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Flanagan SR, Vasavada P. Intralobar Pulmonary Sequestration: A Case Report. Cureus 2023; 15:e46794. [PMID: 37954799 PMCID: PMC10632745 DOI: 10.7759/cureus.46794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 11/14/2023] Open
Abstract
Pulmonary sequestration is a congenital lung malformation characterized by a mass of nonfunctioning lung tissue that receives its arterial supply from an aberrant systemic artery. If symptomatic, most newborns present with respiratory distress. Recurrent infection is the most common presentation after the neonatal period. It is often diagnosed prenatally and is treated with elective surgical resection between ages six and twelve months. We present a case of an infant diagnosed with congenital pulmonary airway malformation prenatally revealed to be pulmonary sequestration at the age of six months, emphasizing the need for appropriate postnatal imaging.
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Affiliation(s)
- Shawn R Flanagan
- Diagnostic Radiology, Liberty University College of Osteopathic Medicine, Lynchburg, USA
| | - Pauravi Vasavada
- Pediatric Radiology, University Hospitals Cleveland Medical Center, Cleveland, USA
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Abu Zahira I, Haddad RN, Meot M, Bonnet D, Malekzadeh-Milani S. Transcatheter Management of Pulmonary Sequestrations in Children-A Single-Center Experience. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1197. [PMID: 37508694 PMCID: PMC10378210 DOI: 10.3390/children10071197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/26/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND A pulmonary sequestration (PS) is an area of bronchopulmonary tissue with aberrant arterial supply. Transcatheter occlusion of PSs is an appealing treatment option, but data on outcomes remain scarce. We aim to describe our experience with transcatheter management of PS in infants and children. METHODS Retrospective review of clinical data of all patients with suspected PS sent for diagnostic and/or interventional cardiac catheterization at our institution between January 1999 and May 2021. Procedural considerations, techniques, standard safety, and outcomes were assessed. RESULTS We identified 71 patients (52.1% males), with median age and weight of 4.9 months (IQR, 2.1-26.6) and 4.2 kg (IQR, 3.9-12.1), respectively. Sixty-one (86%) patients had associated congenital heart defects (CHDs). Forty-two (59%) patients had pulmonary arterial hypertension (PAH) at the time of diagnosis. Fifty-three (74.7%) patients underwent embolization of the PS feeding vessel using microcoils and/or vascular plugs, and eight (15.1%) of these were neonates who presented with severe PAH and cardiac failure. Two patients had large feeding vessels and were treated surgically. Sixteen (22.5%) patients with small feeding vessels received conservative management. At median follow-up of 36.4 months (IQR, 2.1-89.9), seven patients had died, 24 patients had CHD corrective surgeries, 26 patients had redo catheterizations, and five patients had persistent PAH. No PS surgical resection was needed, and no infection of the remaining lung tissue occurred. CONCLUSIONS Transcatheter assessment and treatment of PSs is a safe and effective procedure. Neonates with large PSs are severely symptomatic and improve remarkably after PS closure. PS embolization and surgical repair of associated CHDs generally leads to the normalization of pulmonary pressures.
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Affiliation(s)
- Ibrahim Abu Zahira
- M3C-Necker, Hôpital Universitaire Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), 75015 Paris, France
| | - Raymond N Haddad
- M3C-Necker, Hôpital Universitaire Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), 75015 Paris, France
| | - Mathilde Meot
- M3C-Necker, Hôpital Universitaire Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), 75015 Paris, France
| | - Damien Bonnet
- M3C-Necker, Hôpital Universitaire Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), 75015 Paris, France
- Faculté de Médecine, Université de Paris Cité, 15 Rue de l'École de Médecine, 75006 Paris, France
| | - Sophie Malekzadeh-Milani
- M3C-Necker, Hôpital Universitaire Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), 75015 Paris, France
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Mukherjee R, Das O, Chakravorty S, Mohanty S, Chatterjee U. Extralobar Pulmonary Sequestration in Adrenal Mimicking Neuroblastoma: A Case Report. Fetal Pediatr Pathol 2023; 42:310-314. [PMID: 35796300 DOI: 10.1080/15513815.2022.2094513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background: Extralobar pulmonary sequestration (ELS) is a malformation composed of bronchopulmonary tissue outside the lungs that is discontinuous from the main tracheobronchial tree. ELS can present as a suprarenal space occupying lesion. Case Report: A 1-day old girl presented with a right supra-adrenal mass, first detected in-utero at 34 weeks. The differential included congenital neuroblastoma, but the urinary VMA was normal. At resection, there was lung tissue composed of dilated and tortuous bronchioles lined by columnar epithelium present in a back- to- back arrangement along with thick-walled vessels, features of an ELS with congenital pulmonary airway malformation type II. Conclusion: ELS enters the differential diagnosis of neonatal suprarenal masses with normal urinary catecholamines, and can have the morphology of a type II congenital pulmonary airway malformation.
