to Group B (P < 0.05). The most common type of seizure in both groups was generalized tonic convulsions, and there were no statistical differences in the laboratory results between the two groups. Further, Group B showed more frequent abnormal findings than Group B with respect to EEG and brain imaging studies (P < 0.05). All of the abnormal findings in brain imaging studies were structural abnormalities unrelated with CwG, and patients with abnormal EEGs showed no recurrent seizure attacks and exhibited normal follow-up EEGs after discharge. CONCLUSION: CwG with complex-type seizure frequently occurred in children older than three years of age regardless of gender, and also in patients with underlying CNS diseases. Regardless of recurrent seizures or seizures lasting more than 15 minutes, patients diagnosed as CwG would receive a favorable prognosis.

Causative Organisms of Community Acquired Urinary Tract Infection and Their Antibiotic Susceptibility at a Secondary hospital in Korea / 소아감염

PURPOSE: We investigated the causative organism and its antibiotic susceptibility of community acquired urinary tract infection (UTI) in children at a secondary hospital to test the adequacy of the current guidelines. METHODS: Children diagnosed with UTI at the Department of Pediatrics, Kwandong University Myongji Hospital by pyuria and bacterial growth of greater than 1.0x10(5) CFU/mL on clean catch midstream urine from January 2005 to December 2008 were studied retrospectively. The epidemiologic data, causative organism, and the antibiotic susceptibility were analyzed. RESULTS: Sixty two children were diagnosed with sixty four cases of UTI's. Two bacteria were isolated in one case and thus data on 65 urine cultures were analyzed. The male:female ratio was 1.6:1 and 78.1% were less than 12 months of age. Escherichia coli was the predominant cause consisting of 53 cases (82.8%) of the cases. K. pneumoniae (5), Enterobacter (4), Enterococcus (1), beta-streptococcus (1), Diphtheroides (1) were isolated. The antibiotic resistance of E. coli were as follows; ampicillin 69.8%, cefotaxime 1.9%, gentamicin 15.1%, amikacin 0.0%, levofloxacin 1.9%, and trimethoprim/sulfamethoxazole 26.4%. Only one case of the E. coli was extended spectrum beta-lactamase (ESBL) positive. CONCLUSION: Compared to prior reports from other tertiary hospitals in Korea, E. coli was the predominant cause in childhood UTI and the rate of ESBL positivity was low. The antibiotic resistance was also different compared to prior reports. We conclude that a difference in the cause and antibiotic resistance of childhood UTI exists between centers and this should be taken into consideration when prescribing antibiotics for childhood UTIs.

A study of factors influencing advanced puberty / 소아과

PURPOSE: The purpose of this study was to evaluate the timing of puberty and the factors inducing advanced puberty in elemental school students of low grades. METHODS: The 1st, 2nd, and 3rd grade elemental students from the Goyang province were randomly selected, and their sexual maturation rate was assessed by physical examination. After obtaining an informed consent, a questionnaire was administered to the parents; eating habits, lifestyle, use of growth-inducing medication, and present illness of the students were evaluated to determine the factors that induced advanced puberty. The data were statistically analyzed. RESULTS: We selected 170 children and the girls:boys sex ratio was 1.2:1. Two 9-year-old boys were in genital stage 2. Two (14.3%) 6-year-old girls, 6 (19.4%) 7-year-old girls, 15 (39.6%) 8-year-old girls, and 4 (57.1%) 9-year-old girls were in breast stage 2. The average pubertal timing predicted for girls was 9.11+/-1.86 years. The main factors influencing pubertal timing were obesity scale, frequency of eating fast food, and the use of growth-inducing medication. A high rating on the obesity scale and high frequency of eating fast food indicated advanced stage of puberty. Growth-inducing medication induced puberty through obesity. CONCLUSION: We proposed that predictive average pubertal timing in girls was 9.11+/-1.86 years, which was consistent with the previously reported findings from abroad. The significant influencing factors in advanced puberty were obesity scale and frequency of fast food.

