Intralobar pulmonary sequestration associated with congenital broncho-esophageal fistula

Pulmonary sequestration and congenital broncho-esophageal fistula are both rare malformations; nonetheless, in the presence of recurrent pulmonary infection, the possibility that one or the other may be involved should not be disregarded. To our knowledge, the concurrence of intralobar pulmonary sequestration and congenital broncho-esophageal fistula is very rare. Herein, we report a case of intralobar pulmonary sequestration combined with congenital broncho-esophageal fistula, both of which were successfully treated with surgery.

Cardiomyopathy induced by pulmonary sequestration in a 50-year-old man

A 50-year-old black man presented at the emergency department with midsternal, nonradiating chest pressure and chronic dyspnea on exertion. Four years before the current admission, he had been diagnosed with nonischemic cardiomyopathy at another facility. After our complete evaluation, we suspected that his symptoms arose from left-to-left shunting in association with pulmonary sequestration, a congenital malformation. Our preliminary diagnosis of secondary dilated cardiomyopathy was confirmed by normalization of the patient's ventricular size and function after lobectomy. To our knowledge, this patient is the oldest on record to present with cardiomyopathy consequent to pulmonary sequestration. His case is highly unusual because of his age and the rapid resolution of his symptoms after lobectomy. We believe that pulmonary sequestration should be included in the differential diagnosis of dilated cardiomyopathy.

Concurrent aortic valvular disease and pulmonary sequestration: clinical implications

Pulmonary sequestration refers to segmental lung tissue that has no connection with the bronchial tree or pulmonary arteries. In adults, the clinical sequelae are usually related to infection. Patients are typically referred for sequestrectomy even when they are asymptomatic. There are no guidelines for treating patients who have pulmonary sequestration and coexisting cardiac valvular disease, in which case the venous drainage patterns of sequestra pose the additional risks of infective endocarditis and volume overload. We present the cases of 2 adult patients--one symptomatic and one asymptomatic--who had concurrent aortic valvular disease and pulmonary sequestration, and we discuss the factors involved in our evaluation of their cardiac risk and our treatment decisions. In view of the sparse data to predict cardiac risks, we think that pulmonary sequestrectomy in adult patients with concurrent valvular conditions should be considered on a case-by-case basis.

Intralobar Pulmonary Sequestration Presenting as Chronic Non-productive Cough

We report a case of a 60-year-old female who was known to have intralobar pulmonary sequestration and her only symptom was chronic cough. She had no history of infections and surgical resection led to complete resolution of her chronic cough.

Bronchopulmonary sequestration in a 60 year old man

We report a case of bronchopulmonary sequestration (BPS) in a 60 year old man with recurrent cough. After failed antibiotic therapy for presumed left lower lobe (LLL) pneumonia seen on chest radiographs, bronchoscopy was performed revealing cryptogenic organizing pneumonia. Further work-up with thoracic imaging demonstrates a feeding artery from the thoracic aorta to the LLL consolidation indicating the presence of BPS. A brief review of the clinical and radiological features and management options of BPS are listed, with particular emphasis on the various imaging modalities and techniques in the diagnosis and pre-surgical planning of intralobar sequestration.

Two concomitant congenital lung malformations mimicking a paravertebral mass

We report the case of a 47-year-old woman who presented with the unique asymptomatic malformation of an extralobar pulmonary sequestration communicating with a bronchogenic cyst. Despite computed tomography and magnetic resonance imaging of the chest, the diagnosis could not be established before a left thoracotomy was performed. The sequestrated lobe and bronchogenic cyst were then successfully resected.

Intrathoracic caudate lobe of the liver: A case report and literature review

Heterotopic supradiaphragmatic livers are rare. A total of 23 cases of primary supradiaphragmatic livers have been reported in the literature. The clinical presentations of heterotopic supradiaphragmatic liver are variable. The simultaneous detection of intrathoracic accessory liver and pulmonary sequestration is extremely rare, and only one case has previously been reported. It is difficult to make a correct diagnosis preoperatively. We presented a 53-year-old woman with complaints of an intermittent, productive cough and dyspnea for two months that was refractory to medical treatment. She had no previous history of trauma or surgery. A chest radiograph only showed a widening of the mediastinum. Contrast-enhanced computed tomography of the chest revealed a well-circumscribed homogenous soft-tissue mass, approximately 4.35 cm × 2.5 cm × 6.14 cm in size, protruding through the right diaphragmatic crura to the right pleural cavity, attached to the inferior vena cava, esophagus and liver. There was no conclusive diagnosis before surgery. After the operation, we discovered that this patient was the first case of a supradiaphragmatic heterotopic liver, which passed through the inferior vena cava foramen and was coincidentally combined with an intralobar pulmonary sequestration that was found intraoperatively. We discussed its successful management with surgical resection via a thoracic approach and reviewed the published literature.