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Affiliation(s)
- Raktim Mukherjee
- Department of Pathology, Institute of Postgraduate Medical Education & Research (IPGME&R), Kolkata, India
| | - Oindrila Das
- Department of Pathology, Institute of Postgraduate Medical Education & Research (IPGME&R), Kolkata, India
| | - Subhankar Chakravorty
- Department of Neonatology, Institute of Postgraduate Medical Education & Research (IPGME&R), Kolkata, India
| | - Suravi Mohanty
- Department of Pathology, Kalinga Institute of Medical Sciences, Bhubaneswar, India
| | - Uttara Chatterjee
- Department of Pathology, Institute of Postgraduate Medical Education & Research (IPGME&R), Kolkata, India
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4
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Li J, Jiang Y, Xiao J, Liang G. Extralobar pulmonary sequestration with a cyst: a case report. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:969. [PMID: 32953769 PMCID: PMC7475435 DOI: 10.21037/atm-20-3815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Extralobar pulmonary sequestration (EPS) is a congenital malformation. In contrast with intralobar sequestration, EPS located outside the normal lung tissue and with a distinct pleural covering. In the current case report, we present a rare case of EPS. To our knowledge, this is the first report of a cyst occurring within the EPS. A 17-year-old male patient presented with chest pain for 1 month. Computed tomography (CT) scan demonstrated a sharply circumscribed mass at the left side of the lower thoracic vertebrae. No aberrant vessel was observed on contrast-enhanced CT. The preoperative diagnosis was a posterior mediastinal tumor or EPS and surgical resection was recommended to the patient. During the operation, an extrapulmonary sequestration lobe was found in the left chest cavity. There was an aberrant artery connecting the sequestration lobe and the descending aorta. A cyst was located in the apex of the sequestration lobe. Surgical resection was performed via thoracoscopy. The postoperative histopathology confirmed an extrapulmonary sequestration combined with a cyst. The patient recovered successfully and was discharged on the sixth day postoperatively. He did not present with recurrent chest pain at the 6-month follow up. EPS should be considered when a posterior mediastinal conical mass is shown on chest CT.
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Affiliation(s)
- Jian Li
- Department of Thoracic Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Yingmei Jiang
- Department of Thoracic Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Jiarong Xiao
- Department of Thoracic Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
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Soni S, Moldenhauer JS, Rintoul N, Adzick NS, Hedrick HL, Khalek N. Perinatal Outcomes in Fetuses Prenatally Diagnosed with Congenital Diaphragmatic Hernia and Concomitant Lung Lesions: A 10-Year Review. Fetal Diagn Ther 2020; 47:630-635. [PMID: 32380499 DOI: 10.1159/000507481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 03/23/2020] [Indexed: 11/19/2022]
Abstract
AIM To describe perinatal outcomes of fetuses with a prenatal diagnosis of a concomitant lung lesion in the setting of congenital diaphragmatic hernia (CDH) and to compare outcomes with an isolated CDH control group without a lung lesion, matched by ultrasound-based prognostic markers including presence of liver herniation and lung measurements. MATERIAL AND METHODS This was a retrospective case-control study, wherein all pregnancies diagnosed with CDH and concomitant lung lesions were identified between July 1, 2008, and December 31, 2018. For each case, 2 controls with isolated CDH from the same study period were selected after matching for the presence of liver herniation into the thoracic cavity and ultrasound-based lung measurements either observed over expected lung-to-head ratio (LHR) or absolute LHR with their corresponding gestational age. The outcomes analyzed in the 2 groups included survival to hospital discharge, neonatal intensive care unit (NICU) length of stay (LOS), extracorporeal membrane oxygenation (ECMO) requirement and need for supplemental oxygen (O2) at day 30 of life. RESULTS A total of 21 pregnancies were identified with CDH and a concomitant lung lesion in the study period. All the lung lesions were stratified into a "low-risk category" with a congenital cystic adenomatoid malformation volume ratio of less than 1.0 at the time of presentation. None of these fetuses developed hydrops or required in utero intervention. Overall survival in the group was 80.7% (17/21) and rate of ECMO was 38.1%. Causes of mortality included pulmonary insufficiency, sepsis, renal failure, and bowel infarction. Upon comparison between the cases and controls, the 2 groups were similar with respect to pregnancy demographics. There were no fetal demises in either group. Outcomes including survival rate, NICU LOS, ECMO requirements and need for supplemental O2 at day 30 of life, were comparable among the 2 groups. CONCLUSIONS In our descriptive series, the presence of a concomitant, low-risk lung lesion in the setting of fetal CDH did not have a significant impact on the natural course of the disease, nor was it associated with a worse prognosis.
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Affiliation(s)
- Shelly Soni
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA, .,Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA, .,Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,
| | - Julie S Moldenhauer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Natalie Rintoul
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - N Scott Adzick
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Holly L Hedrick
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Nahla Khalek
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Lima M, Maffi M, Gargano T, Ruggeri G, Libri M, Destro F. Thoracoscopic Approach for Congenital Diaphragmatic Hernia: A Useful Tool in Diagnosis and Treatment of Unexpected Associated Lung Lesion. European J Pediatr Surg Rep 2016; 4:10-12. [PMID: 28018801 PMCID: PMC5177555 DOI: 10.1055/s-0036-1580705] [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: 12/21/2015] [Accepted: 02/12/2016] [Indexed: 11/04/2022] Open
Abstract
We report the case of a neonate affected by prenatally diagnosed congenital diaphragmatic hernia (CDH), treated by thoracoscopy. During the procedure, we detected an associated extralobar pulmonary sequestration (EPS), which was preoperatively undiagnosed, and we removed it. EPS has been shown to be associated with CDH in up to 15 to 40% of cases. A possible explanation hypothesized is that pulmonary sequestration, which develops at 4 to 5 weeks of gestation, can disturb the fusion of the diaphragm and closure of the pleuroperitoneal canal. The thoracoscopic approach permitted us to identify the thoracic EPS that probably would have been otherwise missed.