A Case of Developmental Delay with Canavan's Disease: A case report

Canavan's disease is a hereditary disease that causes development delay by demyelinization of white matter in brain. The cardinal symptoms of Canavan's disease are head-lag, macrocephaly, developmental delay, blindness, epilepsy and hypotonia. Seven-month old baby delivered by Caesarean section at gestational age 40 weeks was complaining of an inability to keep head up. In past history, he was treated for congenital nystagmus. Chromosomal study was normal. Brain MRI showed delay of myelination of 5 months old. During neurodevelopment treatment in our hospital about development delay, macrocephaly was observed with head circumference 46 cm (90~97 percentile). He couldn't control his head yet. Brain MRI was done when he was 12-month old. There was no myelination in whole brain compared with that of same age group. The peak elevation of N-acetylaspartic acid (NAA) was showed in magnetic resonance spectroscopy (MRS). NAA was detected as high as 29.7 mmol/molCr, we diagnosed him as Canavan's disease. So we reported this case with a brief review of related literatures.

Hemiconvulsion-hemiplegia-epilepsy Syndrome Sparing Paracentral Lobule:Early Magnetic Resonance Imaging Findings and Neuroradiological Follow-up

HHE syndrome is characterized by hemiconvulsive seizure, hemiplegia and epilepsy occurring in sequence. Recently, cytotoxic edematous swelling of one hemisphere was presented as the pathogenesis because high signal intensity was shown in the diffusion image but no remarkable findings were noticed in the FLAIR image and T2WI in two cases presented by Freeman etc. The clinical course and the radiologic findings in our patient was the same as the above description other than sparing paracentral lobule. This reinforces the assumption that the brain damage in HHE syndrome is not induced by vascular hypoxic damage but by selectively cytotoxic damage through immunologic pathogenesis. Therefore, diffusion image is needed for the diagnosis of HHE syndrome in a febrile convulsive child. Also, early adequate treatment is required such as immunosuppressive treatment with high dose steroid and intravenous immunoglobulin. Furthermore, a proper measure to reduce cerebral edema is essential for the prevention of neurologic sequalae and deterioration to epilepsy.

A Study of Clinical Significance of Dizziness in Diagnostic Approach for Children with Chronic Headache

PURPOSE: Headache is a common neurologic symptom in children but chronic headache in them must be diagnosed in different ways. The aim of this study is to determine the algorithm of diagnostic approach for children with chronic headache and know the clinical significance of dizziness in evaluating those children. METHODS: We recruited children with headache at Myongji Hospital from January 2004 to July 2006. The study was based on a retrospective review of their medical records and interviews with the children and their parents. We divided them into two groups : Group A headache with dizziness, Group B headache without dizziness. RESULTS: The medical records of 86 children and adolescents with headache were reviewed. Age for group A ranged from 10 to 15 years(73.7%) and gender ratio was 1:1.7. Age for group B ranged mostly under 7 years(56.3%) and gender ratio was 1:0.85. Headache in group A frequently occurred predominantly in the morning(37.3%). The duration of the attack was over 90 min(87.5%) in group A and over 90 min(50.0%) in group B. Associated symptoms were mainly nausea(34.2%), vomiting(18.4%), blurred vision(12.7%) in group A. Over 90% of them had headache 4 times a week and so did dizziness. The final diagnoses in cases of group A were migraine(31.6%), orthostatic hypotension(15.8%), postural orthostatic tachycardia syndrome(13.2%), and benign paroxysmal positional vertigo(10.5%). While in group B diagnoses included sinusitis(50.0%), migraine(31.3%), and complications of migraine(8.3%). CONCLUSION: This study revealed high percentage of headache concurred with dizziness in children. The association of headache with dizziness is complex and maybe coincidental. If chronic headache with dizziness in girls occurs mainly in the morning, it maybe related to vestibular disorder and orthostatic instability. In conclusion, dizziness and other associated symptoms or clinical features should carefully be assessed in the diagnosis of headache.

A Case of Cerebral Sinus Expansion and Concurrent Diffuse Meningeal Enhancement in Postlumbar Puncture Headache

Post-lumbar puncture headache (PLPH) is a common complication developed after lumbar puncture, and it usually begins within 48 hours. The pain is postural; the it is relieved by reclining and worsened by sitting. Moreover, there are some related symptoms such as nausea, vomiting, tinnitus and blurred vision. PLPH is rare in children and it is effectively treated by bed rest and conservative treatment. However, when the pain is too severe or continuous or different types of headache are seen after LP, it is worthwhile to conduct brain MRI for exact diagnosis and proper treatment. Therefore, we report a patient with PLPH in whom brain MRI showed diffuse meningeal enhancement and concurrent cerebral venous expansion, with a review of literatures.

