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Ji S, Zhang H, Guan Y, Song C, Han M. Analysis of imaging in pediatric bronchopulmonary foregut malformations with literature review: case reports. Front Pediatr 2024; 12:1400124. [PMID: 38813545 PMCID: PMC11133687 DOI: 10.3389/fped.2024.1400124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 04/26/2024] [Indexed: 05/31/2024] Open
Abstract
Background Bronchopulmonary foregut malformation (BPFM) is an uncommon condition, with few case reports documented in both national and international literature. This scarcity underscores the importance of utilizing effective imaging techniques to improve our understanding and diagnostic precision concerning this disorder. Case description In the first case report, a neonate, born at full term and aged 15 days, presented with symptoms including dyspnea, coughing, wheezing, cyanosis, and vomiting. Initial diagnostic evaluations, which included chest radiography and upper gastrointestinal tract radiography, led to an erroneous initial diagnosis of a left-sided diaphragmatic hernia, accompanied by a suspicion of infection. In the second case report, another neonate, also born at full term but aged 5 days, exhibited symptoms such as coughing, choking, and mild vomiting. Utilizing a combination of computed tomography (CT) scans (plain, enhanced, and reconstructed), chest x-ray, and upper gastrointestinal tract radiography, the diagnosis of BPFM was accurately determined. Conclusion Comprehensive imaging examinations play a crucial role in reducing misdiagnosis and diagnostic oversights in cases of BPFM. Given its rarity, BPFM often manifests as a sequestered lung accompanied by gastrointestinal abnormalities. Hence, the integration of CT scans with gastrointestinal tract radiography can substantially improve diagnostic precision in such cases.
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Affiliation(s)
| | | | | | | | - Meirong Han
- Department of Radiology, Shanxi Children’s Hospital and Women Health Center of Shanxi, Taiyuan, Shanxi, China
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2
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Cai CS, Li B, Yuan YC, Fu LN, Zhang XY, Wang J. Bronchopulmonary foregut malformation with severe hemoptysis in advanced age: a case report and literature review. Front Med (Lausanne) 2024; 11:1268008. [PMID: 38384406 PMCID: PMC10880485 DOI: 10.3389/fmed.2024.1268008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 01/08/2024] [Indexed: 02/23/2024] Open
Abstract
Bronchopulmonary foregut malformation (BPFM) is a rare developmental malformation disease due to embryonic defects, with an even rarer occurrence in adults. We report a diagnosed case in an adult patient, and notably, this is the first reported case of such advanced age. Additionally, she experienced coughing up approximately 1 liter of blood and partial lung tissue, accompanied by respiratory failure and shock. Following treatment with transcatheter arterial embolization, her condition improved, and she has remained stable during follow-up. We present a case report and conducted a systematic review on this particular case.
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Affiliation(s)
- Cheng-Sen Cai
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Bin Li
- Department of Radiology, Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Yu-chun Yuan
- Department of Radiology, Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Li-na Fu
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Xiao-ye Zhang
- Department of Pathology, Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Jun Wang
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
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3
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Han Z, Yu T, Huang J, Liu D, Fu L, Yang S, Peng Y. Computed tomography findings of communicating bronchopulmonary foregut malformation: a retrospective study of 18 patients. Pediatr Radiol 2023; 53:1063-1075. [PMID: 36847802 DOI: 10.1007/s00247-023-05610-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Communicating bronchopulmonary foregut malformation is a rare anomaly characterized by a patent congenital communication between the esophagus or stomach and an isolated portion of the respiratory system. An esophagogram is taken as the gold standard for diagnosis. Compared with esophagography, computed tomography (CT) is more widely used and easily obtained, but CT findings have been described as nonspecific. PURPOSE To describe CT findings in 18 patients with communicating bronchopulmonary foregut malformation to assist with early diagnosis. MATERIAL AND METHODS A retrospective review of 18 patients who had proven communicating bronchopulmonary foregut malformation between January 2006 and December 2021 was conducted. For each patient, the medical records, including demographics, clinical manifestations, upper gastrointestinal radiography, magnetic resonance imaging and CT findings, were reviewed. RESULTS Among the 18 patients, there were 8 males. The right to left ratio was 3.5:1. An entire lung was involved in 10 patients, a lobe or a segment was involved in 7 patients and an ectopic lesion was located in the right neck in 1 patient. The isolated lung may arise from the upper esophagus, mid-esophagus, lower esophagus or stomach, which were detected in 1, 3, 13, and 1 patient, respectively. On chest CT, an extra bronchus which did not arise from the trachea was detected in 14 patients. Contrast-enhanced chest CT was performed in 17 patients, the isolated lung receiving its blood supply from the pulmonary artery in 13 patients, the systemic artery in 11 patients and both pulmonary and systemic arteries in 7 patients. CONCLUSIONS The presence of an extra bronchus, which does not arise from the trachea, highly suggests the diagnosis of communicating bronchopulmonary foregut malformation. Contrast-enhanced chest CT can provide accurate information regarding the airways, lung parenchyma and vascular structures that is useful to plan surgery.
