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Kargl S, Schlader F, Scala M, Kammel J. Vascular Anatomy in Congenital Lung Lesions-Description and Classification. Front Pediatr 2022; 10:900538. [PMID: 35633957 PMCID: PMC9135351 DOI: 10.3389/fped.2022.900538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Simon Kargl
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria.,Department of Pediatric Surgery, Kepler University Hospital, Linz, Austria
| | - Florian Schlader
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria.,Department of Pediatric Surgery, Kepler University Hospital, Linz, Austria
| | - Mario Scala
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria.,Competence Center for Pediatric Radiology, Kepler University Hospital, Linz, Austria
| | - Julian Kammel
- Competence Center for Pediatric Radiology, Kepler University Hospital, Linz, Austria
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2
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Matsuoka S, Eguchi T, Takeda T, Miura K, Hamanaka K, Shimizu K. Three-dimensional computed tomography and indocyanine green-guided technique for pulmonary sequestration surgery. Gen Thorac Cardiovasc Surg 2020; 69:621-624. [PMID: 33074471 DOI: 10.1007/s11748-020-01511-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022]
Abstract
Patients with pulmonary sequestration are at risk of life-threatening bleeding during lung resection. To perform safe and adequate lung resection in patients with pulmonary sequestration, we utilized the following combination of techniques: (1) three-dimensional computed tomographic (3D-CT) imaging for preoperative planning and intraoperative identification of blood vessels, including aberrant arteries, and (2) intraoperative intravenous administration of indocyanine green (ICG). We describe our surgical technique through three cases who underwent lung resection for pulmonary sequestration using 3D-CT and fluorescence navigation with ICG. Intraoperative identification and division of the aberrant arteries, draining veins, and resection margins of the lungs were successfully completed.
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Affiliation(s)
- Shunichiro Matsuoka
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi Matsumoto, Nagano, 390-8621, Japan
| | - Takashi Eguchi
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi Matsumoto, Nagano, 390-8621, Japan
| | - Tetsu Takeda
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi Matsumoto, Nagano, 390-8621, Japan
| | - Kentaro Miura
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi Matsumoto, Nagano, 390-8621, Japan
| | - Kazutoshi Hamanaka
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi Matsumoto, Nagano, 390-8621, Japan
| | - Kimihiro Shimizu
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi Matsumoto, Nagano, 390-8621, Japan.
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3
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Marx T, Sigaux A, Desmettre T. Spontaneous hemothorax revealing an intralobar bronchopulmonary sequestration. Chirurgia (Bucur) 2020. [DOI: 10.23736/s0394-9508.18.04949-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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4
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Dewberry LC, Trecartin A, Galambos C, Hilton SA, Dannull K, Zaretsky MV, Behrendt N, Galan HL, Marwan AI, Liechty KW. A congenital cystic pulmonary airway malformation occurring together with both an extralobar pulmonary sequestration and an esophageal duplication cyst. Clin Case Rep 2020; 8:18-23. [PMID: 31998479 PMCID: PMC6982492 DOI: 10.1002/ccr3.2455] [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: 06/22/2019] [Revised: 08/15/2019] [Accepted: 08/23/2019] [Indexed: 12/28/2022] Open
Abstract
A foregut duplication cyst occurring together with both a congenital cystic pulmonary airway malformation and extralobar pulmonary sequestration is an unusual combination. Prenatal ultrasound, MRI, and postnatal CT are helpful for operative planning. Surgical resection is the definitive management for all three anomalies.
