Extralobar pulmonary sequestration presenting with torsion: a case report and review of literature

Extralobar pulmonary sequestration in children with abdominal pain: Four case reports

BACKGROUND

Extralobar pulmonary sequestration (ELS) with torsion is extremely rare, consequently, the diagnosis of ELS with torsion in children presents a challenge for clinicians. Herein, we report four cases of ELS with torsion that presented with abdominal pain, and further review the relevant literature to summarize the clinical features.

CASE SUMMARY

Four children presented to our department with abdominal pain. All underwent chest computed tomography, which revealed an intrathoracic soft tissue mass with pleural effusion. All four children underwent thoracoscopic resection of the identified pulmonary sequestration, and the vascular pedicle was clipped and excised. None of the patients experienced any postoperative complications.

CONCLUSION

Clinicians should consider the possibility of ELS with torsion in children presenting with abdominal pain as the chief complaint.

A seven-month-old baby presenting excessive crying for pulmonary sequestration with torsion: A case report and literature review

Pulmonary sequestration with torsion is a rare condition. We describe a seven-month-old baby presenting excessive crying for pulmonary sequestration with torsion. Contrast-enhanced chest computed tomography demonstrated an oval-shaped mass in the posteromedial right lower chest, no systemic arterial supply was evident. The edge of the mass showed slight linear reinforcement, and its interior had no reinforcement. Thoracoscopic segmentectomy was carried out and histology confirmed pulmonary sequestration with torsion.

Clinical analysis of extralobar pulmonary sequestration with torsion in children: report of 6 cases

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.

A rare case of torsion and infarction of an extralobar pulmonary sequestration with MR, CT, and surgical correlation

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.

Extralobar pulmonary sequestration with a complication of torsion: A case report and literature review

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.

Non-operative management of extralobar pulmonary sequestration: a safe alternative to resection?

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.

Extralobar pulmonary sequestration with absence of pericardium and atrial septal defect in a woman

BACKGROUND

Extralobar sequestration is a rare congenital malformation of lung tissue, which can be combined with other foregut and cardiac abnormalities. Our case is the first to report extralobar sequestration, absence of pericardium and atrial septal defect in the same patient.

CASE PRESENTATION

A 22-year-old female with atrial septal defect came for her recent atypical symptom of intermittent palpitation and shortness of breath. Her computed tomography showed a cystic mass located in left superior anterior mediastinum near the pulmonary trunk. With specious of cystic teratoma prior to video-assisted thoracoscopic surgery, she finally was diagnosed as extralobar sequestration, while incidentally found with congenital absence of pericardium during surgery.

CONCLUSIONS

Extralobar sequestration, absence of pericardium and atrial septal defect can occur in the same patient. The preoperative diagnostic rate of extralobar sequestration and asymptomatic absence of pericardium remains low attributed to atypical imaging features. A cardiac magnetic resonance imaging is highly recommended if necessary. Regular follow-up is essential to asymptomatic absence of pericardium and atrial septal defect patients. To patients with extralobar sequestration, an operation could be performed.

Infarction of torsed extralobar pulmonary sequestration in adolescence

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.

Torsion of right lung sequestration mimicking a posterior mediastinal mass presenting as acute abdomen: Usefulness of MR imaging

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.

Extralobar pulmonary sequestration with hemorrhagic infarction in a child: preoperative imaging diagnosis and pathological correlation

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.

Fetal MRI of Torsed Bronchopulmonary Sequestration with Tension Hydrothorax and Hydrops in a Twin Gestation

While bronchopulmonary sequestration typically has a benign course, this congenital lung malformation has a high mortality rate when associated with untreated in utero tension hydrothorax and hydrops. Hydrops related to bronchopulmonary sequestration is believed to result from torsion of the mass with compromise of the associated blood supply. The impaired venous return of the mass then leads to tension hydrothorax with compression of the heart and mediastinal vessels, impairing global venous return. To our knowledge, this scenario has only been described prenatally by ultrasound. We present the imaging findings of a dichorionic, diamniotic twin gestation with one fetus developing tension hydrothorax and hydrops from presumed intermittent torsion of a bronchopulmonary sequestration. This diagnosis was only able to be confirmed by MRI prior to the use of ultrasound-guided interstitial laser photocoagulation for the treatment of this anomaly.

A case of systemic arterial supply to the right lower lobe of the lung: imaging findings and review of the literature

Systemic arterialization of the lung without pulmonary sequestration is the rarest form of anomalous systemic arterial supply to the lung. This condition is characterised by an aberrant arterial branch arising from the aorta which supplies an area of lung parenchyma with normal bronchopulmonary anatomy. It is often diagnosed following investigation of an incidental cardiac murmur or based on abnormal imaging, as most patients are asymptomatic or minimally symptomatic. Thoracic computed tomography and computed tomography angiography are generally the most useful diagnostic tests. We present a case of a 22-year old female who was diagnosed with systemic arterial supply to a portion of otherwise normal right lower lobe following investigation of low volume haemoptysis.