Background: Congenital cystic adenomatoid malformation (CCAM) is a rare pulmonary anomaly typically diagnosed prenatally. In developing countries like Afghanistan, limited medical infrastructure leads to delayed diagnosis and improper treatment. This case highlights diagnostic challenges in resource-constrained settings.

Methods: A 3.5-month-old boy presented with respiratory distress, cough, fever, and tachypnea. Symptoms began at 15 days, with repeated ineffective pneumonia treatments. A pediatric surgeon's referral led to a chest CT scan revealing CCAM in the right lung's upper and middle lobes. The patient required oxygen and bronchodilators but avoided intubation. A right upper and middle lobectomy was performed, with discharge four days later.

Conclusions: This case illustrates challenges in diagnosing congenital lung anomalies in resource-limited environments. CCAM misdiagnosis as pneumonia underscores the need for comprehensive diagnostic approaches. Key observations include the necessity of advanced imaging, increased clinical awareness, and robust pediatric respiratory disease management. Healthcare providers must maintain high suspicion when treating recurrent respiratory conditions unresponsive to standard treatments. Conclusions: Improving maternal healthcare access and diagnostic capabilities in low-income countries is crucial for timely CCAM detection. Addressing challenges requires expanding diagnostic capabilities, enhancing healthcare education, and investing in medical technologies. These improvements will ensure better patient outcomes in resource-constrained settings.