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Affiliation(s)
- Mario Lima
- Department of Pediatric Surgery, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Michela Maffi
- Department of Pediatric Surgery, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Tommaso Gargano
- Department of Pediatric Surgery, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Giovanni Ruggeri
- Department of Pediatric Surgery, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Michele Libri
- Department of Pediatric Surgery, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Francesca Destro
- Department of Pediatric Surgery, S. Orsola Hospital, University of Bologna, Bologna, Italy
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Stocker LJ, Wellesley DG, Stanton MP, Parasuraman R, Howe DT. The increasing incidence of foetal echogenic congenital lung malformations: an observational study. Prenat Diagn 2014; 35:148-53. [PMID: 25256093 DOI: 10.1002/pd.4507] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 09/08/2014] [Accepted: 09/21/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the incidence of congenital lung malformations over the past 19 years. Congenital lung malformations (CLM) are a heterogeneous group of lung abnormalities. The antenatal diagnosis is important for foetal and neonatal management but there have been no studies examining whether the reported incidence of this abnormality is constant. METHODS A retrospective cross-sectional study of cases identified from the Wessex Antenatally Detected Anomalies (WANDA) register 1994-2012. RESULTS One hundred and thirty-three cases of CLM in 524 372 live and stillbirths were identified. All but seven were identified on antenatal ultrasound. During the early registry (1994-1998) the average incidence of CLM was 1.27 per 10,000 births. By the last 4 years (2008-2012) this had risen to 4.15 per 10,000 births, with a progressive increase during the intervening years. CONCLUSION There was over a three-fold increase in the antenatally detected CLM in the Wessex region 1994-2012. Comparison with the antenatal detection of diaphragmatic hernia suggests that this is a true rise in incidence rather than an artefactual increase due to increased antenatal recognition secondary to improved ultrasound resolution and operator experience. These results have clinical and cost implications for practitioners of foetal medicine, neonatology and paediatric surgery services.
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Affiliation(s)
- Linden J Stocker
- University of Southampton, Faculty of Medicine, Academic Unit of Human Development and Health, UK
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8
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Pleuropulmonary blastoma in extrapulmonary lung tissue: A case report. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2014. [DOI: 10.1016/j.epsc.2014.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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9
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Bernard Stover L, Marchese SM, Saenz NC, Shayan K. Torsion of an extralobar pulmonary sequestration: A rare cause of acute chest & flank pain in an adolescent. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2014. [DOI: 10.1016/j.epsc.2014.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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10
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Marchiori DM. Diseases of the Airways. Clin Imaging 2014. [DOI: 10.1016/b978-0-323-08495-6.00022-1] [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]
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11
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Extralobar pulmonary sequestration: The importance of intraoperative vigilance. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2013. [DOI: 10.1016/j.epsc.2013.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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12
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Chen W, Wagner L, Boyd T, Nagarajan R, Dasgupta R. Extralobar pulmonary sequestration presenting with torsion: a case report and review of literature. J Pediatr Surg 2011; 46:2025-8. [PMID: 22008345 DOI: 10.1016/j.jpedsurg.2011.07.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2011] [Revised: 07/13/2011] [Accepted: 07/13/2011] [Indexed: 11/29/2022]
Abstract
Posterior mediastinal masses have widely variant presentations and a broad differential diagnosis. We describe an adolescent boy presenting with a posterior mediastinal mass, associated with abdominal pain and pleural effusion. Radiologic, operative, and pathologic findings are reviewed. This patient was found to have torsion of an extralobar pulmonary sequestration, of which only 2 other cases have been reported in the literature. Although radiologic findings of a systemic arterial supply to the mass may be absent, with patients presenting with this constellation of symptoms, a high index of suspicion of a sequestration should be maintained.
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Affiliation(s)
- Wendy Chen
- Department of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Abstract
Intralobar pulmonary sequestration is characterized by the presence of nonfunctional parenchymal lung tissue, receiving systemic arterial blood supply. It lacks normal communication with tracheobronchial tree. Failure to diagnose and treat this condition can lead to recurrent pneumonia and fatal hemoptysis. The aim of this case report is to increase awareness about the condition and to review criteria of its definitive diagnosis and subsequent treatment.