Relationship between Recurrence in Febrile Seizures and Serum Zinc Levels

PURPOSE: The etiology of febrile seizures is not yet ascertained but it is known that genetic factors, cytokines or trace elements are associated with pathogenesis of febrile seizures. Among them, zinc deficiency is known to play some role of pathogenesis of febrile seizures. We purposed to know the relation between recurrence of febrile seizures and serum zinc level. METHODS: The subjects were recurrent febrile seizures group who were admitted to our hospital from June 2003 to July 2005 because of more than 3 times febrile seizures. The other two control groups were simple febrile seizures and acute febrile illness groups admitted to our hospital in same period. Simple febrile seizures group showed no more seizure over 1 year after first onset. We investigated serum zinc level in each group. RESULTS: The number of patient in each group is 33 children. Recurrent febrile seizures group was composed of 20 boys and 13 girls (the ratio of 1.5:1) with an average age 30 months old. The mean serum zinc levels in the recurrent febrile seizures group (123.7+/-9.6 microgram/dL) were not statistically different from those of the simple febrile seizures group(112.5+/-8.9 microgram/dL). Both of the recurrent and simple febrile seizures groups had significantly lower serum zinc levels than the febrile illness group(154.1+/-6.8 microgram/dL). CONCLUSION: We suggested that serum zinc level is not relationship with recurrence of febrile seizures. Nevertheless, the fact remains that serum zinc level was decreased in recurrent and simple febrile seizures groups compared with acute febrile illness group.

A Case of Epstein-Barr Virus Associated Encephalitis Improved after High-Dose Intravenous Immunoglobulin Therapy

Neurologic complications of Epstein-Barr virus (EBV) infection are diverse including a number of neurologic diseases such as encephalitis, encephalomyelitis, Guillain-Barre syndrome, optic neuritis, acute disseminated encephalomyelitis, cerebellitis, and Alice-In-Wonderland syndrome. In general encephalitis caused by EBV in children has been considered a self-limited disease with few or no sequelae. Occasionally it leaves a severe neurologic sequela and complications. Therefore administration of high dose acyclovir and steroid in early stages of EBV encephalitis is recommended currently. In this case, the patient of a 8-year-old boy was admitted because of generalized tonic seizure of 2 times. He showed 16% of atypical lymphocytosis in peripheral blood smear and positive findings in VCA-IgM and EA-IgM tests. EBV DNA Antibody, and virus PCR in CSF was not evaluated. He also showed hepatosplenomegaly in abdominal sonography. Brain MRI revealed a bilateral increased signal intensity at lenticular nucleus and caudate nucleus, multiple high signal intensity at cortical layer of both gyrus reti, both frontal, inferior parietal, and dorsal aspect of the right paracentral lobue. As mentioned in serologic and imaging study, he was diagnosed as the EBV- associated encephalitis. Although we administered high dose acyclovir and corticosteroids, he showed clinical deterioration with confusion, delirium, and ataxia. Therefore, we administered additional high dose intravenous immunoglobulin, and finally he was recovered. We report the case of improvement of EBV-associated encephalitis after high-dose Intravenous immunoglobulin therapy.

A Case of Epstein-Barr Virus Associated Encephalitis Improved after High-Dose Intravenous Immunoglobulin Therapy

Neurologic complications of Epstein-Barr virus (EBV) infection are diverse including a number of neurologic diseases such as encephalitis, encephalomyelitis, Guillain-Barre syndrome, optic neuritis, acute disseminated encephalomyelitis, cerebellitis, and Alice-In-Wonderland syndrome. In general encephalitis caused by EBV in children has been considered a self-limited disease with few or no sequelae. Occasionally it leaves a severe neurologic sequela and complications. Therefore administration of high dose acyclovir and steroid in early stages of EBV encephalitis is recommended currently. In this case, the patient of a 8-year-old boy was admitted because of generalized tonic seizure of 2 times. He showed 16% of atypical lymphocytosis in peripheral blood smear and positive findings in VCA-IgM and EA-IgM tests. EBV DNA Antibody, and virus PCR in CSF was not evaluated. He also showed hepatosplenomegaly in abdominal sonography. Brain MRI revealed a bilateral increased signal intensity at lenticular nucleus and caudate nucleus, multiple high signal intensity at cortical layer of both gyrus reti, both frontal, inferior parietal, and dorsal aspect of the right paracentral lobue. As mentioned in serologic and imaging study, he was diagnosed as the EBV- associated encephalitis. Although we administered high dose acyclovir and corticosteroids, he showed clinical deterioration with confusion, delirium, and ataxia. Therefore, we administered additional high dose intravenous immunoglobulin, and finally he was recovered. We report the case of improvement of EBV-associated encephalitis after high-dose Intravenous immunoglobulin therapy.