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Affiliation(s)
- Zhonglong Han
- Department of Radiology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, No. 56, Nanlishilu Road, Xicheng District, Beijing, 100045, People's Republic of China
| | - Tong Yu
- Department of Radiology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, No. 56, Nanlishilu Road, Xicheng District, Beijing, 100045, People's Republic of China
| | - Jinshi Huang
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Dingyi Liu
- Department of Thoracic Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Libing Fu
- Department of Pathology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Shuangfeng Yang
- Department of Radiology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, No. 56, Nanlishilu Road, Xicheng District, Beijing, 100045, People's Republic of China
| | - Yun Peng
- Department of Radiology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, No. 56, Nanlishilu Road, Xicheng District, Beijing, 100045, People's Republic of China.
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4
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Gupta A, Snehil A, Kumar S, Chanchlani R, Ahmad R, Swarnkar K, Goel G. Bronchiectasis without lower respiratory symptoms in the presence of multisystem anomalies - a clinical clue to diagnose esophageal lung anomaly. Monaldi Arch Chest Dis 2022; 93. [PMID: 35791619 DOI: 10.4081/monaldi.2022.2342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 06/27/2022] [Indexed: 11/22/2022] Open
Abstract
Esophageal lung is a type of Group-II communicating bronchopulmonary foregut malformations (CBPFM) usually diagnosed beyond neonatal period during investigation for recurrent respiratory symptoms and persistent radiographic features suggesting pneumonia or bronchiectasis. In our case, we noticed bronchiectasis and disproportionately severe volume loss in an infant with associated multisystem anomalies in the absence of "significant" lower respiratory tract symptoms. A detailed evaluation with repeat imaging confirmed a Group-II CBPFM, a congenital pathology instead of an infective cause. Pneumonectomy is a more prudent option instead of undertaking major airway reconstruction for the dysplastic "dysfunctional" tissue. Amongst the various associated anomalies reported till now, the associated rib and renal anomalies noted by us have not been described earlier to the best of our knowledge.
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Affiliation(s)
- Amit Gupta
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Bhopal.
| | - Aman Snehil
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhopal.
| | - Sujeet Kumar
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Bhopal.
| | - Roshan Chanchlani
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Bhopal.
| | - Reyaz Ahmad
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Bhopal.
| | - Keerti Swarnkar
- Department of Pediatrics, All India Institute of Medical Sciences, Bhopal.
| | - Garima Goel
- Department of Pathology, All India Institute of Medical Sciences, Bhopal.
