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Guo R, Huang S, Zhang S, Zhao H, Lv L, Zhai Y. Simultaneous unilateral thoracoscopic resection of bilateral pulmonary sequestration. BMC Pediatr 2024; 24:604. [PMID: 39342249 PMCID: PMC11437768 DOI: 10.1186/s12887-024-05083-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 09/16/2024] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND Intra-lobar (ILS) and extra-lobar lung (ELS) sequestrations represent rare congenital lung malformations. Despite their benign nature, the lesions pose risks such as recurrent pulmonary infections, hemoptysis, congestive heart failure, and tumor development. Pulmonary sequestration (PS) typically manifests in two forms, ILS and ELS, with bilateral occurrence being exceptionally rare and mostly requiring bilateral thoracic surgery. CASE PRESENTATION A 9-year-old child, who initially presented with bilateral lung lesions without respiratory symptoms, was diagnosed with PS following a chest computed tomography scan. The surgical approach was determined based on the absence of inflammation and the clear demarcation of the lesions from normal lung tissue, highlighted by a unique tissue connection between the ILS and ELS across the chest cavities. We used a novel method wherein the left ELS was successfully pulled into the right chest cavity and both sequestrations were concurrently resected. Postoperative recovery was smooth, with no complications or residual lesions. CONCLUSIONS Our findings highlight the importance of thorough preoperative planning with enhanced computed tomography. Simultaneous unilateral thoracoscopic surgery can be a viable, less invasive option for treating bilateral PS, offering benefits such as reduced recovery time and better cosmetic outcomes.
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Affiliation(s)
- Rui Guo
- Department of Thoracic and Tumor Surgery, Children's Hospital Affiliated to Shandong University, Jinan, 250022, Shandong, China
- Department of Thoracic and Tumor Surgery, Jinan Children's Hospital, Jinan, 250022, Shandong, China
| | - Sai Huang
- Department of Thoracic and Tumor Surgery, Children's Hospital Affiliated to Shandong University, Jinan, 250022, Shandong, China
- Department of Thoracic and Tumor Surgery, Jinan Children's Hospital, Jinan, 250022, Shandong, China
| | - Shisong Zhang
- Department of Thoracic and Tumor Surgery, Children's Hospital Affiliated to Shandong University, Jinan, 250022, Shandong, China
- Department of Thoracic and Tumor Surgery, Jinan Children's Hospital, Jinan, 250022, Shandong, China
| | - Huashan Zhao
- Department of Thoracic and Tumor Surgery, Children's Hospital Affiliated to Shandong University, Jinan, 250022, Shandong, China
- Department of Thoracic and Tumor Surgery, Jinan Children's Hospital, Jinan, 250022, Shandong, China
| | - Longfei Lv
- Department of Thoracic and Tumor Surgery, Children's Hospital Affiliated to Shandong University, Jinan, 250022, Shandong, China
- Department of Thoracic and Tumor Surgery, Jinan Children's Hospital, Jinan, 250022, Shandong, China
| | - Yunpeng Zhai
- Department of Thoracic and Tumor Surgery, Children's Hospital Affiliated to Shandong University, Jinan, 250022, Shandong, China.
- Department of Thoracic and Tumor Surgery, Jinan Children's Hospital, Jinan, 250022, Shandong, China.
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Galanis M, Sommer E, Gioutsos K, Nguyen TL, Dorn P. Pulmonary Sequestration: A Monocentric Case Series Report. J Clin Med 2024; 13:5784. [PMID: 39407844 PMCID: PMC11476800 DOI: 10.3390/jcm13195784] [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: 07/22/2024] [Revised: 09/19/2024] [Accepted: 09/20/2024] [Indexed: 10/20/2024] Open
Abstract
Purpose: Pulmonary sequestration is a rare pulmonary malformation that often necessitates surgical intervention due to potential complications such as recurrent infections or hemoptysis. This case series presents the clinical trajectory of four patients diagnosed with pulmonary sequestration, from initial diagnosis through postoperative care, with a specific focus on the limited arterial supply in two of the cases. Materials and Methods: We conducted a retrospective descriptive analysis of four patients diagnosed with pulmonary sequestration who underwent surgical treatment at our institution between January 2013 and November 2022. The affected lung segments were excised via either thoracoscopy or thoracotomy. We evaluated perioperative and postoperative complications, hospital stay duration, histological findings, and the vascular supply of the affected areas. Results: Thoracoscopic surgery was initially preferred for all patients, though one required conversion to an open procedure due to technical challenges. Perioperative complications included increased pain and atelectasis. Two patients developed pleural empyema postoperatively, necessitating additional surgical intervention. The overall outcomes were favorable, with appropriate management addressing the complications effectively. Conclusions: Pulmonary sequestration, despite its rarity, often requires surgical treatment. Both thoracoscopic and open surgical methods are effective, though thoracoscopic surgery is generally preferred when feasible. The findings underscore the importance of meticulous preoperative planning and vigilant postoperative care to manage and mitigate potential complications.
