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Alem N, Alsufiani H, Alsaadi A, Aljohani S, Arkoubi M. The utility of CT virtual bronchoscopy in the esophageal lung diagnosis: A case report. Respir Med Case Rep 2022; 37:101658. [PMID: 35585904 PMCID: PMC9108735 DOI: 10.1016/j.rmcr.2022.101658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 04/28/2022] [Indexed: 11/27/2022] Open
Abstract
The esophageal lung is a variant of the communicating bronchopulmonary foregut malformation (CBPFM). It needs a high index of suspicion for diagnosis because it is a rare condition and does not have specific symptoms. A CT scan or an esophageal contrast study, showing direct communication between the airways and the esophagus or stomach, confirms the diagnosis. Patients with esophageal lung need flexible bronchoscopy for evaluating tracheobronchial anomalies. We present a three-month-old boy with a right esophageal lung in which the CT virtual bronchoscopy showed an absence of the right main bronchus at the carina level. This case report highlights the importance of CT virtual bronchoscopy as an alternative to flexible bronchoscopy for the diagnosis of tracheobronchial anomalies associated with CBPFM.
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Parelkar S, Soundharya S, Sanghvi B, Gupta R, Mudkhedkar K, Shah R, Makhija D, Khidtta K. Thoracoscopic (3-D) pneumonectomy of congenital bronchopulmonary foregut malformation in an infant. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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3
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Villamizar E, Villamizar MDM, Ciro MP, Pulido J, Rodriguez M, Villamizar JC. Esophageal Lung in a Preterm Boy-Report on a Multidisciplinary Treatment. European J Pediatr Surg Rep 2019; 7:e110-e113. [PMID: 31788411 PMCID: PMC6882685 DOI: 10.1055/s-0039-3400475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 09/20/2019] [Indexed: 11/24/2022] Open
Abstract
Esophageal lung is a rare entity that results from embryological alterations during the formation of the ventral wall of the anterior intestine. The clinical manifestations of this pathology are vague, including respiratory or digestive symptoms, repetitive respiratory infections, dysphagia, or inability to swallow. The management is based on the exact anatomical and vascular abnormalities. We report the diagnostic and therapeutic approach in a preterm boy with esophageal lung. Also, we present a three-dimensional model for the classification of this pathology. In conclusion, the management relies on proper definition of the anatomy and the surgical strategy.
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Affiliation(s)
- Enrique Villamizar
- Department of Pediatric Surgery, Hospital Universitario Erasmo Meoz, Bogota, Colombia
| | | | | | - Jean Pulido
- Department of Surgery, Universidad El Bosque Facultad de Medicina, Bogota, Colombia
| | - Maria Rodriguez
- Registered Nurse, Morton College, Cicero, Illinois, United States
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Yang G, Chen L, Xu C, Yuan M, Li Y. Congenital bronchopulmonary foregut malformation: systematic review of the literature. BMC Pediatr 2019; 19:305. [PMID: 31477056 PMCID: PMC6721191 DOI: 10.1186/s12887-019-1686-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/22/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Congenital bronchopulmonary foregut malformation (CBPFM) is a rare congenital malformation involving both the digestive and respiratory system. Early diagnosis is difficult, and delayed recognition may result in considerable complications. The aim of the study was to identify and analyze the clinical characteristics and radiological features of CBPFMs. METHODS A systematic review was conducted in accordance with PRISMA guidelines. PubMed, Ovid database, EMBASE were searched for relevant publications to identify all published case-reports of CBPFM since 1992. Data about the demography, clinical presentation, pathology, imaging features, treatment and prognosis were collected. RESULTS Sixty-one cases were included in our study. Cases were aged from 1 day to 59 years with the majority aged 3 years or younger. The most common type was group III (37.7%), followed by group II (29.5%)group I (27.9%) and group IV (4.9%). The presentations included respiratory distress (32.8%), cough/choking following food intake and other presentations associated respiratory infection. Thirty-eight cases (62.3%) were diagnosed by upper gastrointestinal series (UGI). Misdiagnosis was common. Eight cases (13.1%) of the included cases died. CONCLUSIONS Early recognition and extensive delineation of the anatomy of CBPFM are important to correct these anomalies successfully. UGI is the first choice to confirm the abnormal bronchus communicating with the esophagus. Resection of abnormal pulmonary tissue, lobe or even unilateral lung is preferred. Reconstruction procedures are feasible in selected patients.