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5
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Boughdir M, Daib A, Bouthour H, Tlili S, Laribi S, Kchaou R, Ben abdallah R, Hellal Y, Kaabar N. Esophageal lung associated to isolated dextrocardia in a six-month-old infant. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2021.102115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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6
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Aldosari AK, Alwazzan SB, Alotaibi AM. Unilateral esophageal lung with dextroposition of the heart. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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7
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Morita K, Kawahara I, Yashita H, Hatakeyama T. Right esophageal lung with esophageal atresia and left bronchial stenosis. Pediatr Int 2022; 64:e14982. [PMID: 35298853 DOI: 10.1111/ped.14982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/06/2021] [Accepted: 09/01/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Keiichi Morita
- Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan
| | - Insu Kawahara
- Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan
| | - Hiroki Yashita
- Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan
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8
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Jadhav B, Vaseeharan R, Sekaran P, Folaranmi SE, Awad K. Communicating Bronchopulmonary Foregut Malformation Type IB: Diagnostic and Surgical Challenges. European J Pediatr Surg Rep 2021; 9:e80-e83. [PMID: 34917448 PMCID: PMC8668381 DOI: 10.1055/s-0041-1740321] [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: 05/11/2020] [Accepted: 01/18/2021] [Indexed: 11/30/2022] Open
Abstract
Communicating bronchopulmonary foregut malformations (CBPFM) are extremely rare. We present a complex case of type IB CBPFM with esophageal atresia and distal tracheoesophageal fistula (EA/TOF), duodenal atresia/annular pancreas (DA/AP), and intestinal malrotation who underwent primary repair for EA/TOF on day 3. Bilious aspirates on day 8 prompted an upper gastrointestinal (GI) contrast revealing a duodenal obstruction and communication between the right lung lower lobe and the esophagus (T8-T9 level). DA/AP and malrotation were repaired by a gastrojejunostomy and Ladd's procedure. A repeat contrast swallow identified a 2nd communication from the esophagus into the right lower lobe (T5-T6 level) raising the suspicion of a recurrent TOF. Computed tomography (CT) thorax confirmed above findings with an anomalous blood supply to right lung. An exploratory thoracotomy identified a three-lobed lung. However, the lower lobe was enlarged and connected in two separate locations to the esophagus. The child recovered after the disconnection of the esophageal connections and partial right lower lobectomy. CBPFM are extremely rare anomalies requiring a high index of suspicion, use of an upper GI contrast series, and CT scans for diagnosis. The treatment of choice is resection of the affected lung and disconnection of the esophageal communications.
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Affiliation(s)
- Bhushanrao Jadhav
- Department of Paediatric Surgery, Noah's Ark Children's Hospital for Wales, Cardiff, United Kingdom of Great Britain and Northern Ireland
| | - Ranjithatharsini Vaseeharan
- Department of Paediatric Surgery, Noah's Ark Children's Hospital for Wales, Cardiff, United Kingdom of Great Britain and Northern Ireland
| | - Prabhu Sekaran
- Department of Paediatric Surgery, Noah's Ark Children's Hospital for Wales, Cardiff, United Kingdom of Great Britain and Northern Ireland
| | - Semiu Eniola Folaranmi
- Department of Paediatric Surgery, Noah's Ark Children's Hospital for Wales, Cardiff, United Kingdom of Great Britain and Northern Ireland
| | - Karim Awad
- Department of Paediatric Surgery, Noah's Ark Children's Hospital for Wales, Cardiff, United Kingdom of Great Britain and Northern Ireland.,Department of Paediatric Surgery, Ain Shams University, Cairo, Cairo, Egypt
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9
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Gower WA, Vece TJ. Pediatric pulmonology 2019 year in review: rare and diffuse lung disease. Pediatr Pulmonol 2021; 56:1324-1331. [PMID: 33559960 DOI: 10.1002/ppul.25297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 12/31/2020] [Accepted: 01/20/2021] [Indexed: 11/07/2022]
Abstract
Pediatric Pulmonology publishes original research, review articles, and case reports on topics related to a wide range of children's respiratory disorders. Here we review manuscripts published in 2019 in this journal and others on (1) anatomic lung, airway, and vascular malformations, (2) children's interstitial lung disease, and (3) primary ciliary dyskinesia and non-cystic fibrosis bronchiectasis.
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Affiliation(s)
- William A Gower
- Division of Pediatric Pulmonology, Program for Rare and Interstitial Lung Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Timothy J Vece
- Division of Pediatric Pulmonology, Program for Rare and Interstitial Lung Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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10
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Weon JL, Megison S, Timmons CF, Rakheja D. Esophagus-Like Bronchus: A Noncommunicating Bronchopulmonary Foregut Malformation. Int J Surg Pathol 2021; 29:847-849. [PMID: 33709821 DOI: 10.1177/10668969211002255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We describe a previously unreported bronchopulmonary foregut malformation wherein a segment of a bronchus of the lower lobe of the left lung in a 4-year-old girl was entirely esophageal in structure. No communication was identified between the tracheobronchial tree and the esophagus by radiologic examination or at surgery. The esophagus-like bronchus was associated with an adjacent atretic bronchus and a downstream cavity in the lower lobe of the left lung. The child sought clinical attention because of recurrent pulmonary infections localized to the lower lobe of the lung. We posit that this esophagus-like bronchus is a novel noncommunicating bronchopulmonary foregut malformation.