A Study on the Clinical Features and the Predictors of Febrile Seizure Plus

PURPOSE: We intended to investigate the clinical features and the predictors of febrile seizure plus(FS+), not suspected of generalized epilepsy with febrile seizure plus (GEFS+). METHODS: We selected 24 patients, aged more than 6 years old, who were admitted to Myongji Hospital of Kwandong University from January, 2001 to March, 2005 due to febrile seizures. All of those had neither a family history of febrile seizures or epilepsy nor abnormalities in the EEG or MRI. We examined sex, age of seizure onset, type of seizure, duration of seizure, the time until seizure after fever and frequency of febrile seizure. We investigated also the statistical significances of these clinical features by comparing with patients of simple febrile seizure(FS) as a control group. RESULTS: The male to female of the FS+ group was 2:1, which had no statistical significance compared with the FS. The age of seizure onsets in the FS+(39.4+/-5.0 months) was significantly older than FS the group(24.1+/-2.1 months)(P<0.05). In the types of seizures, non-generalized tonic clonic seizures occurred significantly more often in the FS+ group(20.9%) than the FS(8.4%)(P<0.05). The frequency of febrile seizures also was high in the FS+ group(n=3.2+/-0.8) than the FS group(n=1.1+/-0.1)(P<0.05). The duration of seizures and the time until seizure after fever did not have statistical significance. CONCLUSION: We suggest that FS+ can be characterized by late onsets of initial seizures, more frequent non-generalized tonic clonic seizures and recurrent febrile seizures. Therefore, FS+ should be suspected for patients more than 4 years old with non-generalized tonic clonic seizures or recurrent febrile seizures of more than 4 times.

A Case of Multiple Large Renal Abscesses Completely Resolved by Conservative Antibiotics Administration

Renal abscess in childhood is a rare disease, and generally treatment of renal abscesses in childhood follows the guidelines in adults. The guidelines of treatment of renal abscesses in adults include the following:renal abscesses smaller than 3 cm in size can be managed by antibiotics administration, while renal abscesses above 3 cm in size must be considered for percutaneous abscess drainage or open drainage. We experienced a case of a 2 year-old girl with multiple renal abscesses greater than 4 cm in size which resolved by oral antibiotics administration after 2 weeks of intravenous administration. We report this case with literature review.

Clinical Usefulness of Serum Uric Acid in Gastroenteritis Patients with Dehydration / 대한소아소화기영양학회지

PURPOSE: The estimation of fluid deficit is crucial to the proper management of dehydrated children. Without well-documented serial weights on the same scale, the estimation of any given child's fluid deficit is imprecise and dependent largely on subjective clinical criteria. Despite the abundance of literature on clinical and laboratory evaluation of dehydration, few studies have focused on serum uric acid. So, we examined the usefulness of serum uric acid in gastroenteritis patients with dehydration. METHODS: Medical records of 90 gastroenteritis patients were retrospectively reviewed. By the body weight loss, we classified patients with mild, moderate, and severe dehydration groups. We studied the relevance of laboratory data (BUN, creatinine, serum bicarbonate, glucose, urine specific gravity, and uric acid) with dehydration. RESULTS: 54 children (60%) were dehydrated mildly, 24 (26%) dehydrated moderately, and 12 (14%) dehydrated severely. Statistically significant differences in BUN, creatinine, serum bicarbonate, glucose, and urine specific gravity could not be observed. But there was significant relationship between uric acid and the degree of dehydration. Data analysis suggested that the level of 7.0 mg/dL is the best cut-off value for predicting the development of moderate or severe dehydration. At this cut-off value, the sensitivity and specificity were 66.6% and 87.1%. CONCLUSION: Our study supports that the measurement of serum uric acid with traditional scales is useful for predicting the development of dehydration. But, in order to be used as the indicator for proper treatment at an earlier stage, further validation about serum uric acid is necessary.