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Affiliation(s)
- R Prasad
- Department of Pulmonary Medicine, Chhatrapati Sahuji Maharaj Medical University (erstwhile, King George's Medical University), Uttar Pradesh, Lucknow, India
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Berna P, Cazes A, Bagan P, Riquet M. Intralobar sequestration in adult patients. Interact Cardiovasc Thorac Surg 2011; 12:970-2. [DOI: 10.1510/icvts.2010.263897] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Makhija Z, Moir CR, Allen MS, Cassivi SD, Deschamps C, Nichols FC, Wigle DA, Shen KR. Surgical Management of Congenital Cystic Lung Malformations in Older Patients. Ann Thorac Surg 2011; 91:1568-73; discussion 1573. [DOI: 10.1016/j.athoracsur.2011.01.080] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 01/26/2011] [Accepted: 01/28/2011] [Indexed: 11/29/2022]
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Correia-Pinto J, Gonzaga S, Huang Y, Rottier R. Congenital lung lesions--underlying molecular mechanisms. Semin Pediatr Surg 2010; 19:171-9. [PMID: 20610189 DOI: 10.1053/j.sempedsurg.2010.03.003] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Congenital lung lesions comprise a broad spectrum of rare but clinically significant developmental abnormalities, including congenital cystic adenomatoid malformation, bronchopulmonary sequestrations, congenital lobar emphysema, and bronchogenic cysts, which are commonly surgically treated. Although the terms congenital cystic adenomatoid malformation, bronchopulmonary sequestrations, congenital lobar emphysema, and bronchogenic cysts are entrenched in clinical usage and comfortably correspond to rigid pathologic definitions, there is a considerable overlap in the findings. Disregarding the controversy about lesion nomenclature and classification, it is widely accepted that congenital lung lesions result from perturbations in lung and airway embryogenesis. It is generally accepted that both place (level in the tracheobronchial tree) and timing (gestational age) of the embryologic insult correlates with the type of lesion and histopathology that is manifested. The objective of this review is to briefly review normal lung development and to analyze the known molecular mechanisms underlying those diseases.
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Affiliation(s)
- Jorge Correia-Pinto
- Surgical Sciences Research Domain, Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.
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Ganeshan A, Freedman J, Hoey ETD, Steyn R, Henderson J, Crowe PM. Transcatheter coil embolisation: a novel definitive treatment option for intralobar pulmonary sequestration. Heart Lung Circ 2010; 19:561-5. [PMID: 20542467 DOI: 10.1016/j.hlc.2010.05.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 05/10/2010] [Indexed: 01/15/2023]
Abstract
Pulmonary sequestrations have been conventionally treated surgically with removal of the tissue mass and ligation of its feeding vessels. There is established evidence to support the use of transcatheter arterial coil embolisation as an effective definitive treatment option for extralobar sequestration especially in the paediatric literature describing good long-term clinical outcomes. We present a case of an adult with intralobar sequestration in whom the diagnosis was established with multi-detector computed tomography (MDCT) and in whom transcatheter arterial coil embolisation was successfully performed as a definitive treatment option to support the growing body of evidence of transcatheter arterial coil embolisation as a safe and effective treatment option for both form of pulmonary sequestrations.
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Affiliation(s)
- A Ganeshan
- Cardiovascular and Interventional Radiology, Heart of England NHS Foundation Trust, Birmingham, UK.
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Abbey P, Das CJ, Pangtey GS, Seith A, Dutta R, Kumar A. Imaging in bronchopulmonary sequestration. J Med Imaging Radiat Oncol 2009; 53:22-31. [DOI: 10.1111/j.1754-9485.2009.02033.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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[Surgical treatment of lung sequestration]. VOJNOSANIT PREGL 2008; 65:33-9. [PMID: 18368936 DOI: 10.2298/vsp0801033c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIM Pulmonary sequestration is a congenital malformation which consists of afunctional part of the lung, separated of the normal airway, and vascularisated with anomal systemic artery instead of pulmonary artery. There are two kinds of sequestration. Intralobar is surrounded with normal lung and its pleura, and extralobar which has extrapulmonary position and pleura of its own. This anomaly is very rare and appears in 1.1-1.8% of all congenital lung malformations. The illness is revealed either in early childhood whith other life-threatening anomalies or in adulthood and middle age when secondary infection arises. The aim of this paper was to show our own experience in surgical treatment of pulmonary sequestration and to emphasize sequestration as a real differential-diagnostic possibility with patients with recidive bronchopneumonias. METHODS We retrospectively analyzed medical records for the period from 1967-2007 and found 15 patients with pulmonary sequestration at the average age of 30 years. We pointed out the well known problems with identification of this anomaly, preoperative diagnostic procedures and surgical possibilities of treatment. RESULTS There were 13 patients with intralobar and two patients with extralobar sequestration. By the use of preoperative angiography, seven patients were found to have intralobar pulmonary sequestration. All intralobar sequestrations were clinically manifested, the most often with recidive bronchopneumonia. Six patients had no preoperative diagnosis of lung sequestration. The most common locality of intralobar sequestration was the left lower lobe (eight patients). We performed nine lobectomies, three sequestrectomies, two segmentectomies and one pneumonectomy. Both extralobar sequestrations were diagnosed intraoperatively. CONCLUSION Pulmonary sequestration is a rare malformation. Diagnosis is established by angiography. Treatment is exclusively surgical. In the last three years we have had one patient per year. This experience obliges to consider pulmonary sequestration as a real differn tial diagnostic possibility in patients with localised repeated bronchopneumonias.