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Affiliation(s)
- Jenny L Weon
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Stephen Megison
- University of Texas Southwestern Medical Center, Dallas, TX, USA.,Children's Health, Dallas, TX, USA
| | - Charles F Timmons
- University of Texas Southwestern Medical Center, Dallas, TX, USA.,Children's Health, Dallas, TX, USA
| | - Dinesh Rakheja
- University of Texas Southwestern Medical Center, Dallas, TX, USA.,Children's Health, Dallas, TX, USA
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11
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Intralobar Pulmonary Sequestration with Anomalous Artery Arising from the Celiac Trunk. SURGERIES 2021. [DOI: 10.3390/surgeries2010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pulmonary saequestration is a rare congenital malformation characterized by a dysplastic portion of lung parenchyma supplied by an anomalous artery originating from the aorta or its branches. The worldwide incidence of pulmonary sequestration among all congenital lung malformations in children ranges from 1.5% to 6.4%. There are two main types of pulmonary sequestration according to the localization of the malformation, i.e., intrapulmonary sequestration (dysplastic tissue located inside a lobe of the normal lung) and extrapulmonary sequestration. Our case presentation aims to make physicians aware of this rare anomaly which may be difficult to diagnose because of its oligosymptomatic course prior to first presentation. We present the case of a 10-year-old girl who suffered from a second episode of prolonged pneumonia of the left lower lobe. Contrast-enhanced-computed-tomography (CT) scan of the thoraco-abdominal segment of the aorta and its branches revealed intrapulmonary sequestration localized at the left lower lobe of the lung. The intrapulmonary sequester was perfused by a large artery arising from the celiac trunk. The girl underwent open surgery with ligation of the anomalous feeding artery and atypical pulmonary resection of the affected area of the left lower lobe. Postoperatively, the child recovered without any complications.
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12
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Shama N, Mathai J, Rai E, Kodiatte TA. Elucidating the anatomy of a rare communicating bronchopulmonary foregut malformation (CBPFM) in a preschool child. BMJ Case Rep 2021; 14:14/1/e235095. [PMID: 33431437 PMCID: PMC7802663 DOI: 10.1136/bcr-2020-235095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Communicating bronchopulmonary foregut malformations (CBPFMs) are complex and rare anomalies. Their characteristic feature is an anomalous communication between the respiratory system (trachea, lung or bronchus) on one side and the gastrointestinal tract (oesophagus or stomach) on the other. Though acquired CBPFMs are known, the large majority of them are congenital and single. CBPFMs often go undetected even at surgery and require more than one operation before they are successfully addressed. This is because the symptomatology of CBPFM resembles the more common oesophageal atresia (OA) with tracheoesophageal fistula, wherein it may coexist. We report a patient with OA who had a rare form of CBPFM where the upper lobe of the right lung communicated with the upper oesophagus. This account highlights a novel method of working out the uncertain anatomy, in such cases. There may be associated anomalies of the lung parenchyma and vasculature usually involving the pulmonary arterial supply to the affected lung. Clinical, radiological, endoscopic and pathological characterisation permit precise diagnosis in most instances, with an occasional case that defies definition.
