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Ti Y, Wang Y, Huang J, Zheng F, Zhang Q. Clinical analysis of extralobar pulmonary sequestration with torsion in children: report of 6 cases. J Cardiothorac Surg 2022; 17:168. [PMID: 35768850 PMCID: PMC9241176 DOI: 10.1186/s13019-022-01921-8] [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: 01/09/2022] [Accepted: 06/18/2022] [Indexed: 12/05/2022] Open
Abstract
Background Extralobar pulmonary sequestration is an uncommon congenital pulmonary malformation. Clinically, pedicle torsion of extralobar pulmonary sequestration is extremely rare. Due to inadequate awareness of its atypical presentation and imaging characteristics, clinical diagnosis is very difficult, and it is extremely easy to misdiagnose.
Case presentation There were 6 children (3 males and 3 females), aged 3–12 years old. The main clinical symptoms of the children were abdominal and chest pain (3 cases), abdominal pain (1 case), chest pain (1 case), and vomiting and abdominal distension (1 case). Two cases were accompanied by fever. Preoperative ultrasound revealed a well-bordered mass with soft-tissue density, accompanied by pleural effusion. On contrast-enhanced computed tomography scans, the mass showed no obvious enhancement. A blood supply was only present in 1 case, and there was no feeding artery shown in the other 5 cases. Extralobar pulmonary sequestration with haemorrhagic infarction was pathologically confirmed. On postoperative days 2–6, the children were discharged uneventfully. There were no complications during the median follow-up of 4 months. Conclusions Torsed extralobar pulmonary sequestration usually occurs in childhood or adolescence, with abdominal and/or chest pain as the primary symptoms. Imaging examination shows a well-defined soft-tissue mass without enhancement. The feeding vessel is not clearly displayed in the mass, and extralobar pulmonary sequestration is accompanied by varying amounts of pleural effusion. Video-assisted thoracoscopic surgical resection is associated with excellent prognosis.
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Affiliation(s)
- Yunxing Ti
- Department of Cardiothoracic Surgery, Shenzhen Children's Hospital, No.7019, Yitian Road, Shenzhen, 518038, Guangdong, China
| | - Yuanxiang Wang
- Department of Cardiothoracic Surgery, Shenzhen Children's Hospital, No.7019, Yitian Road, Shenzhen, 518038, Guangdong, China.
| | - Junrong Huang
- Department of Cardiothoracic Surgery, Shenzhen Children's Hospital, No.7019, Yitian Road, Shenzhen, 518038, Guangdong, China
| | - Fengnan Zheng
- Department of Cardiothoracic Surgery, Shenzhen Children's Hospital, No.7019, Yitian Road, Shenzhen, 518038, Guangdong, China
| | - Qing Zhang
- Department of Cardiothoracic Surgery, Shenzhen Children's Hospital, No.7019, Yitian Road, Shenzhen, 518038, Guangdong, China
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Walcutt J, Abdessalam S, Timmons Z, Winningham P, Beavers A. A rare case of torsion and infarction of an extralobar pulmonary sequestration with MR, CT, and surgical correlation. Radiol Case Rep 2021; 16:3931-3936. [PMID: 34712371 PMCID: PMC8529221 DOI: 10.1016/j.radcr.2021.09.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 01/06/2023] Open
Abstract
Extralobar pulmonary sequestration is a rare congenital pulmonary malformation that may present early in life or remain asymptomatic. Here we present a case of torsion of an extralobar pulmonary sequestration on its vascular pedicle. Although the patient's initial symptomatology suggested intraabdominal pathology, the correct preoperative diagnosis was determined in large part by the lesion's MRI characteristics, which strongly suggested tissue infarction.