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Grethel EJ, Farrell J, Ball RH, Keller RL, Goldstein RB, Lee H, Farmer DL, Harrison MR, Nobuhara KK. Does Congenital Diaphragmatic Hernia Associated with Bronchopulmonary Sequestration Portend a Better Prognosis? Fetal Diagn Ther 2008; 23:250-3. [DOI: 10.1159/000123609] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2006] [Accepted: 11/14/2006] [Indexed: 11/19/2022]
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Schertler T, Wildermuth S, Teodorovic N, Mayer D, Marincek B, Boehm T. Visualization of congenital thoracic vascular anomalies using multi-detector row computed tomography and two- and three-dimensional post-processing. Eur J Radiol 2006; 61:97-119. [PMID: 17055684 DOI: 10.1016/j.ejrad.2006.08.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2006] [Accepted: 08/04/2006] [Indexed: 11/22/2022]
Abstract
Anomalies of the vascular system are caused by false embryogenesis and are therefore present from birth. Single-detector row spiral computed tomography angiography (CTA) and multi-detector row computed tomography angiography (MDCTA) have gained increasing importance in the non-invasive assessment of vascular pathologies and replace conventional angiography in many cases. High-resolution volumetric datasets that are acquired during a single breath-hold give the possibility of two- (2D) and three-dimensional (3D)-post-processing. Due to post-processing, even complex vascular malformations are visualized in an understandable way. Furthermore, CTA, in contrast to conventional angiography, depicts not only the vascular structures but also allows assessment of the surrounding anatomical structures. We present cases of rare congenital anomalies of the thoracic vessels using MDCT with special respect to 2D- and 3D-post-processing.
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Affiliation(s)
- Thomas Schertler
- Department of Medical Radiology, Institute of Diagnostic Radiology, University Hospital Zurich, Switzerland
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Kuo LT, Chang CH, Kuo KT, Chang DC, Lai HS. Pulmonary sequestration at the posterior mediastinum in a neonate. J Thorac Cardiovasc Surg 2006; 132:185-7. [PMID: 16798334 DOI: 10.1016/j.jtcvs.2006.01.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2005] [Accepted: 01/13/2006] [Indexed: 11/29/2022]
Affiliation(s)
- Lu-Ting Kuo
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Freedom RM, Yoo SJ, Goo HW, Mikailian H, Anderson RH. The bronchopulmonary foregut malformation complex. Cardiol Young 2006; 16:229-51. [PMID: 16725062 DOI: 10.1017/s104795110600031x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/05/2005] [Indexed: 12/24/2022]
Affiliation(s)
- Robert M Freedom
- Department of Paediatrics, Division of Cardiology, The University of Toronto, Toronto, Canada
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24
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Harris K. Extralobar sequestration with congenital diaphragmatic hernia: a complicated case study. Neonatal Netw 2004; 23:7-24. [PMID: 15612417 DOI: 10.1891/0730-0832.23.6.7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
This article presents a case study of an infant (JG) with an antenatal diagnosis of a left diaphragmatic hernia and an extralobar sequestration of his right lung, which was noted postnatally. JG's course was complicated by persistent pulmonary hypertension of the newborn (PPHN) and suspected pulmonary hypoplasia, and he required support with extracorporeal life support (ECLS). JG's case was unusual in his presentation of extreme PPHN that was unresponsive to inhaled nitric oxide and ECLS. His PPHN was nearly intractable, requiring treatment with vasodilators combined with intravenous sildenafil, which had never been tried in our institution before this case. The article concludes with a discussion of the etiology, diagnosis, and management of congenital diaphragmatic hernia and extralobar sequestration, singly and in combination.
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Affiliation(s)
- Kathryn Harris
- Children's and Women's Health Centre of British Columbia, NICU, Vancouver, Canada.
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25
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Chowdhury M, Samuel M, Ramsay A, Constantinou J, McHugh K, Pierro A. Spontaneous postnatal involution of intraabdominal pulmonary sequestration. J Pediatr Surg 2004; 39:1273-5. [PMID: 15300545 DOI: 10.1016/j.jpedsurg.2004.04.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Prenatal ultrasonography in 2 pregnant women identified a suprarenal echogenic mass. The lesions were treated conservatively and involuted with time. These masses were consistent with a suprarenal pulmonary sequestration.
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Affiliation(s)
- M Chowdhury
- Department of Paediatric Surgery, Institute of Child Health and Great Ormond Street Hospital for Children, London, England, UK
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26
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Hosgor M, Karaca I, Karkiner A, Ucan B, Temir G, Erdag G, Fescekoglu O. Associated malformations in delayed presentation of congenital diaphragmatic hernia. J Pediatr Surg 2004; 39:1073-6. [PMID: 15213902 DOI: 10.1016/j.jpedsurg.2004.03.050] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND/PURPOSE Delayed presentation of congenital diaphragmatic hernia (CDH) has been considered rare, and clinical manifestations differ from the more common newborn entity. Associated malformations in late-appearing CDH have been reported in a few patients. The authors reviewed their clinical experience to catalogue the frequency and clinical importance of associated malformations in patients with late-presenting CDH. METHODS The records of patients greater than 1 month of age with Bochdalek type CDH treated in the authors' clinic, from 1991 to 2001, were retrospectively reviewed. Twenty patients (age range, 1 month to 10 years) were included in the study. RESULTS Associated malformations were documented in 16 of the patients (80%) and included malrotation in 12 patients, umbilical hernia in 2, pulmonary hypoplasia in 4, pulmonary sequestration in 1, gastroesophageal duplication cyst coexisting with polysplenia in 1, atrial septal defect and ventricular septal defect in 1, hydronephrosis in 1, wandering spleen in 1, talipes equinovarus in 1, and type I diabetes mellitus in 1. CONCLUSIONS The results of this study show a significant incidence and a wide spectrum of associated malformations. These findings suggest that patients with late CDH should be evaluated carefully for additional anomalies that may help to establish correct diagnosis and treatment.