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Affiliation(s)
- Niveditha Shama
- Paediatric Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - John Mathai
- Paediatric Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Ekta Rai
- Anaesthesia, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Thomas Alex Kodiatte
- General Pathology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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13
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Harumatsu T, Kaji T, Nagano A, Matsui M, Murakami M, Sugita K, Matsukubo M, Ieiri S. Successful thoracoscopic treatment for tracheoesophageal fistula and esophageal atresia of communicating bronchopulmonary foregut malformation group IB with dextrocardia: a case report of VACTERL association. Surg Case Rep 2021; 7:11. [PMID: 33409676 PMCID: PMC7788125 DOI: 10.1186/s40792-020-01099-y] [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: 11/21/2020] [Accepted: 12/23/2020] [Indexed: 11/10/2022] Open
Abstract
Background A communicating bronchopulmonary foregut malformation (CBPFM) group IB is very rare congenital malformation. Group IB is associated with tracheoesophageal fistula and esophageal atresia (TEF-EA) and a portion of one lung arisen from the esophagus (Gerle et al. in N Engl J Med. 278:1413–1419, 1968). The coexistence of TEF-EA and dextrocardia is also a rare and challenging setting for repair of TEF-EA. Therefore, the thoracoscopic surgery for TEF-EA require the technical devise because of the small operative space. We herein report a rare case of CBPFM group IB with intralobar sequestration of lung and a successful performing of thoracoscopic surgery for EA with dextrocardia in VACTERL association. Case presentation A 2.2-kg term male neonate was born with an anal atresia, coarctation of the aorta, TEF-EA, renal anomalies, radial hemimelia, limb abnormalities (VACTERL association) and hypoplasia of the right lung with dextrocardia. The patient developed respiratory distress after admission. A two-stage operation for the TEF-EA was planned because of multiple anomalies and cardiac condition. In the neonatal period, esophageal banding at the gastroesophageal junction and gastrostomy were performed to establish enteral nutrition. After gaining body weight and achieving a stable cardiac condition, thoracoscopic surgery for TEF-EA was performed. The thoracoscopic findings revealed a small working space due to dextrocardia. To obtain a sufficient working space and to perform secure esophageal anastomosis, an additional 3-mm assistant port was inserted. To close the upper and lower esophagus, anchoring sutures of the esophagus were placed and were pulled to suspend the anastomotic site. Esophageal anastomosis was successfully performed. An esophagogram after TEF-EA surgery showed the connection between the lower esophagus and right lower lung. The definitive diagnosis was CBPFM group IB with intralobar sequestration. The thoracoscopic surgery was performed again for establishing oral intake. After transection of the bronchoesophageal fistula, the patient could perform oral feeding without pneumonia or respiratory distress. Conclusions CBPFM type IB with intralobar sequestration is a rare condition. CBPFM type IB should be considered for a patients with respiratory symptom after radical operation for TEF-EA. In the present case, suspending the anastomotic site was effective and useful in thoracoscopic surgery for a TEF-EA patient with dextrocardia.
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Affiliation(s)
- Toshio Harumatsu
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, 890-8520, Japan
| | - Tatsuru Kaji
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, 890-8520, Japan.,Clinical Training Center, Kagoshima University Hospital, Kagoshima, Japan
| | - Ayaka Nagano
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, 890-8520, Japan
| | - Mayu Matsui
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, 890-8520, Japan
| | - Masakazu Murakami
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, 890-8520, Japan
| | - Koshiro Sugita
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, 890-8520, Japan
| | - Makoto Matsukubo
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, 890-8520, Japan
| | - Satoshi Ieiri
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, 890-8520, Japan.
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14
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Tambucci R, Wautelet O, Haenecour A, François G, Goubau C, Scheers I, Halut M, Menten R, Schmitz S, de Toeuf C, Pirotte T, D'hondt B, Reding R, Poncelet A. Esophageal Trachea, a Unique Foregut Malformation Requiring Multistage Surgical Reconstruction: Case Report. Front Pediatr 2020; 8:605143. [PMID: 33330293 PMCID: PMC7714922 DOI: 10.3389/fped.2020.605143] [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: 09/11/2020] [Accepted: 10/26/2020] [Indexed: 11/13/2022] Open
Abstract
Abnormal connections between the esophagus and low respiratory tract can result from embryological defects in foregut development. Beyond well-known malformations, including tracheo-esophageal fistula and laryngo-tracheo-esophageal cleft, rarer anomalies have also been reported, including communicating bronchopulmonary foregut malformations and tracheal atresia. Herein, we describe a case of what we have called "esophageal trachea," which, to our knowledge, has yet to be reported. A full-term neonate was born in our institution presenting with a foregut malformation involving both the middle esophagus and the distal trachea, which were found to be longitudinally merged into a common segment, 3 cm in length, located just above the carina and consisted of esophageal tissue without cartilaginous rings. At birth, the esophagus and trachea were surgically separated via right thoracotomy, the common segment kept on the tracheal side only, creating a residual long-gap esophageal atresia. The resulting severe tracheomalacia was treated via simultaneous posterior splinting of such diseased segment using an autologous pericardium patch, as well as by anterior aortopexy. Terminal esophagostomy and gastrostomy were created at that stage due to the long distance between esophageal segments. Between ages 18 and 24 months, the patient underwent native esophageal reconstruction using a multistage traction-and-growth surgical strategy that combined Kimura extra-thoracic esophageal elongations at the upper esophagus and Foker external traction at the distal esophagus. Ten months after esophageal reconstruction, prolonged, refractory, and severe tracheomalacia was further treated via anterior external stenting using a semitubular ringed Gore-Tex® prosthesis, through simultaneous median sternotomy and tracheoscopy. Currently, 2 years after the last surgery, respiratory stabilization, and full oral feeding were stably achieved. Multidisciplinary management was crucial for assuring lifesaving procedures, correctly assessing anatomy, and planning for multiple sequential surgical approaches that aimed to restore long-term respiratory and digestive functions.