[Transcatheter embolization device as a promising option in the treatment of pulmonary sequestration. Case reports]

INTRODUCTION

Pulmonary sequestration (PS) has been treated for many years with conventional surgical removal of the ectopic lung tissue and ligation of aberrant vessels that arise from the aorta. There is evidence, especially in English-language literature that supports the use of transcatheter arterial embolization through a device for occlusion of the anomalous vessel, as a safe option and definitive treatment for intralobar PS.

OBJECTIVE

To show our experience pioneering the technique of PS treatment through transcatheter embolization.

CASE REPORT

The case reports of two teenagers aged 13 and 14 and a 26-day-old newborn that developed intralobar PS are described. The diagnosis was made through computerized axial tomography (CT scan) and successfully and without complication, during early and long term follow-up, treated by arterial embolization transcatheter.

CONCLUSION

The use of transcatheter arterial embolization is a less invasive and definitive treatment for patients with PS.

Rare localization of an extralobar pulmonary sequestration in a child as a diagnostic challenge: a case report and review of the literature

We present a child with a rare finding of an extralobar pulmonary sequestration localized in the upper mediastinum. Findings of the prenatal screening enabled early postnatal diagnostic measures that revealed a heterogeneous mass situated next to the thymus. Based on the localization and inconclusive computed tomography images, the preoperative prediagnoses included enterogenic cyst, thymus cyst and teratoma. Intraoperative features of the vascular supply and structure of the mass drew the surgeons' suspicion to extralobar pulmonary sequestration, which was confirmed in the histopathological examination. The scans were reevaluated after the surgery. Surgical management was implemented prior to the occurrence of any symptoms, which led to a positive general outcome. The presented case should raise the awareness of radiologists, pediatric surgeons and other consultants involved in the diagnostic process of mediastinal lesions in children. The rare localization and lack of visualization of a systemic feeding artery can divert suspicion away from extralobar pulmonary sequestration in the preoperative differential diagnosis.

[Extralobar pulmonary sequestration mimicking posterior mediastinal tumor]

The case was 13-year-old man. He visited local hospital due to high fever and back pain. He was diagnosed as acute pleuritis based on a chest computed tomography( CT) scan and referred to our hospital for treatment. Chest CT scan revealed a round shaped mass with clear margin at the left vertebrophrenic angle. A neurogenic posterior mediastinal tumor was suspected. Thoracoscopic surgery revealed that the mass had 2 thin string-like structures connecting to the descending aorta, and was suspected to be a pulmonary sequestration. The resected tumor was pathologically confirmed to be an extralobar pulmonary sequestration most of which was hemorrhagic necrosis caused by arterial infarction.

Pulmonary sequestration-differences in diagnosis and treatment in a single institution

BACKGROUND

Pulmonary sequestration (PS) is a rare congenital lung malformation. In this study, we evaluated the diagnosis and treatment of PS in 31 adult patients at a single institution.

METHODS

A retrospective review of all patients 16 years of age and older with PS in a single institution between January 1985 and January 2011 was conducted. The following data were analyzed for all patients: major symptoms, diagnostic procedures, operative findings, operative techniques, postoperative complications, and outcome.

RESULTS

Our study involved 31 patients, 17 male and 14 female, with an average age of 32.1 (17-57) years, who underwent surgical intervention for PS. The preoperative symptoms of these patients included cough, hemoptysis, fever, pneumonia, and chest pain. Thirty (96.8%) patients were diagnosed by thoracic computed tomography. Of the 31 patients, 29 were diagnosed with intralobar pulmonary sequestration and two had extralobar pulmonary sequestration. Surgical procedures for intralobar pulmonary sequestration included lobectomy in 22 patients (including one thoracoscopic lobectomy), segmentectomy in six, and wedge resection in one of the patients. Thoracoscopic simple mass excision was performed on the two patients with extralobar pulmonary sequestration. Two patients had a postoperative complication (prolonged air leak in 1 patient and postoperative hemothorax in the other). The average hospital stay for all study patients was 6.4 (4-18) days, and there was no mortality.

CONCLUSION

Diagnostic tools may enable the clinician to obtain a definitive diagnosis in patients where there is a strong suspicion of PS via a noninvasive procedure. Computed tomography angiography may be the diagnostic imaging method of choice for optimal evaluation of the sequestrated lung and its vascular supply.

Pulmonary sequestration infected with nontuberculous mycobacteria: a report of two cases and literature review

We report two cases of pulmonary sequestration infected with nontuberculous mycobacteria (NTM): Mycobacterium avium and Mycobacterium abscessus. Chest computed tomography showed pneumonic consolidation in the right lower lobe, which received a systemic blood supply from the descending aorta in both patients. Video-assisted thoracoscopic surgeries were successfully performed and pathological examinations revealed multiple caseating granulomas. A review of the literature revealed only seven previous case reports of pulmonary sequestration infected with NTM, and no case with Mycobacterium abscessus has been reported.