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Affiliation(s)
- Julie Walcutt
- Department of Radiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Shahab Abdessalam
- Department of Pediatric Surgery, Boystown National Research Hospital, Nebraska, USA
| | - Zebulon Timmons
- Department of Pediatric Emergency Medicine, Children's Hospital and Medical Center, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Peter Winningham
- Department of Pediatric Radiology, Children's Hospital and Medical Center, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Angela Beavers
- Department of Pediatric Radiology, Children's Hospital and Medical Center, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Abstract
RATIONALE Pulmonary sequestration is a congenital abnormality of the lower airway. It is characterized by a nonfunctioning mass of lung tissue that lacks normal communication with the tracheobronchial tree or pulmonary arteries and always receives its arterial blood supply from the systemic circulation. Most cases of extralobar pulmonary sequestrations (ELSs) are asymptomatic and found incidentally or in prenatal ultrasound screening. PATIENT CONCERNS A 10-year-old boy had severe chest pain and vomiting for 2 days. DIAGNOSES ELS was diagnosed, and torsion of the ELS had developed as a complication. INTERVENTIONS In video-assisted thoracoscopic surgery, the ELS was resected. OUTCOMES The clinical symptoms were relieved the 2nd day after surgery and did not recur over a follow-up period of 3 months. LESSONS In young patients with sudden abdominal pain or chest pain, in whom computed tomography shows a well-defined mass of homogeneous soft-tissue density in the thorax, ELS with torsion should be suspected. The presence of a feeding artery greatly supports the diagnosis of ELS, and the absence of this classic finding may indicate torsion of the pulmonary sequestration.
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Robson VK, Shieh HF, Wilson JM, Buchmiller TL. Non-operative management of extralobar pulmonary sequestration: a safe alternative to resection? Pediatr Surg Int 2020; 36:325-331. [PMID: 31707604 DOI: 10.1007/s00383-019-04590-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE This retrospective cohort study compares the natural history of patients with extralobar sequestrations (ELS) who do not undergo intervention with those who undergo resection to assess the safety of non-operative management. METHODS 126 patients with pulmonary sequestrations or congenital pulmonary airway malformations born between 1999 and 2016 were identified. 49 patients had ELS on postnatal imaging, but two were excluded for associated congenital diaphragmatic hernia. Demographic and clinical data were retrospectively reviewed, with phone follow-up for non-operative patients with no records for > 1 year. Statistical analysis was by Fisher's exact test or Wilcoxon signed-rank test (two-tailed p < 0.05). RESULTS 40% (19/47) were managed non-operatively and 60% (28/47) underwent resection. Non-operative patients were less likely to have an intrathoracic ELS: 47% (9/19) vs. 75% (21/28), p = 0.07. No symptoms were attributable directly to the ELS. Non-operative patients had median follow-up 3.2 years, during which time 88% (15/17) of ELS decreased in size on serial imaging. For patients who underwent resection, there was 100% concordance between imaging and intraoperative findings. There was no evidence of inflammation, infection or malignancy on final pathology, though 57% (16/28) of resected lesions had foci of non-aerated cysts. CONCLUSIONS Although further longitudinal study is required, this study supports the safety of non-operative ELS management.
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Affiliation(s)
- Victoria K Robson
- Department of Medicine and Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Hester F Shieh
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Fegan 3rd Floor, Boston, MA, 02115, USA
| | - Jay M Wilson
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Fegan 3rd Floor, Boston, MA, 02115, USA
| | - Terry L Buchmiller
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Fegan 3rd Floor, Boston, MA, 02115, USA.
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Son SA, Do YW, Kim YE, Lee SM, Lee DH. Infarction of torsed extralobar pulmonary sequestration in adolescence. Gen Thorac Cardiovasc Surg 2019; 68:77-80. [PMID: 30875002 DOI: 10.1007/s11748-019-01105-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 03/07/2019] [Indexed: 10/27/2022]
Abstract
Torsion of pulmonary extralobar sequestration is extremely rare in childhood and adolescence, and as it presents with a variety of symptoms ranging from intermittent pain to fever from infarction, differential diagnosis is necessary. Herein, we report a rare case of 13-year-old girl who presented with abdominal pain and fever was diagnosed as infarction of torsed extralobar pulmonary sequestration. Torsed extralobar pulmonary sequestration was removed by thoracoscopic surgery, and the patient remained in good clinical condition.