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Affiliation(s)
- Lindel C. Dewberry
- Department of SurgeryLaboratory for Fetal and Regenerative BiologyUniversity of Colorado Denver School of Medicine and Children's Hospital ColoradoAuroraColorado
| | - Andrew Trecartin
- Division of Pediatric SurgeryDepartment of SurgeryChildren's Hospital of ColoradoAuroraColorado
| | - Csaba Galambos
- Department of PathologyUniversity of Colorado School of Medicine and Children's Hospital ColoradoAuroraColorado
| | - Sarah A. Hilton
- Department of SurgeryLaboratory for Fetal and Regenerative BiologyUniversity of Colorado Denver School of Medicine and Children's Hospital ColoradoAuroraColorado
| | - Kimberly Dannull
- Department of RadiologyUniversity of Colorado Denver School of Medicine and Children's Hospital ColoradoAuroraColorado
| | - Michael V. Zaretsky
- Colorado Fetal Care CenterColorado Institute for Fetal & Maternal HealthChildren's Hospital of ColoradoAuroraColorado
- Division of Maternal Fetal MedicineUniversity of Colorado Denver School of Medicine and Children's Hospital ColoradoAuroraColorado
| | - Nicholas Behrendt
- Colorado Fetal Care CenterColorado Institute for Fetal & Maternal HealthChildren's Hospital of ColoradoAuroraColorado
- Division of Maternal Fetal MedicineUniversity of Colorado Denver School of Medicine and Children's Hospital ColoradoAuroraColorado
| | - Henry L. Galan
- Colorado Fetal Care CenterColorado Institute for Fetal & Maternal HealthChildren's Hospital of ColoradoAuroraColorado
- Division of Maternal Fetal MedicineUniversity of Colorado Denver School of Medicine and Children's Hospital ColoradoAuroraColorado
| | - Ahmed I. Marwan
- Colorado Fetal Care CenterColorado Institute for Fetal & Maternal HealthChildren's Hospital of ColoradoAuroraColorado
| | - Kenneth W. Liechty
- Department of SurgeryLaboratory for Fetal and Regenerative BiologyUniversity of Colorado Denver School of Medicine and Children's Hospital ColoradoAuroraColorado
- Colorado Fetal Care CenterColorado Institute for Fetal & Maternal HealthChildren's Hospital of ColoradoAuroraColorado
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5
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Li XK, Luo J, Wu WJ, Cong ZZ, Xu Y, Hua TT, Shao CY, Ji SG, Diao YF, Liu KC, Qiang Y, Zhou H, Jiang ZS, Shen Y. Effect of different therapeutic strategies on the clinical outcome of asymptomatic intralobar pulmonary sequestration. Interact Cardiovasc Thorac Surg 2019; 29:706-713. [PMID: 31237938 DOI: 10.1093/icvts/ivz152] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/22/2019] [Accepted: 05/06/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Pulmonary sequestration is a rare congenital pulmonary malformation. The aim of this study was to explore the effect of different therapeutic strategies on the clinical outcome of asymptomatic intralobar pulmonary sequestration. METHODS We retrospectively reviewed the clinical data of 37 patients diagnosed with intralobar sequestration. All the patients were asymptomatic. Seventeen patients underwent video-assisted thoracoscopic surgery (VATS) once diagnosed and 20 patients chose to undergo observation. Of these 20 patients, 16 patients developed symptoms during the observation period and also underwent VATS; 4 patients never showed symptoms and did not have surgery. The 33 patients who had VATS were divided into 2 groups: group 1, patients who underwent VATS once diagnosed; group 2, patients who underwent VATS once symptoms appeared. Postoperative data and respiratory function data were compared between the 2 groups. RESULTS Twenty of the patients were men and 17 were women (mean age 37.05 ± 7.89 years). Results of a comparative analysis of the 2 groups indicated that patients in group 1 had better values for median estimated blood loss, median duration of chest tube insertion, postoperative hospital stay and postoperative hospital stay than those in group 2. Postoperative complications were reported in 1 patient in group 1 and in 3 patients in group 2. Meanwhile, the loss of lung function between group 1 and group 2 was statistically significant, which also suggested that patients benefited from surgery once diagnosed. CONCLUSIONS For asymptomatic intralobar sequestration, VATS could be effective and safe. The surgical intervention should be performed once the condition is diagnosed to avoid manifestations occurring and to preserve patients' quality of life.
