Anomalous Systemic Arterial Supply to the Lung: To Which Category Should This Belong?

Three-dimensional CT angiography facilitates uniportal thoracoscopic anatomic lung resection for pulmonary sequestration: a retrospective cohort study

Background

Pulmonary sequestration (PS) is a rare lesion with independent blood supply from an anomalous systemic artery. A timely resection is considered as the best treatment for PS. Three-dimensional computed tomography angiography (3D-CTA) has been widely utilized for precise thoracic surgery. This study aimed to investigate the role of preoperative 3D-CTA and resection simulation in uniportal video-assisted thoracoscopic surgery (VATS) anatomical lung surgery for PS.

Methods

The data of 20 consecutive PS patents undergoing anatomic lung resection between April 2011 and May 2021 in a single centre were retrospectively reviewed. These patients were divided into the 3D-CTA group (10 patients) and the control group (10 patients) according to the initial surgical planning with or without 3D-CTA. The perioperative parameters regarding safety and fluency such as the incidence of conversion to open thoracotomy, operation time, blood loss, complications and chest tube duration were analyzed.

Results

This cohort included 12 female and 8 male patients, with a mean age of 45 years old (range 24–60 years). Nine cases demonstrated recurrent febrile, cough, or hemoptysis; whereas the other 11 patients were asymptomatic on admission. Eighteen (90.0%) intralobar and 2 extralobar PS were confirmed, whereas 18 (90.0%) lesions were located in the left thorax. The feeding vessels originated from the thoracic aorta in 16 patients (80.0%), the abdominal aorta in 3 (15.0%), and the inferior phrenic artery in 1 patient (5.0%). There was no major bleeding or 30 days mortality. The initial surgical planning included 9 uniportal and 1 two-port VATS in the 3D-CTA group, as compared with 10 two-port VATS in the control group. Thirteen lobectomies, 5 segmentectomies and 2 mass excisions were performed. However, no conversion was needed in the 3D-CTA group; whereas 6 (60.0%) conversions (4 to multiple-port and 2 to thoracotomy) occurred in the control group, indicating a significant difference (P = 0.003). In addition, the operation time in the 3D-CTA group was significantly shorter than those in the control group [(108.5 ± 24.9) min vs. (154.5 ± 39.4) min, P = 0.006]. The other surgery-related outcomes were similar between the two groups.

Conclusion

Preoperative 3D-CTA facilitates the safe and fluent performance of uniportal VATS anatomical lung resection for PS with shortened operation time and lessened surgical conversions.

Intralobar pulmonary sequestration supplied by vessel from the inferior vena cava: Literature overview and case report

Sequestration is a congenital abnormality that can occur in both children and adults. The clinical presentation often manifests as recurrent pneumonia throughout the lifetime of the patient. Pathologically, sequestration is a disorganized region of lung parenchyma without a normal pulmonary artery and with no interconnecting air passage (ie, it is isolated from the bronchi and pulmonary arteries). Sequestration can be either intralobar or extralobar and is usually supplied with blood from an anomalous vessel originating from the thoracic aorta or abdominal aorta (big circulation/systemic circulation), which is one of the mandatory criteria for diagnosing sequestration. CT angiography or catheter angiography can assist in identifying the anomalous vessel both for diagnosis and surgical resection. We present a rare case of intralobar sequestration with the distinction of being supplied with blood from the abdominal vena cava, as confirmed by CT angiography, surgery, and postoperative pathology. It is hoped that this study will contribute to the literature by introducing a rare case of congenital lung abnormality and pulmonary vascular malformation.