[Congenital cystic lung lesions--review of the literature with three clinical cases]

Congenital cystic lung lesions are rare. Mainly affects the lower respiratory patishta.i are congenital cystic malformation and adematozna bronchopulmonary sequestration (BPS). The pathogenesis of the occurrence of these malformations is not clear but they have a common clinical course. In most cases, the anomaly is asymptomatic and occurs with infections of the lung during the first year of life. Currently congenital lung lesions were classified into five types and is considered by most authors. The anomaly is due to the abnormal proliferation of terminal bronchioles accompanied by inhibition of alveolar development between 7-17 weeks, obstructed airway dysplasia and metaplasia of normal lung tissue. Early diagnosis is vital in making a medical decision on how to treat CCAM. Associated with abnormalities of the urinary tract, cardiovascular system, gastrointestinal atresia, diaphragmatic hernia skeletal abnormalities. In pregnancies in which prenatal lung lesions weighs registered necessary series of ultrasound examinations to track finding and using the Doppler to assess how the blood supply of the fault. The clinical presentation of malformations is respiratory distress, respiratory infection, and dyspnea. The use of CT and MRA allows better visualization of the pulmonary lesions. With its combination with arteriography and bronchoscopy are used to differentiate CCAM and pulmonary sequestration. We present three cases with lung lesions were born in Neonatologia clinic at the University Hospital of Obstetrics and Gynecology "Maternity" Sofia for the period 2010-2012 three cases CCAMs type 1, operated by 5 meters after birth with a good final outcome without complications in the postoperative period and lack of pulmonary symptoms up to 1 year after birth.

Extralobar pulmonary sequestration with an unusual venous drainage to the portal vein: preoperative diagnosis and excision by video-assisted thoracoscopy

Pulmonary sequestration is an uncommon congenital malformation of the lung that can be classified as intralobar or extralobar (ELS). Approximately 90% of ELS occur in the left hemithorax. Approximately 10% of ELS may present below the diaphragm. Both types of sequestrations are characterized by pulmonary tissue that does not communicate with the bronchial tree. The arterial blood supply to 80% ELS is through a direct branch of the thoracic or abdominal aorta, in 15% via another systemic artery and 5% from the pulmonary artery. The venous drainage of ELS is variable, predominantly into the systemic circulation (via the azygos vein, hemiazygos vein, or inferior vena cava). Approximately 25% drain completely or partially through the pulmonary veins. We report an extremely rare case of ELS with unusual venous drainage to the portal vein.

Intralobar bronchopulmonary sequestra in adults over age 50: case series and review

INTRODUCTION

Bronchopulmonary sequestration (BPS) is a rare congenital lung malformation, comprising only 0.15 to 6.4% of all cases of congenital lung malformation. It is characterized by an abnormal segment of bronchopulmonary tissue supplied by an aberrant systemic artery. Diagnostic delays are common in the adult patients since the symptoms often mimic other common diseases such as pneumonia, emphysema, and lung abscess. In 60% of cases, intralobar pulmonary sequestration (ILS) is typically diagnosed at age 20 or younger and is rarely found in adults older than 40 years. Since a heightened clinical suspicion needs to be maintained to entertain this diagnosis in the adult population, we conducted a retrospective chart review of all adult patients at our institution over age 50.

MATERIALS AND METHODS

A retrospective chart review of all adult patients evaluated at our institution with a pathological proven diagnosis of BPS and subsequent surgical correction from January 1993 through December 2008 was conducted. Data obtained included demographics, clinical presentation, diagnostic procedures, location and origin of the lesion, operative therapy, histology of the surgical specimen, and postoperative complications.

RESULTS

Three patients had undergone surgical correction for BPS. All three patients at our institution were female. The average age was 59 years with a range from 57 to 62 years. All three patients had symptoms preoperatively including intermittent cough and recurrent pneumonia. Radiologic evaluation revealed an enlarging lung mass in one patient and lesions suggestive of BPS in two of the patients. Two patients had a right lower lobe sequestration and one patient had a left lower lobe sequestration. All three patients underwent lower lobectomies without any significant postoperative complications.

CONCLUSION

BPS in patients older than 50 is very rare. Persistent lower lobe consolidation in medial or posterior basal segments accompanied by an aberrant artery in adults should heighten suspicion for it. Recurrent pneumonias, cough, chest pain occur in the majority of patients. Surgical excision after correctly identifying the aberrant vessel is curative and also diagnostic in some cases.

A case report of extralobar pulmonary sequestration in a dog

Pulmonary sequestration is a rare congenital anomaly in the veterinary literature. This malformation is characterized by a cystic mass of non-functioning primitive lung tissue that does not communicate with the tracheobronchial tree or with the pulmonary arteries. This article describes gross and histopathological characteristics of extralobar pulmonary sequestration in a dog. Grossly, a mass was observed in the left side of the thoracic cavity, closed to the caudal lobes of the lung, without communication with the tracheobronchial tree and the pulmonary arteries that was separated by pleural covering. Histopathologic examination showed emphysematous alveoli and bronchi, hypertrophy of smooth muscles and presence of the undifferentiated mesenchymal tissue. Therefore, based on microscopic findings, extralobar pulmonary sequestration was diagnosed. To the best of our knowledge, this is the first report of extralobar pulmonary sequestration in dog.