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Affiliation(s)
- Xiao-Kun Li
- Department of Cardiothoracic Surgery, Jingling Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Jing Luo
- Department of Cardiothoracic Surgery, Jingling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Wen-Jie Wu
- Department of Clinical Medicine, School of Medicine, Southeast University, Nanjing, China
| | - Zhuang-Zhuang Cong
- Department of Cardiothoracic Surgery, Jingling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yang Xu
- Department of Cardiothoracic Surgery, Jingling Hospital, Jingling School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Tian-Tian Hua
- Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing, China
| | - Chen-Ye Shao
- Department of Cardiothoracic Surgery, Jingling Hospital, Jingling School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Sai-Guang Ji
- Department of Cardiothoracic Surgery, Jingling Hospital, Bengbu Medical College, Anhui, China
| | - Yi-Fei Diao
- Department of Cardiothoracic Surgery, Jingling Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Kai-Chao Liu
- Department of Cardiothoracic Surgery, Jingling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yong Qiang
- Department of Cardiothoracic Surgery, Jingling Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Hai Zhou
- Department of Cardiothoracic Surgery, Jingling Hospital, Jingling School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Zhi-Sheng Jiang
- Department of Cardiothoracic Surgery, Jingling Hospital, Bengbu Medical College, Anhui, China
| | - Yi Shen
- Department of Cardiothoracic Surgery, Jingling Hospital, School of Medicine, Southeast University, Nanjing, China.,Department of Cardiothoracic Surgery, Jingling Hospital, Medical School of Nanjing University, Nanjing, China
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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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7
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Dewberry L, Bunn J, Galambos C, Galan HL, Zaretsky MV, Behrendt N, Reynolds R, Meyers M, Marwan AI, Liechty KW. Concurrent extrapulmonary bronchopulmonary sequestration and bronchogenic cyst. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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8
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Alsumrain M, Ryu JH. Pulmonary sequestration in adults: a retrospective review of resected and unresected cases. BMC Pulm Med 2018; 18:97. [PMID: 29871620 DOI: 10.1186/s12890-018-0663-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 05/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pulmonary sequestration (PS) is a form of congenital pulmonary malformation that is generally diagnosed in childhood or adolescence and usually resected when diagnosed. We aim to identify the clinical presentation and course of patients diagnosed to have PS during adulthood. METHODS Using a computer-assisted search of Mayo clinic medical records, we identified adult patients with PS diagnosed between 1997 and 2016. Clinical and radiological data were collected including postoperative course for those who underwent surgical resection. RESULTS We identified 32 adult patients with PS; median age at diagnosis was 42 years (IQR 28-53); 17 patients (53%) were men. The median sequestration size was 6.6 cm (IQR 4.4-9.3). The type of sequestration was intralobar in 81% and extralobar in 19%. The most common location was left lower lobe posteromedially (56%). Forty-seven percent of the patients presented with no relevant symptoms. The most common radiographic finding was mass/consolidation in 61% and the most common feeding artery origin was the thoracic aorta (54%). Surgical resection was performed in 18 patients (56%) and postoperative complication was reported in 5 patients (28%). There was no surgical mortality. Median duration of follow-up after diagnosis for unresected cases, most of whom were asymptomatic, was 19 months (IQR 4-26) with no complications related to the PS reported. CONCLUSIONS Nearly one-half of adult patients with PS present with no relevant symptoms. The decision regarding surgical resection needs to weigh various factors including clinical manifestations related to PS, risk of surgical complications, comorbidities, and individual patient preferences.