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Affiliation(s)
- Shin-Ah Son
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, South Korea
| | - Young Woo Do
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, South Korea
| | - Young Eun Kim
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, South Korea
| | - So Mi Lee
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Deok Heon Lee
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, South Korea.
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Yokota R, Sakamoto K, Urakawa H, Takeshita M, Yoshimitsu K. Torsion of right lung sequestration mimicking a posterior mediastinal mass presenting as acute abdomen: Usefulness of MR imaging. Radiol Case Rep 2019; 14:551-554. [PMID: 30847012 PMCID: PMC6393704 DOI: 10.1016/j.radcr.2019.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/05/2019] [Accepted: 02/08/2019] [Indexed: 12/11/2022] Open
Abstract
A 15-year-old boy with extralobar sequestration torsion is presented, who presented as an acute abdomen. Chest X-ray and computed tomography on admission revealed an apparent posterior mediastinal mass on the right side at the lower thoracic vertebral level. MR imaging, however, clearly showed scanty fluid around the mass and the subpleural fat layer between the vertebral body and the mass, suggesting its extrapulmonary and intrapleural cavity location. Its hemorrhagic nature was also suggested by the reduced signal on the in-phase as compared to out-of-phase chemical shift images, which helped make correct preoperative diagnosis.
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Affiliation(s)
- Risa Yokota
- Department of Radiology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Keiko Sakamoto
- Department of Radiology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Hiroshi Urakawa
- Department of Radiology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Morishige Takeshita
- Department of Pathology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Kengo Yoshimitsu
- Department of Radiology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
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Zucker EJ, Epelman M, Newman B. Perinatal Thoracic Mass Lesions: Pre- and Postnatal Imaging. Semin Ultrasound CT MR 2015; 36:501-21. [PMID: 26614133 DOI: 10.1053/j.sult.2015.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Chest masses present a common problem in the perinatal period. Advances in prenatal ultrasound, supplemented by fetal magnetic resonance imaging, now allow early detection and detailed characterization of many thoracic lesions in utero. As such, in asymptomatic infants, assessment with postnatal computed tomography or magnetic resonance imaging can often be delayed for several months until the time at which surgery is being contemplated. Bronchopulmonary malformations comprise most of the thoracic masses encountered in clinical practice. However, a variety of other pathologies can mimic their appearances or produce similar effects such as hypoplasia of a lung or both lungs. Understanding of the key differentiating clinical and imaging features can assist in optimizing prognostication and timely management.
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Affiliation(s)
- Evan J Zucker
- Department of Radiology, Stanford University School of Medicine, Lucile Packard Children's Hospital, Stanford, CA.
| | - Monica Epelman
- Department of Medical Imaging, Nemours Children's Hospital, Orlando, FL
| | - Beverley Newman
- Department of Radiology, Stanford University School of Medicine, Lucile Packard Children's Hospital, Stanford, CA
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Choe J, Goo HW. Extralobar pulmonary sequestration with hemorrhagic infarction in a child: preoperative imaging diagnosis and pathological correlation. Korean J Radiol 2015; 16:662-7. [PMID: 25995698 PMCID: PMC4435998 DOI: 10.3348/kjr.2015.16.3.662] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 01/17/2015] [Indexed: 11/15/2022] Open
Abstract
We describe a rare case of extralobar pulmonary sequestration with hemorrhagic infarction in a 10-year-old boy who presented with acute abdominal pain and fever. In our case, internal branching linear architecture, lack of enhancement in the peripheral portion of the lesion with internal hemorrhage, and vascular pedicle were well visualized on preoperative magnetic resonance imaging that led to successful preoperative diagnosis of extralobar pulmonary sequestration with hemorrhagic infarction probably due to torsion.
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Affiliation(s)
- Jooae Choe
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
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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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