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Motohashi Y, Kato T, Kato N, Aragaki M, Fujiwara-Kuroda A, Tachibana T, Hida Y, Kaga K, Wakasa S. Intralobar pulmonary sequestration associated with left main coronary artery obstruction and mitral regurgitation. Gen Thorac Cardiovasc Surg 2021; 69:1575-1579. [PMID: 34546531 DOI: 10.1007/s11748-021-01708-z] [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: 05/31/2021] [Accepted: 09/04/2021] [Indexed: 10/20/2022]
Abstract
A 4-year-old boy with left intralobar pulmonary sequestration associated with left main coronary artery obstruction (LMCAO) and severe mitral regurgitation (MR) was admitted to our hospital. Since the patient presented with dyskinesia of the cardiac apex and increased left ventricular end-diastolic volume (LVEDV), left main coronary artery reconstruction and mitral annuloplasty were performed. The enlargement of the left ventricle was improved after sequential surgeries. There was a risk of deterioration of MR and regrowth of LVEDV due to shunt blood flow; therefore, left lower lobectomy and aberrant artery division were performed. This is a very rare case of a patient with pulmonary sequestration associated with LMCAO and severe MR.
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Affiliation(s)
- Yusuke Motohashi
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, N15W7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Tatsuya Kato
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, N15W7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Nobuyasu Kato
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, N15W7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Masato Aragaki
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, N15W7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Aki Fujiwara-Kuroda
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, N15W7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Tsuyoshi Tachibana
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, N15W7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Yasuhiro Hida
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, N15W7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Kichizo Kaga
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, N15W7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Satoru Wakasa
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, N15W7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
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von Scheidt F, Eicken A, Wowra T, Brunner H, Apitz C. Bilateral Pulmonary Sequestration in a Preterm Infant. J Pediatr 2018; 194:260-260.e1. [PMID: 29224936 DOI: 10.1016/j.jpeds.2017.10.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 10/26/2017] [Accepted: 10/30/2017] [Indexed: 12/14/2022]
Affiliation(s)
| | - Andreas Eicken
- Department of Pediatric Cardiology and Congenital Heart Disease German Heart Center Munich Munich, Germany
| | - Tobias Wowra
- Children's Hospital University of Ulm Ulm, Germany
| | - Horst Brunner
- Department of Diagnostic and Interventional Radiology University of Ulm
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Suda K, Okawada M, Doi T, Miyano G, Koga H, Lane GJ, Arakawa A, Yamataka A. Thoracoscopic resection of an unusually hypervascular extra-lobar pulmonary sequestration that resembled an arteriovenous malformation in a 2-year-old boy. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2017.03.009] [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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Simultaneous Resection of Bilateral Intralobar and Extralobar Pulmonary Sequestrations With Video-Assisted Thoracoscopic Surgery. Ann Thorac Surg 2009; 87:1939-41. [DOI: 10.1016/j.athoracsur.2008.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Revised: 11/02/2008] [Accepted: 11/03/2008] [Indexed: 11/23/2022]
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Woerner A, Schwendener K, Wolf R, Nelle M. Neonatological and pulmonological management of bilateral pulmonary sequestration in a neonate. World J Pediatr 2008; 4:301-4. [PMID: 19104895 DOI: 10.1007/s12519-008-0054-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Accepted: 05/13/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bronchopulmonary sequestration is a lung malformation characterized by nonfunctioning lung tissue without primary communication with the tracheobronchial tree. Intrauterine complications such as mediastinal shift, pleural effusion or fetal hydrothorax can be present. We present the case of a newborn with bilateral intralobar pulmonary sequestration. METHODS Prenatal ultrasonography in a primigravida at 20 weeks of gestation revealed echogenic masses in the right fetal hemithorax with mediastinal shift towards the left side. Serial ultrasound confirmed persistence of the lesion with otherwise appropriate fetal development. Delivery was uneventful and physical examination revealed an isolated intermittent tachypnea. Chest CT scan and CT angiography showed a bilateral intrathoracic lesion with arterial supply from the aorta. Baby lung function testing suggested possible multiple functional compartments. RESULTS Right and left thoracotomy was performed at the age of 7 months. A bilateral intralobar sequestration with vascularisation from the aorta was resected. Pathological and histological examination of the resected tissue confirmed the surgical diagnosis. At the age of 24 months, the child was doing well without pulmonary complications. CONCLUSIONS Bilateral pulmonary sequestration requires intensive prenatal and postnatal surveillance. Though given the fact of a bilateral pulmonary sequestration, postnatal outcome showed similar favourable characteristics to an unilateral presentation. Baby lung function testing could provide additional information for optimal postnatal management and timing of surgical intervention.