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Affiliation(s)
- Mohammad Alsumrain
- Division of Pulmonary and Critical Care Medicine, Gonda 18 South, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Gonda 18 South, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
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9
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Oliver ER, DeBari SE, Giannone MM, Pogoriler JE, Johnson AM, Horii SC, Gebb JS, Howell LJ, Adzick NS, Coleman BG. Going With the Flow: An Aid in Detecting and Differentiating Bronchopulmonary Sequestrations and Hybrid Lesions. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:371-383. [PMID: 28795424 DOI: 10.1002/jum.14346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 04/30/2017] [Accepted: 05/05/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To assess the ability of prenatal ultrasound (US) in identifying systemic feeding arteries in bronchopulmonary sequestrations and hybrid lesions and report the ability of US in classifying bronchopulmonary sequestrations as intralobar or extralobar. METHODS Institutional Review Board-approved radiology and clinical database searches from 2008 to 2015 were performed for prenatal lung lesions with final diagnoses of bronchopulmonary sequestrations or hybrid lesions. All patients had detailed US examinations, and most patients had ultrafast magnetic resonance imaging (MRI). Lesion location, size, and identification of systemic feeding arteries and draining veins were assessed with US. RESULTS The study consisted of 102 bronchopulmonary sequestrations and 86 hybrid lesions. The median maternal age was 30 years. The median gestational age was 22 weeks 5 days. Of bronchopulmonary sequestrations, 66 had surgical pathologic confirmation, and 100 had postnatal imaging. Bronchopulmonary sequestration locations were intrathoracic (n = 77), intra-abdominal (n = 19), and transdiaphragmatic (n = 6). Of hybrid lesions, 84 had surgical pathologic confirmation, and 83 had postnatal imaging. Hybrid lesion locations were intrathoracic (n = 84) and transdiaphragmatic (n = 2). Ultrasound correctly identified systemic feeding arteries in 86 of 102 bronchopulmonary sequestrations and 79 of 86 hybrid lesions. Of patients who underwent MRI, systemic feeding arteries were reported in 62 of 92 bronchopulmonary sequestrations and 56 of 81 hybrid lesions. Ultrasound identified more systemic feeding arteries than MRI in both bronchopulmonary sequestrations and hybrid lesions (P < .01). Magnetic resonance imaging identified systemic feeding arteries that US did not in only 2 cases. In cases in which both systemic feeding arteries and draining veins were identified, US could correctly predict intrathoracic lesions as intralobar or extralobar in 44 of 49 bronchopulmonary sequestrations and 68 of 73 hybrid lesions. CONCLUSIONS Ultrasound is most accurate for systemic feeding artery detection in bronchopulmonary sequestrations and hybrid lesions and can also type the lesions as intralobar or extralobar when draining veins are evaluated.
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Affiliation(s)
- Edward R Oliver
- 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 Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Suzanne E DeBari
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Mariann M Giannone
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jennifer E Pogoriler
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Pathology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ann M Johnson
- 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 Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Steven C Horii
- 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 Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Juliana S Gebb
- 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
| | - Lori J Howell
- 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
| | - 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
| | - Beverly G Coleman
- 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 Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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10
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Wagenaar AE, Tashiro J, Satahoo SS, Sola JE, Neville HL, Hogan AR, Perez EA. Resection of pediatric lung malformations: National trends in resource utilization & outcomes. J Pediatr Surg 2016; 51:1414-20. [PMID: 27292597 DOI: 10.1016/j.jpedsurg.2016.04.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 04/24/2016] [Accepted: 04/28/2016] [Indexed: 12/24/2022]
Abstract
PURPOSE We sought to determine factors influencing survival and resource utilization in patients undergoing surgical resection of congenital lung malformations (CLM). Additionally, we used propensity score-matched analysis (PSMA) to compare these outcomes for thoracoscopic versus open surgical approaches. METHODS Kids' Inpatient Database (1997-2009) was used to identify congenital pulmonary airway malformation (CPAM) and pulmonary sequestration (PS) patients undergoing resection. Open and thoracoscopic CPAM resections were compared using PSMA. RESULTS 1547 cases comprised the cohort. In-hospital survival was 97%. Mortality was higher in small vs. large hospitals, p<0.005. Survival, pneumothorax (PTX), and thoracoscopic procedure rates were higher, while transfusion rates and length of stay (LOS) were lower, in children ≥3 vs. <3months (p<0.001). Multivariate analysis demonstrated longer LOS for older patients and Medicaid patients (all p<0.005). Total charges (TC) were higher for Western U.S., older children, and Medicaid patients (p<0.02). PSMA for thoracoscopy vs. thoracotomy in CPAM patients showed no difference in outcomes. CONCLUSION CLM resections have high associated survival. Children <3months of age had higher rates of thoracotomy, transfusion, and mortality. Socioeconomic status, age, and region were independent indicators for resource utilization. Extent of resection was an independent prognostic indicator for in-hospital survival. On PSMA, thoracoscopic resection does not affect outcomes.