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Affiliation(s)
- Roberto Tambucci
- Pediatric Surgery and Transplantation Unit, Department of Surgery, Saint-Luc University Clinics, Brussels, Belgium
| | - Océane Wautelet
- Pediatric Surgery and Transplantation Unit, Department of Surgery, Saint-Luc University Clinics, Brussels, Belgium
| | - Astrid Haenecour
- Pediatric Intensive Care Unit, Emergency Department, Saint-Luc University Clinics, Brussels, Belgium
| | - Geneviève François
- General Pediatric Unit, Department of Pediatrics, Saint-Luc University Clinics, Brussels, Belgium
| | - Christophe Goubau
- Pediatric Pneumology Unit, Department of Pediatrics, Saint-Luc University Clinics, Brussels, Belgium
| | - Isabelle Scheers
- Pediatric Gastroenterology and Hepatology Unit, Department of Pediatrics, Saint-Luc University Clinics, Brussels, Belgium
| | - Marin Halut
- Pediatric Radiology Unit, Department of Radiology, Saint-Luc University Clinics, Brussels, Belgium
| | - Renaud Menten
- Pediatric Radiology Unit, Department of Radiology, Saint-Luc University Clinics, Brussels, Belgium
| | - Sandra Schmitz
- Otolaryngology Unit, Department of Surgery, Saint-Luc University Clinics, Brussels, Belgium
| | - Caroline de Toeuf
- Otolaryngology Unit, Department of Surgery, Saint-Luc University Clinics, Brussels, Belgium
| | - Thierry Pirotte
- Pediatric Anesthesiology Unit, Emergency Department, Saint-Luc University Clinics, Brussels, Belgium
| | - Beelke D'hondt
- Pediatric Surgery and Transplantation Unit, Department of Surgery, Saint-Luc University Clinics, Brussels, Belgium
| | - Raymond Reding
- Pediatric Surgery and Transplantation Unit, Department of Surgery, Saint-Luc University Clinics, Brussels, Belgium
| | - Alain Poncelet
- Pediatric Cardiac and Thoracic Surgery Unit, Department of Surgery, Saint-Luc University Clinics, Brussels, Belgium
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Villamizar E, Villamizar MDM, Ciro MP, Pulido J, Rodriguez M, Villamizar JC. Esophageal Lung in a Preterm Boy-Report on a Multidisciplinary Treatment. European J Pediatr Surg Rep 2019; 7:e110-e113. [PMID: 31788411 PMCID: PMC6882685 DOI: 10.1055/s-0039-3400475] [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: 09/05/2019] [Accepted: 09/20/2019] [Indexed: 11/24/2022] Open
Abstract
Esophageal lung is a rare entity that results from embryological alterations during the formation of the ventral wall of the anterior intestine. The clinical manifestations of this pathology are vague, including respiratory or digestive symptoms, repetitive respiratory infections, dysphagia, or inability to swallow. The management is based on the exact anatomical and vascular abnormalities. We report the diagnostic and therapeutic approach in a preterm boy with esophageal lung. Also, we present a three-dimensional model for the classification of this pathology. In conclusion, the management relies on proper definition of the anatomy and the surgical strategy.
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Affiliation(s)
- Enrique Villamizar
- Department of Pediatric Surgery, Hospital Universitario Erasmo Meoz, Bogota, Colombia
| | | | | | - Jean Pulido
- Department of Surgery, Universidad El Bosque Facultad de Medicina, Bogota, Colombia
| | - Maria Rodriguez
- Registered Nurse, Morton College, Cicero, Illinois, United States
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