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Affiliation(s)
- Gang Yang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Guoxue Xiang No.37, Chengdu, 610041, China
| | - Lina Chen
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Chang Xu
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Guoxue Xiang No.37, Chengdu, 610041, China
| | - Miao Yuan
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Guoxue Xiang No.37, Chengdu, 610041, China
| | - Yuan Li
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Guoxue Xiang No.37, Chengdu, 610041, China.
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Ichino M, Pugni L, Zanini A, Morandi A, Mosca F, Macchini F. Possible Approach to Esophageal Lung with Long Tracheobronchial Gap. European J Pediatr Surg Rep 2019; 7:e28-e31. [PMID: 31214483 PMCID: PMC6579730 DOI: 10.1055/s-0039-1692407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/28/2019] [Indexed: 11/22/2022] Open
Abstract
Esophageal lung is a rare bronchopulmonary foregut malformation characterized by an anomalous origin of one of the main bronchi which arises from the esophagus. Less than 30 cases are reported in the literature. Therefore, there are no standardized guidelines for the treatment of this condition. We report a case of right esophageal lung diagnosed in a neonate. The patient was treated with thoracoscopic closure of the ectopic main bronchus in the neonatal period, followed by delayed pneumonectomy at 5 months of age. No prosthetic substitute was implanted in the ipsilateral hemithorax after pneumonectomy. The patient is now 4 years old and doing well, postpneumonectomy syndrome was never observed. Our strategy and the possible alternatives are discussed here.
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Affiliation(s)
- Martina Ichino
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Lorenza Pugni
- Department of Neonatal Intensive Care Unit, Fondazione IRCCS "Ca' Granda" Ospedale Maggiore Policlinico, Milano, Italy
| | - Andrea Zanini
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Anna Morandi
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Fabio Mosca
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Francesco Macchini
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
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Majidi S, Nazarzadeh R, hiradfar M, Joudi M, mohamadipour A, Tajali H. Esophageal lung in an infant. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2018.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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7
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The Pediatric Esophagus. Dysphagia 2018. [DOI: 10.1007/174_2018_180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Colleran GC, Ryan CE, Lee EY, Sweeney B, Rea D, Brenner C. Computed tomography and upper gastrointestinal series findings of esophageal bronchi in infants. Pediatr Radiol 2017; 47:154-160. [PMID: 27785539 DOI: 10.1007/s00247-016-3724-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 08/14/2016] [Accepted: 10/04/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Esophageal bronchus is a rare form of communicating bronchopulmonary foregut malformation and a rare but important cause of an opaque hemithorax on chest radiography. A higher incidence of esophageal bronchus is associated with esophageal atresia, tracheo-esophageal fistula (TEF) and VACTERL (vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities) association. In the presence of these conditions, the pediatric radiologist may be the first to consider the diagnosis of esophageal bronchus or esophageal lung. OBJECTIVE To describe the imaging features in five children with esophageal bronchus. MATERIALS AND METHODS We reviewed hospital records and teaching files at two large pediatric tertiary referral centers over the 24-year period from January 1992 to January 2016. We reviewed all imaging studies and tabulated findings on radiography, fluoroscopic upper gastrointestinal (GI) series and CT. We then described the imaging features of esophageal bronchi with emphasis on CT and upper GI findings in four infants and one toddler. RESULTS Three cases were identified from one institution (cases 2, 3, 4) and two from another (cases 1, 5). All five cases occurred in association with other midline malformations: four of the five had VACTERL association and three of the five had esophageal atresia and TEF. CONCLUSION Lung opacification, ipsilateral mediastinal shift, and an abnormal carina and anomalous vascular anatomy suggest an esophageal bronchus or an esophageal lung on CT. While esophageal bronchus is a rare cause of an opaque hemithorax, CT and upper GI imaging play key roles in its diagnosis. Associations with esophageal atresia with tracheo-esophageal fistula and VACTERL association are particularly pertinent. Early diagnosis of esophageal bronchus might prevent complications such as aspiration and infection, which can allow for parenchymal sparing surgery as opposed to pneumonectomy.