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Affiliation(s)
- Amy E Wagenaar
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jun Tashiro
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Shevonne S Satahoo
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Juan E Sola
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Holly L Neville
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Anthony R Hogan
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eduardo A Perez
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
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11
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Yeker R, Segura B, Saltzman D, Hess D. Case report: Giant congenital pulmonary airway malformation initially managed and resected on ECMO. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2016. [DOI: 10.1016/j.epsc.2016.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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12
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Kuhajda I, Milosevic M, Ilincic D, Kuhajda D, Pekovic S, Tsirgogianni K, Tsavlis D, Tsakiridis K, Sakkas A, Kantzeli A, Zarogoulidis K, Zarogoulidis P, Zissimopoulos A, Durić D. Pulmonary arteriovenous malformation-etiology, clinical four case presentations and review of the literature. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:171. [PMID: 26261842 DOI: 10.3978/j.issn.2305-5839.2015.06.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 06/17/2015] [Indexed: 11/14/2022]
Abstract
Pulmonary arteriovenous malformation (PAVM) is a rare clinical condition with abnormal direct communication between the branches of pulmonary artery and vein. It may occur as an isolated anomaly or in association with hereditary hemorrhagic telangiectasia (HHT). Although these vascular pulmonary pathologies are quite uncommon, they are the important part of the differential diagnosis of common pulmonary problems such as hypoxemia and pulmonary nodules. The diagnosis of PAVM in patients remains a diagnostic challenge to the emergency physician. The most common clinical signs of PAVM are recurrent episodes of epistaxis and hemoptysis, so surgical resection is deemed the best curative option to avoid further episodes and recurrence of hemoptysis. Quite often the diagnosis is established after pathohistological examinations. We report a case of a female patient with a massive recurrent hemoptysis and without pathologic radiological findings which would suggest to PAVM and who was successfully treated with lobectomy.
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Affiliation(s)
- Ivan Kuhajda
- 1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Misel Milosevic
- 1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dejan Ilincic
- 1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Danijela Kuhajda
- 1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Sandra Pekovic
- 1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Katerina Tsirgogianni
- 1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Drosos Tsavlis
- 1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Kosmas Tsakiridis
- 1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Antonios Sakkas
- 1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Angeliki Kantzeli
- 1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Konstantinos Zarogoulidis
- 1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Paul Zarogoulidis
- 1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Athanasios Zissimopoulos
- 1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dejan Durić
- 1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece
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Hellmund A, Berg C, Bryan C, Schneider M, Hraka V, Gembruch U. Large Fetal Pulmonary Arteriovenous Malformation Detected at Midtrimester Scan with Subsequent High Cardiac Output Syndrome and Favorable Postnatal Outcome. Fetal Diagn Ther 2014; 35:133-6. [DOI: 10.1159/000353913] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 06/18/2013] [Indexed: 11/19/2022]
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Nijagal A, Jelin E, Feldstein VA, Courtier J, Urisman A, Jones KD, Lee H, Hirose S, MacKenzie TC. The diagnosis and management of intradiaphragmatic extralobar pulmonary sequestrations: a report of 4 cases. J Pediatr Surg 2012; 47:1501-5. [PMID: 22901907 DOI: 10.1016/j.jpedsurg.2011.11.066] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 11/22/2011] [Accepted: 11/23/2011] [Indexed: 10/28/2022]
Abstract
BACKGROUND/PURPOSE Intradiaphragmatic extralobar pulmonary sequestrations (IDEPSs) are a rare subset of bronchopulmonary sequestrations (BPS). We report the largest series of patients with IDEPS and describe the diagnostic and operative challenges associated with this condition. METHODS We retrospectively reviewed our experience with fetal and pediatric BPS from 1995 to 2010 to identify patients with IDEPS. RESULTS We identified 27 patients with BPS and 4 patients in whom the masses were within the diaphragm. In 1 patient, the prenatal ultrasound correctly identified the mass as being within the diaphragm itself, whereas the remaining cases were thought to be intraabdominal or had discordant preoperative imaging findings. The diagnosis of an IDEPS proved challenging to make prospectively using prenatal ultrasound, computed tomography, or magnetic resonance imaging. All patients underwent attempted resection. Two cases required a combined laparoscopic and thoracoscopic approach to accurately localize the mass. The postoperative recovery of these patients was uneventful. CONCLUSIONS We present the largest reported experience of IDEPS. Because preoperative imaging studies cannot always determine whether a sequestration is intraabdominal, intrathoracic, or intradiaphragmatic, operative planning may pose a challenge. However, the use of minimally invasive approaches can allow exploration of both the thoracic and abdominal cavities with low morbidity.