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Affiliation(s)
- Andreas Woerner
- Division of Neonatology, Department of Pediatrics, University Children's Hospital, Bern, Switzerland.
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Millendez MB, Ridout E, Pole G, Edwards M. Neonatal hyperreninemia and hypertensive heart failure relieved with resection of an intralobar pulmonary sequestration. J Pediatr Surg 2007; 42:1276-8. [PMID: 17618895 DOI: 10.1016/j.jpedsurg.2007.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Intralobar pulmonary sequestrations are congenital lung malformations sometimes known to cause symptoms of heart failure in the neonate because of shunting of blood flow from an anomalous systemic feeding artery into the pulmonary venous system. These are cured by pulmonary lobectomy. We report the case of a 37-weeks' gestational age infant who presented with bilateral pleural effusions perinatally, followed by hypertensive heart failure and hyperreninemia 2 weeks postnatally. Computed tomography revealed a large artery from the infradiaphragmatic aorta proximal to the celiac axis supplying a right lower lobe intralobar pulmonary sequestration and 4 small nonstenosed renal arteries. Subsequent to a right lower lobectomy, the patient recovered with a precipitous drop in plasma renin assay level and was discharged from the neonatal intensive care unit in good condition 12 days postoperatively. This is the first reported case of hyperreninemia treated by lobectomy. We hypothesize that the aberrant feeding vessel resulted in a relative deficiency in renal perfusion via a "steal" effect that was relieved by surgical ligation of the artery.
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Affiliation(s)
- Maridelle B Millendez
- Uniformed Services University of the Health Sciences, F. Edward Hebert School of Medicine, Bethesda, MD, USA
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Stern R, Berger S, Casaulta C, Raio L, Abderhalden S, Zachariou Z. Bilateral intralobar pulmonary sequestration in a newborn, case report and review of the literature on bilateral pulmonary sequestrations. J Pediatr Surg 2007; 42:E19-23. [PMID: 17448748 DOI: 10.1016/j.jpedsurg.2007.01.054] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We describe a rare case of bilateral intralobar pulmonary sequestration in a newborn with both sequestrations vascularized from a vessel arising from the celiac trunk of the abdominal aorta. The larger sequestration on the right side was diagnosed antenatally, the left side postnatally. At the age of 7 months, the child underwent successful bilateral thoracotomy. In follow-up at the age of more than 1 year, no complications have occurred.
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Affiliation(s)
- Robert Stern
- Department of Surgical Pediatrics, University Hospital of Berne, Switzerland
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Morse CR, Ishitani MB, Cassivi SD. Video-assisted resection of bilateral intralobar pulmonary sequestrations. J Thorac Cardiovasc Surg 2006; 131:917-8. [PMID: 16580457 DOI: 10.1016/j.jtcvs.2005.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2005] [Revised: 12/07/2005] [Accepted: 12/09/2005] [Indexed: 11/19/2022]
Affiliation(s)
- Christopher R Morse
- Division of General Thoracic Surgery, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA
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