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Affiliation(s)
- Munevver Hosgor
- Department of Pediatric Surgery, Dr. Behcet Uz Children's Hospital, Izmir, Turkey
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27
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Abstract
Pulmonary sequestration refers to the situation whereby a portion of lung tissue receives its blood supply from an anomalous systemic artery. Three main variants exist: intralobar, extralobar and communicating bronchopulmonary foregut malformations. Venous drainage is typically via a systemic vein, although drainage into the pulmonary veins is well documented. Pulmonary sequestrations are the second commonest congenital lung anomaly. Affected individuals often have other anomalies which are responsible for most of the mortality associated with sequestrations. Diagnosis requires a high index of suspicion particularly in any child with a chest x-ray suggesting the presence of a mass, those with recurrent chest infections and those with other anomalies seen with the pulmonary sequestration spectrum. Surgical excision is usually advised, although embolisation of the feeding vessel has a role in selected cases.
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Affiliation(s)
- Harriet J Corbett
- Royal Manchester Children's Hospital, Hospital Road, Pendlebury, Manchester, UK
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28
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Vijayaraghavan SB, Rao PS, Selvarasu CD, Rao TMS. Prenatal sonographic features of intralobar bronchopulmonary sequestration. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2003; 22:541-544. [PMID: 12751868 DOI: 10.7863/jum.2003.22.5.541] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Congenital lung lesions that can be diagnosed on the basis of prenatal sonography include cystic adenomatoid malformations and extrapulmonary bronchopulmonary sequestrations. Intralobar bronchopulmonary sequestration is a rare congenital malformation of the lung. The prenatal sonographic features of this condition are reported here.
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29
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Affiliation(s)
- S P Singh
- University of Alabama at Birmingham, Birmingham, AL 35233, USA.
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30
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Tokel K, Boyvat F, Varan B. Coil embolization of pulmonary sequestration in two infants: a safe alternative to surgery. AJR Am J Roentgenol 2000; 175:993-5. [PMID: 11000150 DOI: 10.2214/ajr.175.4.1750993] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- K Tokel
- Department of Pediatric Cardiology, Başkent University Faculty of Medicine, 12. sokak 7/7, Bahçelievler 06490, Ankara, Turkey
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31
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32
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Spinella PC, Strieper MJ, Callahan CW. Congestive heart failure in a neonate secondary to bilateral intralobar and extralobar pulmonary sequestrations. Pediatrics 1998; 101:120-4. [PMID: 9417164 DOI: 10.1542/peds.101.1.120] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- P C Spinella
- Department of Pediatrics, Tripler Army Medical Center, Honolulu, HI 96859-5000, USA
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33
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Urushihara N, Nakagawa Y, Kawashima K, Fukazawa T, Watanabe Y, Todani T. Congenital right diaphragmatic hernias through posterolateral and anterolateral defects associated with extralobar pulmonary sequestration: a case report. J Pediatr Surg 1997; 32:101-2. [PMID: 9021582 DOI: 10.1016/s0022-3468(97)90106-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Multiple diaphragmatic hernias in the unilateral diaphragm are extremely rare. The authors report a neonate with diaphragmatic hernias through two defects in the right diaphragm: a posterolateral defect without a hernia sac and an anterolateral defect with one. After excision of the anterolateral hernia sac, each defect was closed. Histology studies showed extralobar pulmonary sequestration in the removed hernia sac. The presence of sequestrated pulmonary tissue indicates the possibility of interference with the closure of the pleuroperitoneal canal and muscularization in the diaphragm, which may result in multiple defects.
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Affiliation(s)
- N Urushihara
- Department of Pediatric Surgery, National Iwakunt Hospital, Yamaguchi, Japan
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34
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Gamillscheg A, Beitzke A, Smolle-Jüttner FM, Zach M, Stein JI, Steinbrugger B, Eber E, Litscher H. Extralobar sequestration with unusual arterial supply and venous drainage. Pediatr Cardiol 1996; 17:57-9. [PMID: 8778705 DOI: 10.1007/bf02505815] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We present a case of extralobar pulmonary sequestration between the left lower lobe and diaphragm with an unusual arterial blood supply and venous drainage. Angiography revealed a large systemic artery arising from the left subclavian artery. The venous return paralleled this anomalous artery and drained into the left subclavian vein. This case illustrates the wide anatomic variability of such complex bronchovascular anomalies. Careful preoperative evaluation of both the arterial supply and venous drainage is important to avoid intraoperative complications. Angiography provides clear definition of these abnormal vascular structures, which is essential for appropriate therapeutic management.