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Affiliation(s)
- Amar Nijagal
- Department of Surgery, University of California, San Francisco, CA 94143-0570, USA
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Affiliation(s)
- Jason Tsai
- Department of Radiology, Children's Hospital Boston and Harvard Medical School, Boston, MA 02115, USA
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Johnson SM, Grace N, Edwards MJ, Woo R, Puapong D. Thoracoscopic segmentectomy for treatment of congenital lung malformations. J Pediatr Surg 2011; 46:2265-9. [PMID: 22152862 DOI: 10.1016/j.jpedsurg.2011.09.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 09/03/2011] [Indexed: 12/19/2022]
Abstract
PURPOSE Congenital lung malformations (CLM) predispose patients to recurrent respiratory tract infections and pose a rare risk of malignant transformation. Although pulmonary lobectomy is the most common treatment of a CLM, some advocate segmental resection as a lung preservation strategy. Our study evaluated lung-preserving thoracoscopic segmentectomy as an alternative to lobectomy for CLM resection. METHODS We conducted a retrospective review of patients who underwent thoracoscopic segmentectomy for CLM from 2007 to 2010. RESULTS Fifteen patients underwent thoracoscopic segmentectomy for CLM. There were five postoperative complications: three asymptomatic pneumothoraces and a small air leak that resolved without intervention. One patient developed a bronchopulmonary fistula requiring thoracoscopic repair. At follow-up, all patients are asymptomatic. One patient has a small amount of residual disease on postoperative computed tomography (CT), and re-resection has been recommended. CONCLUSIONS Thoracoscopic segmentectomy for CLM is a safe and effective means of lung parenchymal preservation. The approach spares larger airway anatomy and has a complication rate that is comparable with that of thoracoscopic lobectomy. Residual disease can often only be appreciated on postoperative CT scan and may require long-term follow-up or reoperation in rare cases. This lung preservation technique is best suited to smaller lesions.
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Affiliation(s)
- Sidney M Johnson
- Kapi'olani Medical Center for Women & Children, Honolulu, HI, USA.
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Gludovacz K, Vlasselaer J, Mesens T, Van Holsbeke C, Van Robays J, Gyselaers W. Early neonatal complications from pulmonary arteriovenous malformations in hereditary hemorrhagic telangiectasia: case report and review of the literature. J Matern Fetal Neonatal Med 2011; 25:1494-8. [DOI: 10.3109/14767058.2011.629250] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Ectopic extralobar pulmonary sequestrations in children: interest of the laparoscopic approach. J Pediatr Surg 2010; 45:2269-73. [PMID: 21034960 DOI: 10.1016/j.jpedsurg.2010.06.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Revised: 06/02/2010] [Accepted: 06/20/2010] [Indexed: 01/12/2023]
Abstract
BACKGROUND Extralobar pulmonary sequestrations (EPS) are a rare benign congenital bronchopulmonary foregut malformation. Complete resection is necessary to confirm the diagnosis with histopathologic examination. The aim of this study was to describe the laparoscopic minimally invasive surgery (MIS) for a small series of ectopic EPS in small children and to show its feasibility and safety. METHODS From January 2001 to December 2008, 12 cases of EPS were prenatally diagnosed and retrospectively reviewed. From this group, we isolated 6 children with ectopic EPS. Ages ranged from 15 days to 14 months. Three infants were symptomatic, and the others showed persistence of the lesion with parental anxiety. All prenatal diagnoses were confirmed by postnatal Doppler ultrasound and intravascular contrast computed tomography scan with 3-dimensional reconstructions. Postnatally, all were ectopic lesions: 3 were hiatal and intradiaphragmatic, 3 infradiaphragmatic and left paramedian. Laparoscopic MIS consisted of 4 small trocars and low-pressure pneumoperitoneum. We carried out a retroesophageal dissection in 4 cases, an elective control of systemic vessels, and a removal of the EPS with histologic study. RESULTS We performed 5 procedures laparoscopically and 1 thoracoscopically. There were 2 abdominal conversions. Nevertheless, no intraoperative or immediate postoperative complications occurred. Hospital stay ranged from 1 to 5 days (mean, 2.7 days). The diagnosis of pure pulmonary sequestration with feeding vessels in 5 cases was confirmed by histopathology. Follow-up ranged from 13 to 84 months (mean, 43 months). Late complications were benign. CONCLUSIONS Laparoscopic MIS for ectopic EPS in small children is a feasible and safe technique. The great magnification provided by the endoscopic procedure allows for the search of associated congenital anomalies, meticulous retroesophageal dissection, and control of the systemic vessels. Resection provides definitive diagnosis and treatment, and confers the benefits of a minimal access technique.