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Affiliation(s)
- Gabrielle C Colleran
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA. .,Department of Radiology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland.
| | - Ciara E Ryan
- Department of Pathology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA
| | - Brian Sweeney
- Department of Surgery, Our Lady's Children's Hospital Crumlin, Dublin, Ireland
| | - David Rea
- Department of Radiology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland
| | - Clare Brenner
- Department of Radiology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland
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Griesmaier E, Giner T, Posod A, Freund-Unsinn K, Trawöger R, Kiechl-Kohlendorfer U. Clinical presentation and diagnostic work-up of isolated oesophageal lung in a neonate. Arch Dis Child Fetal Neonatal Ed 2014; 99:F295-6. [PMID: 24065726 DOI: 10.1136/archdischild-2013-304886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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10
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Simultaneous correction of esophageal lung and congenital tracheal stenosis: Lessons learned. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2013. [DOI: 10.1016/j.epsc.2013.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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11
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Chung JH, Lim GY, Kim SY. Esophageal lung diagnosed following the primary repair of esophageal atresia with tracheo-esophageal fistula in a neonate. Surg Radiol Anat 2013; 36:397-400. [PMID: 23900505 DOI: 10.1007/s00276-013-1173-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 07/09/2013] [Indexed: 11/26/2022]
Abstract
Communicating bronchopulmonary foregut malformations are a diverse group of congenital anomalies characterized by a fistula between the respiratory and alimentary systems. Among these malformations, the association of an esophageal lung with esophageal atresia (EA) and tracheo-esophageal fistula (TEF) is extremely rare. We report the case of a neonate with esophageal lung detected following the primary repair of EA with TEF. Despite the rarity of esophageal lung with EA and TEF, it should be considered to develop in infants with abnormal findings on chest radiographs and an unusual preoperative and/or in the postoperative clinical course of EA and TEF. Swallowing study with water-soluble contrast medium is the investigation of choice to demonstrate the anatomic connection, if EA and TEF were already primarily repaired. If not, although the use of preoperative CT may be debatable in neonates due to the associated radiation exposure, in selected cases such as our patient, preoperative CT can be useful for early preoperative diagnosis.
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Affiliation(s)
- Jae Hee Chung
- Department of Surgery, Yeouido St' Mary's Hospital, The Catholic University of Korea, 62 Youido-dong, Youngdeungpo-gu, Seoul, 150-713, Korea,
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Abstract
A seven-month-old girl, born prematurely (birth weight 1000 g) from a twin pregnancy, was admitted to hospital due to recurrent pneumonia and atelectasis. She experienced cough and respiratory distress during feeding. The right hemithorax was smaller than the left, with diminished breath sounds and dullness. Chest x-rays revealed decreased lung volume and multiple radiolucent images in the right lung, as well as overdistention of the left lung. An esophagogram revealed three bronchial branches arising from the lower one-third of the esophagus, corresponding to the right lung and ending in a cul-de-sac. A diagnosis of esophageal lung was established. On bronchography, the right lung was absent and the trachea only continued into the left main bronchus. Echocardiography and angiotomography revealed agenesis of the pulmonary artery right branch. The surgical finding was an esophageal right lung, which was removed; the histopathological diagnosis was type II congenital pulmonary airway malformation in an esophageal lung.
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Benson JE. The Pediatric Esophagus. Dysphagia 2012. [DOI: 10.1007/174_2012_582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sugandhi N, Sharma P, Agarwala S, Kabra SK, Gupta AK, Gupta DK. Esophageal lung: presentation, management, and review of literature. J Pediatr Surg 2011; 46:1634-7. [PMID: 21843734 DOI: 10.1016/j.jpedsurg.2011.04.057] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 04/11/2011] [Accepted: 04/22/2011] [Indexed: 10/17/2022]
Abstract
Esophageal lung is an extremely rare type of bronchopulmonary foregut malformation where a main stem bronchus anomalously arises from the esophagus instead of the trachea. Less than 20 cases have been reported, and most of these are in association with esophageal atresia. Most cases are treated with detachment of the esophageal bronchus with repair of the esophagus and resection of the hypoplastic lung. Described herein are the presentation, diagnostic workup, and management of 2 such cases of esophageal lung.