Lipomyelomeningocele with Thoracic Spinal Cord Tumor in VATER Association: A case report

VATER association represents vertebral defects, anal atresia, tracheo-esophageal fistula with esophageal atresia, renal abnormalities and radial limb dysplasia. The probability of the simultaneous occurrence of any three of these defects is so unlikely that it suggests a sporadic non-random association. This non-random association appears to be related to mesodermal defects in early developmental period. We experienced one case of VATER association in 21 months old male child having vertebral anomalies with severe scoliosis, rib defects, imperforated anus, right renal agenesis, lipomyelomeningocele, spinal cord tumor. We reported a case of VATER association with brief review of related literature.

Study of Priority between Prognostic Factors of Status Epilepticus in Childhood

PURPOSE: Poor prognostic factors of status epilepticus(SE) in children have been known as less than 1 year of age, generalized tonic clonic type of convulsion, symptomatic etiology, and duration of longer than 12 hours. Through statistical analysis of morbidity and mortality between these poor prognostic factors, we intended to inquire out the priority of every prognostic factor. METHODS: We selected patients admitted at the Department of Pediatrics of Masan Samsung Hospital because of SE from January to December 2001. We investigated the statistical significance and the priority in morbidity and mortality of each prognostic factor:age, etiology, type of seizure and response to treatment. RESULTS: There were 38 patients with SE. Age distribution showed that the number of patients less than 3 years old is 29(76.3%). The patients more than 3 years old showed increasing morbidity but there is no statistical significance. In the type of seizure, one patient with a mixed type died. The morbidity in partial seizure was 100% and in mixed type of seizure it was 83.3%(P<0.05). In etiology, one patient with non-febrile SE died. The morbidity in non-febrile SE was 60.9%(P<0.05). In the response of treatment, one patient whose seizure activity was controlled after pentothal infusion died. The morbidities of the groups with in phenytoin or phenobarbital, midazolam, and pentothal were 60.0%, 100%, and 75.0%(P<0.05) respectively. In a multivariate statistical analysis, the etiology factor showed the highest priority between the prognostic factors. CONCLUSION: Among the prognostic factors of SE, the etiology factor is the most important and has the higher priority than the other prognostic factors.

A Case of Isolated Interhemisphere Fusion of Frontal Lobe with Intact Septum Pellucidum : A Variant of Holoprosencephaly

Holoprosencephaly is a rare CNS developmental defect with midline cleavage of embryonal forebrain during the fourth week of fetal development characterized with s single ventricle. Holoprosencephaly is divided into three types by the degree of the brain cleavage : alobar, semilobar, and lobar. Depending on the degree of defected regions, there exist variable clinical symptoms and signs such as stillbirth, hypotonia, apnea, convulsion, delayed development and visual disturbance. It was frequently associated with the deformity of the brain as well as the midline facial structures. Advances in neuroimaging over the past decades have led us to a better understanding of the pathogenesis and the variability of holoprosencephaly. As a result, a lot of cases of holoprosencephaly with various clinical and pathologic findings have been reported. We experienced a case of isolated interhemisphere fusion of frontal lobes with intact septum pellucidum in a child with febrile status epilepticus. Is it a variant of holoprosencephaly?

Complementary and Alternative Medical Therapies in Children and Adolescent with Chronic Disease: Utilizations and Patterns / 소아과