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Bhide A, Murphy D, Thilaganathan B, Carvalho JS. Prenatal findings and differential diagnosis of scimitar syndrome and pulmonary sequestration. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 35:398-404. [PMID: 20069562 DOI: 10.1002/uog.7555] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Scimitar syndrome and pulmonary sequestration (PS) have overlapping features. This accounts for postnatal descriptions of a 'sequestrated lung' in scimitar-syndrome patients. We review the similarities and differences in these two conditions, and the antenatal ultrasound findings that allow correct prenatal identification and differential diagnosis. METHODS This was a retrospective analysis of prenatally diagnosed cases of scimitar syndrome or PS that underwent fetal echocardiography between January 1995 and November 2004. RESULTS There were five cases of PS and six of scimitar syndrome. Right-sided mediastinal shift (ipsilateral relative to the affected lung) was the commonest indication for referral in scimitar syndrome whereas in sequestration, referral was because of hyperechogenic lung and contralateral mediastinal shift. Lung echogenicity was normal in scimitar syndrome but focally increased in PS. Abnormal, unobstructed pulmonary venous drainage was identified prenatally in four cases of scimitar syndrome. It was normal in three fetuses with sequestration but abnormal and obstructed in the other two cases complicated by hydrothorax. Abnormal systemic arterial supply to the affected lung was easily demonstrated in all fetuses with PS, but could not be shown prenatally in scimitar-syndrome fetuses. Postnatal embolization was warranted in one case with PS and four with scimitar syndrome, one each in the neonatal period. CONCLUSION Prenatally, scimitar syndrome and PS are clearly distinct entities based on lung echogenicity and laterality of mediastinal shift. Hyperechogenic lung and dextrocardia indicate the possibility of PS and scimitar syndrome, respectively. Complete delineation of the vascular pattern should be attempted in all, but is more challenging in scimitar syndrome. Obstructed venous return in PS may identify fetuses at risk of developing hydrothorax.
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Affiliation(s)
- A Bhide
- Fetal Medicine Unit, St George's Hospital, London, UK
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Nunes SS, Greer KA, Stiening CM, Chen HYS, Kidd KR, Schwartz MA, Sullivan CJ, Rekapally H, Hoying JB. Implanted microvessels progress through distinct neovascularization phenotypes. Microvasc Res 2009; 79:10-20. [PMID: 19833141 DOI: 10.1016/j.mvr.2009.10.001] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Revised: 08/24/2009] [Accepted: 10/02/2009] [Indexed: 01/03/2023]
Abstract
We have previously demonstrated that implanted microvessels form a new microcirculation with minimal host-derived vessel investment. Our objective was to define the vascular phenotypes present during neovascularization in these implants and identify post-angiogenesis events. Morphological, functional and transcriptional assessments identified three distinct vascular phenotypes in the implants: sprouting angiogenesis, neovascular remodeling, and network maturation. A sprouting angiogenic phenotype appeared first, characterized by high proliferation and low mural cell coverage. This was followed by a neovascular remodeling phenotype characterized by a perfused, poorly organized neovascular network, reduced proliferation, and re-associated mural cells. The last phenotype included a vascular network organized into a stereotypical tree structure containing vessels with normal perivascular cell associations. In addition, proliferation was low and was restricted to the walls of larger microvessels. The transition from angiogenesis to neovascular remodeling coincided with the appearance of blood flow in the implant neovasculature. Analysis of vascular-specific and global gene expression indicates that the intermediate, neovascular remodeling phenotype is transcriptionally distinct from the other two phenotypes. Therefore, this vascular phenotype likely is not simply a transitional phenotype but a distinct vascular phenotype involving unique cellular and vascular processes. Furthermore, this neovascular remodeling phase may be a normal aspect of the general neovascularization process. Given that this phenotype is arguably dysfunctional, many of the microvasculatures present within compromised or diseased tissues may not represent a failure to progress appropriately through a normally occurring neovascularization phenotype.