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Affiliation(s)
- A Gamillscheg
- Department of Pediatric Cardiology, University of Graz, Austria
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35
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Abou-Touk B, Baez-Giangreco A, Afzal M, Vel K, Abdulmohsen AS. Subdiaphragmatic extralobar pulmonary sequestration with granulomatous necrotizing reaction simulating a tuberculous infection: A case report. Ann Saudi Med 1995; 15:648-50. [PMID: 17589032 DOI: 10.5144/0256-4947.1995.648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- B Abou-Touk
- Pediatric Surgery Department of Pediatrics, Maternity and Children's Hospital, and Central Laboratory and Blood Bank, Ministry of Health, Riyadh, Saudi Arabia
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36
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Hirose R, Suita S, Taguchi T, Koyanagi T, Nakano H. Extralobar pulmonary sequestration mimicking cystic adenomatoid malformation in prenatal sonographic appearance and histological findings. J Pediatr Surg 1995; 30:1390-3. [PMID: 8523257 DOI: 10.1016/0022-3468(95)90518-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
An infant girl with extralobar pulmonary sequestration (PS) composed of congenital cystic adenomatoid malformation (CCAM)-like structure is presented. Initially, the antenatal sonographic findings indicated CCAM. The macroscopic findings of the resected specimen were compatible with extralobar PS; however, the microscopic findings showed cystic structure mimicking type II CCAM. The combination of PS and CCAM is rare, and it is likely that the embryological origin is common to both. There is confusion in the classification of these two congenital anomalies. In this report, the histological and sonographic findings of PS and CCAM are discussed.
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Affiliation(s)
- R Hirose
- Department of Pediatric Surgery, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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37
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Brus F, Nikkels PG, van Loon AJ, Okken A. Non-immune hydrops fetalis and bilateral pulmonary hypoplasia in a newborn infant with extralobar pulmonary sequestration. Acta Paediatr 1993; 82:416-8. [PMID: 8318813 DOI: 10.1111/j.1651-2227.1993.tb12710.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Extralobar pulmonary sequestration was found in a newborn premature infant that presented with non-immune hydrops fetalis, massive bilateral hydrothorax and polyhydramnios in utero. The baby died of severe respiratory insufficiency 15 h after birth. Postmortem examination revealed distended lymphatic vessels in the sequestered lung tissue probably due to impeded lymph drainage. We suggest that not extralobar pulmonary sequestration itself but a subsequent massive unilateral hydrothorax due to severe obstruction of lymph drainage was the cause of the non-immune hydrops fetalis, pulmonary hypoplasia and polyhydramnios. If these symptoms are diagnosed before delivery, a search for extralobar pulmonary sequestration is indicated.
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Affiliation(s)
- F Brus
- Department of Pediatrics, University Hospital Groningen, The Netherlands
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38
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Kolls JK, Kiernan MP, Ascuitto RJ, Ross-Ascuitto NT, Fox LS. Intralobar pulmonary sequestration presenting as congestive heart failure in a neonate. Chest 1992; 102:974-6. [PMID: 1516442 DOI: 10.1378/chest.102.3.974] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
We recently evaluated a premature infant with intralobar pulmonary sequestration which presented with signs of CHF. The infant initially underwent ligation of a PDA but subsequently developed tachycardia, tachypnea, and a continuous murmur which radiated to the back. The diagnosis of a pulmonary sequestration was suggested by Doppler echocardiography and confirmed by aortography. The sequestration was successfully treated by surgical removal of the involved lobe.
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Affiliation(s)
- J K Kolls
- Louisiana State University Medical Center, New Orleans
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39
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Abstract
A left upper quadrant fetal abdominal mass was detected at 24 weeks gestation. The mass was again confirmed in a postnatal ultrasound. Pathological analysis of the excised mass demonstrated an intraabdominal lung sequestration with Stocker type II congenital cystic adenomatoid malformation (CCAM). The sonographic characteristic of these lesions are those of a homogeneous echogenic mass with variable shape passing through or arising from the diaphragm. Surgical excision is recommended because of the uncertainty of the preoperative diagnosis and the possibility of malignant changes in CCAM.
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Affiliation(s)
- M D Black
- Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Canada
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40
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Yogasakaran BS, Sudhaman DA. Congenital cystic adenomatoid malformation of the lung in combination with a pulmonary sequestration. J Cardiothorac Vasc Anesth 1991; 5:368-72. [PMID: 1873516 DOI: 10.1016/1053-0770(91)90162-m] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- B S Yogasakaran
- Department of Anaesthesia, Grantham Hospital, Aberdeen, Hong Kong
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41
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Ahn CM, Kim HJ, Cho HK, Kim SK, Lee WY, Kim SJ, Kim HK, Lee DY, Lee KB. A case of intrapericardial extralobar pulmonary sequestration--first case in Korea. Korean J Intern Med 1991; 6:85-9. [PMID: 1807369 PMCID: PMC4532116 DOI: 10.3904/kjim.1991.6.2.85] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Extralobar pulmonary sequestration, known as accessory lung, is a rare congenital anomaly and intrapericardial lung sequestration is extremely rare. To the best of our knowledge, only four reported cases were intrapericardial. We report a case with intrapericardial extralobar pulmonary sequestration confirmed by operation and morphologic basis.
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Affiliation(s)
- C M Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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42
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Abstract
Seven cases of neonatal pulmonary sequestration are reviewed which illustrate the varied clinical presentations and radiological findings. In four patients, real time ultrasound scanning was used to image the chest and the features are described. In three cases, the systemic supplying artery was demonstrated by duplex Doppler scanning and further invasive investigations were avoided; after a chest radiograph, this should be the examination of choice in the investigation of a neonate with a possible pulmonary sequestration.