PURPOSE: This study describes how often complementary and alternative medical (CAM) therapies, what patterns of CAM therapies utilization, what types of CAM therapies and why CAM therapies are used in children and adolescent with chronic disease. METHODS: We interviewed and filled out questionnaires with parents of patients suffering from asthma, atopic dermatitis, congenital myopathy, epilepsy and so on from Mar 2004 to Aug 2004. RESULTS: Two hundred fifty two parents answered questionnaires; 160 cases (63.5 percent) had used CAM therapies. Utilization of CAM therapies according to each chronic disease was as follows: congenital myopathy (100 percent), atopic dermatitis (91.1 percent), asthma (72.5 percent), chronic diarrhea (50.0 percent), epilepsy (17.1 percent) etc. Types of CAM therapy were as follows: dietary supplement (31.1 percent), herb medicine (23.4 percent), massage (14.2 percent), acupuncture (4.6 percent) etc. Sixty four (40.0 percent) case underwent more than two types of CAM therapies simultaneously. One hundred thirty three (83.1 percent) case were asked through non-medical prescription. Ninety nine (61.9 percent) case were recognized positive effect of CAM therapies. Parents' and childrens' ages were influential factors in CAM therapies utilization: the older the parents and the younger the children, the higher the utilization. CONCLUSION: Although patients receive treatment with western medicine, many of them not only undergo CAM therapies, especially more than two types, but also recognize the positive effects of CAM therapies. As a result, we suggest that it is easy to use of CAM therapies, and the positive effects of CAM therapies are prominent, domestically. Therefore, medical approach and study about the effectiveness and side effects of CAM therapies is necessary to avoid the imprudent use of such therapies.

Clinical Study of Rotavirus Gastroenteritis in the Last 2 Years / 소아과

PURPOSE: Although the rotavirus-related neonatal death occurred in western part of Kyeonggi Province recently, there were just a few reports about rotavirus gastroentertis in domestic since 2000. We proposed to investigate changes of epidemiology and clinical features of rotavirus gastroenteritis for the last 2 years. METHODS: We selected 166 patients diagnosed as gastroenteritis from January, 2002 to July, 2003 and reviewed the admission records retrospectively such as age distribution, sex ratio, seasonal distribution, admission period, laboratory data and dehydration type in the rotavirus group (RVG) and non-RVG. RESULTS: The percentage of patient under 3 years was 77% on RVG. The non-RVG showed even age distribution (P< 0.05). In RVG, patients occurred in March frequently and 52% occurred from January to March. In non-RVG, patients occurred highly in February and July (P< 0.05). The average of admission period was higher in RVG than non-RVG (P< 0.05). The percentage of patient admitted for over 10 days was 8% in the RVG. In dehydration severity, the RVG showed mild (51%), moderate (44%) and severe (5%) respectively, but non-RVG showed only mild dehydration (P< 0.05). The laboratory findings' did not have statistic significance between RVG and non-RVG. CONCLUSION: Compared to the previous studies, seasonal peak prevalence of rotavirus gastroenteritis changed from autumn to spring and patients over 3 years increased. Therefore, we suggest that there are variable serotypes of rotavirus domestically and there is a need for reinvestigation about clinical features and serotypes of rotavirus gastroenteritis.

A Case of Henoch-Schonlein Purpura after Abdominal Blunt Trauma / 소아과

Henoch-Schonlein purpura is the most common vasculitis in childhood and shows unique clinical features characteristic purpura, arthritis, abdominal pain, intestinal bleeding, nephritis and so forth by IgA mediated leukocytoclastic vasculitis. The etiology of Henoch-Schonlein purpura is unknown, but many variable causative factors are reported such as infection, drugs, vaccination, food, insect bite and so on. Henoch-Schonlein purpura precipitated by trauma is rare. There have been reports in which Henonch-Schonlein purpura was precipitated by trauma of cranio-face and ankle joint. We experienced a case of Henoch-Schonlein purpura precipitated by abdominal blunt trauma. We report it with a review of the literature.

A Case of Congenital Cystic Adenomatoid Malformation of the Lung in the Patient with Recurrent Pneumonia (Mixed type I and II) / 소아알레르기및호흡기학회지

Congenital cystic adenomatoid malformation (CCAM) of the lung is an uncommon embryonic developmental anomaly, characterized by the presence of one or multiple interconnecting cysts. This disease may present various clinical aspects, stillborn or perinatal death, respiratory distress in newborns, and acute and chronic pulmonary infections in older infant and children. We experienced a case of CCAM in a 3-years, 8-month-old male who had frequent upper respiratory tract infection and recurrent pneumonia. Chest X-ray and chest CT showed a cavitary lesion in the right middle lobe. Histologic examination revealed numerous small and large sized cysts in the parenchyma. The large cysts were mainly lined by pseudostratified ciliated cells and the small cysts are lined by simple cuboidal cells and subclassified Stocker type mixed I and II. Wedge resection was done with satisfactory postoperative courses clinically and radiologically. We report a case of CCAM (I and II mixed type) with a brief review.