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Affiliation(s)
- Sara S Nunes
- Cardiovascular Innovation Institute, University of Louisville and Jewish Hospital/St. Mary's Healthcare, Louisville, KY 40202, USA
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Sinkovskaya E, Berkley E, Bogdan D, Sclater A, Abuhamad A. The role of echocardiography in prenatal diagnosis of pulmonary arteriovenous malformation. Prenat Diagn 2009; 29:634-6. [DOI: 10.1002/pd.2261] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Sekiya T, Nishizawa H, Ozawa N, Tada S, Hasegawa K, Hirota Y, Katoh RI, Ban-No T, Udagawa Y. Clinical features and characteristics of blood flow of uterine vascular abnormalities. J Med Ultrason (2001) 2009; 36:19-26. [PMID: 27276905 DOI: 10.1007/s10396-008-0206-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Accepted: 12/23/2008] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to assess the clinical features and characteristics of the blood flow in uterine vascular abnormalities using ultrasound and magnetic resonance imaging (MRI). METHODS A total of 17 women were diagnosed with uterine vascular abnormalities by ultrasound. The clinical characteristics of the patients and the distribution and waveform of the intrauterine vessels were examined using transvaginal gray-scale and Doppler ultrasonography, spin-echo MRI, and MR angiography. RESULTS The average age of the 17 subjects was 44.3 years, and 5 were postmenopausal women. The number of pregnancies and deliveries was 2.0 and 1.7, respectively. Of the 17 subjects, 7 had a moderate or severe grade of dysmenorrhea and 7 had a history of vascular disease. In all subjects, vaginal ultrasound demonstrated tubular or numerous tortuous anechoic areas in the uterine wall, and Doppler ultrasound showed that the tubular or numerous dilated tortuous vessels had an atypical wave flow, unlike that of an artery or a vein. The distribution of displayed flow varied, and the waveforms of the Doppler ultrasound displayed three patterns. The averages of the pulse Doppler flow indices showed low impedance in the abnormal uterine vessel and the uterine artery, especially in cases of true arteriovenous malformations. MR angiography demonstrated distinct, tortuous, and coiled vascular channels in the pelvis during and just after the arterial phase. CONCLUSION Characterization of the clinical features of uterine vascular abnormalities is considered to be valuable for obstetricians and gynecologists.
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Affiliation(s)
- Takao Sekiya
- Department of Obstetrics and Gynecology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, 470-1192, Japan.
| | - Haruki Nishizawa
- Department of Obstetrics and Gynecology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, 470-1192, Japan
| | - Naomi Ozawa
- Department of Obstetrics and Gynecology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, 470-1192, Japan
| | - Shin Tada
- Department of Obstetrics and Gynecology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, 470-1192, Japan
| | - Kiyoshi Hasegawa
- Department of Obstetrics and Gynecology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, 470-1192, Japan
| | - Yutaka Hirota
- Department of Obstetrics and Gynecology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, 470-1192, Japan
| | - Ryo-Ichi Katoh
- Faculty of Radiological Technology, Fujita Health University, School of Health Sciences, Toyoake, Japan
| | - Tatsuo Ban-No
- Department of Radiology, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Yasuhiro Udagawa
- Department of Obstetrics and Gynecology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, 470-1192, Japan
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Abstract
Structural upper and lower airway disorders and parenchymal disorders are uncommon in pediatric practice, but many pediatricians will encounter them and be responsible for the ongoing care of these patients. Pediatricians need to be cognizant of these diagnoses because, even though management of these disorders generally lacks an evidence base, existing principles of good care surrounding accurate diagnosis, classifications of severity, judicious use of investigations, medication, and surgical approaches are essential to good outcomes.
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