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Affiliation(s)
- L M Smart
- X-Ray Department, Royal Hospital for Sick Children, Edinburgh, UK
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43
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Shih SL, Lin JC, Chen BF, Chen CC, Chang KL, Liang DC. Extralobar pulmonary sequestration of the left retroperitoneum. AUSTRALASIAN RADIOLOGY 1990; 34:356-7. [PMID: 2092669 DOI: 10.1111/j.1440-1673.1990.tb02675.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This paper presents an extralobar pulmonary sequestration in the left retroperitoneum in an eight year old girl. The clinical and diagnostic features included abdominal pain, an abdominal mass, elevated VMA, and radiological manifestations simulating a left adrenal mass. A laparatomy was performed. Extralobar pulmonary sequestration of the left retroperitoneum is fairly uncommon. An eight year old girl was admitted with abdominal pain, elevated urinary VMA and an abdominal mass. The radiological manifestations simulated a left adrenal mass. At surgery an extralobar pulmonary sequestration was detected.
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Affiliation(s)
- S L Shih
- Department of Radiology, Mackay Memorial Hospital, Taipei, Taiwan, Republic of China
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44
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Stern E, Brill PW, Winchester P, Kosovsky P. Imaging of prenatally detected intra-abdominal extralobar pulmonary sequestration. Clin Imaging 1990; 14:152-6. [PMID: 2196980 DOI: 10.1016/0899-7071(90)90013-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Intra-abdominal extralobar pulmonary sequestration is a rare congenital anomaly which may present as an abdominal mass. We describe a case of intra-abdominal extralobar pulmonary sequestration detected prenatally as a left suprarenal mass. The ultrasound, computed tomography and magnetic resonance imaging findings are illustrated and correlated with the pathologic findings.
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Affiliation(s)
- E Stern
- Department of Radiology, New York Hospital-Cornell Medical Center, N.Y. 10021
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45
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Abstract
The medical records of 102 live-born children with a congenital diaphragmatic defect were reviewed to determine the frequency and nature of underlying chromosomal, genetic, and nongenetic patterns of malformation. Overall, 40 children (39%) had a major nonpulmonary malformation, and 14 of these children (14%) had a previously recognized pattern of malformation. A group of 18 children (18%) with cardiac anomalies had an increased mortality rate in comparison with those children without cardiac defects (72% vs 38%). The frequency and severity of nonpulmonary abnormalities in children with congenital diaphragmatic defects suggest that examination of affected children should include cardiac evaluation, a karyotype when the defect is one feature of a broader pattern of altered development, and a careful evaluation for minor anomalies, which may provide clues to an overall diagnosis.
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Affiliation(s)
- C Cunniff
- Department of Pediatrics, University of California, San Diego
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46
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Abstract
Pulmonary sequestration is a congenital anomaly resulting in nonfunctioning lung tissue in either the "extralobar" or "intralobar" position. Both forms derive their blood supply from the systemic circulation. Large pulmonary sequestrations can present in the newborn with potentially fatal respiratory distress. Surgical resection is the treatment of choice.
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Affiliation(s)
- W Piccione
- Rush-Presbyterian-St. Luke's Medical Center, Chicago
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47
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Abstract
The term bronchopulmonary foregut malformation (BFM) describes rare cases of pulmonary sequestrations that communicate with the upper gastrointestinal tract. An unusual type of BFM is described; it consisted of esophageal atresia, proximal and distal tracheoesophageal fistulae, and bilateral extralobar pulmonary sequestrations communicating with a common bronchial structure that replaced the distal esophagus. This case is related to other reported cases in the literature, and serves as the basis for a proposed theory of the embryonic development of BFM.
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Affiliation(s)
- C L Fowler
- Department of Pediatric Surgery, Texas Children's Hospital, Houston
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48
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Abstract
Cystic disease of the lung should be considered in the differential diagnosis of any patient presenting with respiratory symptoms. The most important aids available to the thoracic surgeon for the evaluation of cystic disease are history, physical examination, and chest radiograph. Confirmation of diagnosis often requires computed tomography, pulmonary and thoracic aortic angiography, and upper gastrointestinal barium series.
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Affiliation(s)
- F M Shamji
- Division of Cardiothoracic Surgery, Ottawa Civic Hospital, University of Ottawa, Ontario, Canada
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49
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Baumann H, Kirkinen P, Huch A. Prenatal ultrasonographic findings in extralobar subdiaphragmatic lung sequestration--a case report. J Perinat Med 1988; 16:67-9. [PMID: 3042944 DOI: 10.1515/jpme.1988.16.1.67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We present the prenatal ultrasonographic findings of an echo-dense solid mass above the normal left kidney and below the diaphragm. This mass was diagnosed as extralobar lung sequestration (ELS) at laparotomy of the child. ELS (or accessory lungs) is a rare congenital abnormality defined as a lung segment outside a normal lung, usually localized in the left lower thorax. A subdiaphragmatic localization is rare. The prognosis depends upon both the presence (as found in over 50% of reported cases) and severity of additional congenital anomalies.
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Affiliation(s)
- H Baumann
- Department of Obstetrics, University of Zurich, Switzerland
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50
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