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Affiliation(s)
- Nidhi Sugandhi
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi-110029, India
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Abstract
Multidetector CT has broadened the potential of imaging to demonstrate anomalies of the lung and the tracheobronchial tree with increasing frequency. Two-and three-dimensional reformatting improve the understanding of complex tracheobronchial anomalies. Most congenital tracheobronchial anomalies are rare and almost always nonsymptomatic; however, some may be confused with or even responsible for respiratory disease. Tracheal and accessory cardiac bronchi are among the most frequent anomalies, but other ectopic or supernumerary lung buds, developmental tracheobronchial interruption, obstruction, or compression, communicating bronchopulmonary foregut malformations, and bronchial malformations associated with anomalies of situs can be detected, even late after birth.
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Affiliation(s)
- Amandine Desir
- Department of Medical Imaging, University Hospital of Liège, B35 Sart Tilman, B-4000 Liège, Belgium
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Kamalaporn H, Tanguay J, Dell S, Sweezey N. AN ESOPHAGEAL BRONCHUS IN A 9-YEAR-OLD GIRL PREVIOUSLY DIAGNOSED WITH COUGH-VARIANT ASTHMA. Chest 2007. [DOI: 10.1378/chest.132.4_meetingabstracts.711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Seguier-Lipszyc E, Dauger S, Malbezin S, Aigrain Y, de Lagausie P. Reimplantation of oesophageal bronchus following a type III oesophageal atresia repair. Pediatr Surg Int 2005; 21:649-51. [PMID: 16041539 DOI: 10.1007/s00383-004-1359-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2004] [Indexed: 10/25/2022]
Abstract
Oesophageal atresia can be associated with communicating bronchopulmonary foregut malformations, the most common being the oesophageal bronchus. Lung resection may be mandatory, but conservative treatment correcting the abnormal airway has been proposed, raising the difficult issue of perioperative ventilatory support. The authors report a case of successful reimplantation of oesophageal bronchus revealed after surgical cure of an oesophageal atresia with tracheo-oesophageal fistula.
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Affiliation(s)
- E Seguier-Lipszyc
- Department of Pediatric Surgery, Hospital Robert Debré, 48 bd Sérurier, 75019 Paris, France.
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Lucaya J, Garel L, Martín C. Clinical quiz. Extralobar sequestration, esophageal bronchus (bronchopulmonary foregut malformation). Pediatr Radiol 2003; 33:665-6. [PMID: 12898070 DOI: 10.1007/s00247-003-0987-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Javier Lucaya
- Pediatric Radiology Department, Hospital Vall d'Hebron, ps Vall d'Hebron 119-129, 08035 Barcelona, Spain.
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Peuch C, Malbezin S, Saizou C, Couloigner V, Elmaleh M, Nivoche Y, De Lagausie P, Laudenbach V. Separate-lung ventilation strategy for reimplantation of esophageal bronchus. Anesth Analg 2002; 95:333-5, table of contents. [PMID: 12145048 DOI: 10.1097/00000539-200208000-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
IMPLICATIONS We describe an original ventilation method designed to optimize lung recruitment and gas exchanges during surgery in a newborn with congenital esophageal atresia and ectopic esophageal implantation of the left mainstem bronchus. This strategy ensured constant adaptation of the mechanical ventilatory regimen to the surgical procedure-linked constraints.
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Affiliation(s)
- Clarisse Peuch
- Department of Anesthesiology, Hôpital Robert Debré, Paris, France
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Asensio de la Cruz O, Marco Valls M, Gil Vázquez J, Obiols Arderius P, Martín Martín C, Bosque García M. Secuestro pulmonar extralobar con bronquio esofágico supernumerario asociado. An Pediatr (Barc) 2002. [DOI: 10.1016/s1695-4033(02)77795-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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