Infant with bilateral pulmonary sequestrations with portal venous drainage excised by video-assisted thoracic surgery

Simultaneous unilateral thoracoscopic resection of bilateral pulmonary sequestration

BACKGROUND

Intra-lobar (ILS) and extra-lobar lung (ELS) sequestrations represent rare congenital lung malformations. Despite their benign nature, the lesions pose risks such as recurrent pulmonary infections, hemoptysis, congestive heart failure, and tumor development. Pulmonary sequestration (PS) typically manifests in two forms, ILS and ELS, with bilateral occurrence being exceptionally rare and mostly requiring bilateral thoracic surgery.

CASE PRESENTATION

A 9-year-old child, who initially presented with bilateral lung lesions without respiratory symptoms, was diagnosed with PS following a chest computed tomography scan. The surgical approach was determined based on the absence of inflammation and the clear demarcation of the lesions from normal lung tissue, highlighted by a unique tissue connection between the ILS and ELS across the chest cavities. We used a novel method wherein the left ELS was successfully pulled into the right chest cavity and both sequestrations were concurrently resected. Postoperative recovery was smooth, with no complications or residual lesions.

CONCLUSIONS

Our findings highlight the importance of thorough preoperative planning with enhanced computed tomography. Simultaneous unilateral thoracoscopic surgery can be a viable, less invasive option for treating bilateral PS, offering benefits such as reduced recovery time and better cosmetic outcomes.

Vascular Anatomy in Congenital Lung Lesions-Description and Classification

BACKGROUND

Bronchopulmonary sequestration (BPS) and hybrid lesion of congenital pulmonary airway malformation (CPAM) are congenital lung lesions typically presenting with systemic vascular connection. We describe and categorize this atypical systemic vascular anatomy in congenital lung lesions.

METHODS

In a medical chart review from 2005 to 2020 patients with systemic vascular connection of congenital lung lesions were identified. Clinical and radiological data were collected and compared. Two experienced pediatric radiologists reviewed postnatal thoracic contrast-enhanced computed tomography scans to describe and categorize atypical vascular anatomy. We completed our findings with a review on vascular anatomy in congenital lung lesions.

RESULTS

A total of 21 patients with congenital lung lesions (nine extralobar BPS, five intralobar BPS, seven hybrid lesions) had systemic arterial supply; with seven of these additionally having systemic venous drainage. Origin of the feeding arteries from the aorta or aortic main branches was described as supra-diaphragmatic (descending thoracic aorta) in nine and infra-diaphragmatic in ten patients (abdominal aorta, celiac trunk). In two patients with hybrid lesions both supra- and infra-diaphragmatic arterial feeders were found. Additional systemic venous connection of supra-diaphragmatic type drains into the azygos-hemiazygos system (4/21) while the infra-diaphragmatic type (3/21) drains into caval vein, portal or splenic vein.

CONCLUSION

Various variants of systemic arterial and venous connection of congenital lung lesions can be found. Classification of systemic arterial connection as well as venous drainage of congenital lung lesions as supra-diaphragmatic and infra-diaphragmatic types is intuitive, simple and may be important for the surgeon to avoid unanticipated situations and to perform safe resections.

Case Report: An extremely rare case of double extralobar pulmonary sequestration with anomalous supplying arteries originating from the abdominal aorta in the left thoracic cavity

To the best of our knowledge, double or multiple extralobar pulmonary sequestrations (PSs) with anomalous arterial supply in the ipsilateral thoracic cavity have rarely been reported before. PS can be divided into two types: intralobar sequestration (ILS) and extralobar sequestration (ELS). We encountered a 5-month-old infant with double ELS in the left thoracic cavity that was incidentally detected during thoracoscopic surgery. Surgical exploration revealed two separate, well-circumscribed abnormal masses in the left thoracic cavity, and the patient was successfully treated using thoracoscopic surgery. Postoperative pathology confirmed that both masses were PS tissues. Accurate preoperative diagnosis using CT alone may be inadequate in this type of case. Therefore, thoracoscopy may be more suitable for diagnosing and treating unusual ELS.

Role of CT angiography in bilateral pulmonary sequestration: a case report

Bilateral pulmonary sequestration (PS) is a very rare congenital malformation. We describe a case of bilateral intralobar pulmonary sequestration (ILS) in a newborn. Both sequestrations received arterial supply from separate branches of the descending aorta and venous drainage was into ipsilateral inferior pulmonary veins. Prenatal ultrasonography showed cystic changes in the lungs. Computed tomography angiography (CTA) with supplemental two-dimensional (2D) and three-dimensional (3D) images was performed to clearly define the pathology and revealed bilateral intralobar pulmonary sequestration with aberrant blood supply. The child underwent successful video-assisted thoracoscopic surgical (VATS) lobectomy on the left side and thoracoscopic wedge resection on the right side. There were no complications. CTA with supplemental 2D and 3D images plays a vital role in revealing the exact pathology in congenital pulmonary malformations associated with anomalous vasculature.

Risk analysis and outcomes of bronchopulmonary sequestrations

BACKGROUND

Researched and discussed the risks and outcomes of bronchopulmonary sequestrations, especially the intralobar type.

METHODS

A retrospective review of our experiences with bronchopulmonary sequestrations from January 2012 to April 2015 is reported. The present study researched and discusses the risks and outcomes of bronchopulmonary sequestrations, especially the intralobar type, compared with other types of bronchopulmonary sequestrations in symptoms, surgery, pathology, and excretion.

RESULTS

A total of 126 bronchopulmonary sequestrations were diagnosed. All fetal chest cases (18-30 weeks) of solid or high-echo masses were diagnosed antenatally and then confirmed by ultrasound. Enhanced computed tomography was used to confirm the diagnosis. Eighty-three boys and 43 girls were included. The mean age at surgery was 4.2 ± 0.5 months. There were 103 cases of left, 22 cases of right, and 1 case of bilateral sequestration. There were 62 extralobar cases, 51 intralobar cases, 13 cases within the diaphragm, and a rare bilateral case. A preoperative history of recurrent respiratory tract infection was present in 39 cases, including 10 extralobar and 29 intralobar cases. Operations were completed successfully, and diagnoses were confirmed pathologically. Thirty-seven cases were associated with congenital bronchopulmonary malformation changes, of which 4 were extralobar, 31 were intralobar, and 2 were within the diaphragm.

CONCLUSIONS

The intralobar type was relatively uncommon among bronchopulmonary sequestrations. However, due to communication with normal lung tissue, infection is common in the intralobar type. Computed tomography examinations are very important immediately after birth. It is necessary to resect the mass in early childhood.