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Khandelwal S, Mittal A, Sharma S, Prasad A, Singh R, Shah A, Lageju N. Intralobar pulmonary sequestration: a rare cause of hemoptysis: a case report. Ann Med Surg (Lond) 2024; 86:3641-3645. [PMID: 38846891 PMCID: PMC11152832 DOI: 10.1097/ms9.0000000000002028] [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: 01/23/2024] [Accepted: 03/14/2024] [Indexed: 06/09/2024] Open
Abstract
Overview and significance Pulmonary sequestration (PS) is a rare congenital anomaly characterized by aberrant formation of nonfunctional lung tissue with anomalous systemic blood supply. Despite its rarity, PS presents significant diagnostic and management challenges, often necessitating a multidisciplinary approach for optimal patient outcomes. This case report provides insights into the clinical presentation, diagnostic modalities, and management strategies for PS. Case summary The authors present a case of a 30-year-old male who complained of chronic cough and hemoptysis and was eventually diagnosed with intralobar PS by computed tomography (CT) imaging. The patient underwent a surgical procedure, specifically a lobectomy, to address the lung tissue. Clinical discussion The diagnosis of intralobar PS is confirmed by CT imaging, showing features of abnormalities, including irregular cystic communication. A large area with abnormal systemic arterial supply and variable venous fluid. This patient presented with symptoms consistent with PS, including chronic cough and hemoptysis, highlighting the importance of timely diagnosis and intervention to prevent life-threatening complications. Conclusion Lung sequestration has diagnostic challenges due to its variable clinical presentation and potential for misdiagnosis. However, advances in technology, such as CT angiography, make accurate diagnosis and precise surgical planning easier. Prompt intervention via lobectomy or transarterial embolization is important to reduce the risk of life-threatening complications associated with PS. These data highlight the importance of multidisciplinary collaboration between physicians, radiologists, and surgeons to effectively manage PS and improve patient outcomes.
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Affiliation(s)
| | - Aman Mittal
- Department of Radiology, SGT Medical College Hospital, Delhi
| | - Shruti Sharma
- Department of Radiology, Esic Medical College, Bengaluru, Karnataka
| | | | - Roshan Singh
- Kathmandu University School of Medical Sciences, Kathmandu, Nepal
| | - Anil Shah
- B.P. Koirala Institute of Health Sciences, Dharan
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Alsararatee HH, Munje M. Unexpected pulmonary sequestration in a pregnant patient. BMJ Case Rep 2023; 16:e256568. [PMID: 38114298 DOI: 10.1136/bcr-2023-256568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
A pregnant woman in her early 30s, at 20 weeks of gestational age, presented with recurrent haemoptysis, pleuritic chest pain and a productive cough of 6 months duration. She underwent CT pulmonary angiogram which demonstrated right pulmonary sequestration and right-sided consolidation. Pre-existing pulmonary comorbidities such as chronic inflammation, structural abnormalities or weakened blood vessels within the lungs can encourage the growth of abnormal blood vessels. During pregnancy, these dynamics can be further aggravated by increasing cardiac output to promote blood flow to the placenta and increasing oxygen delivery to the developing foetus. These changes likely cause increased blood flow to the pulmonary sequestration, resulting in haemoptysis. The patient was treated conservatively for community-acquired pneumonia with a course of oral amoxicillin 500 mg three times a day for 5 days, and she is doing well on follow-up.
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Affiliation(s)
- Hasan Hazim Alsararatee
- Acute Medicine/ SDEC, Northampton General Hospital NHS Trust, Northampton, Northamptonshire, UK
| | - Muhit Munje
- Acute Medicine/ SDEC, Northampton General Hospital NHS Trust, Northampton, Northamptonshire, UK
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3
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Pederiva F, Rothenberg SS, Hall N, Ijsselstijn H, Wong KKY, von der Thüsen J, Ciet P, Achiron R, Pio d'Adamo A, Schnater JM. Congenital lung malformations. Nat Rev Dis Primers 2023; 9:60. [PMID: 37919294 DOI: 10.1038/s41572-023-00470-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 11/04/2023]
Abstract
Congenital lung malformations (CLMs) are rare developmental anomalies of the lung, including congenital pulmonary airway malformations (CPAM), bronchopulmonary sequestration, congenital lobar overinflation, bronchogenic cyst and isolated congenital bronchial atresia. CLMs occur in 4 out of 10,000 live births. Postnatal presentation ranges from an asymptomatic infant to respiratory failure. CLMs are typically diagnosed with antenatal ultrasonography and confirmed by chest CT angiography in the first few months of life. Although surgical treatment is the gold standard for symptomatic CLMs, a consensus on asymptomatic cases has not been reached. Resection, either thoracoscopically or through thoracotomy, minimizes the risk of local morbidity, including recurrent infections and pneumothorax, and avoids the risk of malignancies that have been associated with CPAM, bronchopulmonary sequestration and bronchogenic cyst. However, some surgeons suggest expectant management as the incidence of adverse outcomes, including malignancy, remains unknown. In either case, a planned follow-up and a proper transition to adult care are needed. The biological mechanisms through which some CLMs may trigger malignant transformation are under investigation. KRAS has already been confirmed to be somatically mutated in CPAM and other genetic susceptibilities linked to tumour development have been explored. By summarizing current progress in CLM diagnosis, management and molecular understanding we hope to highlight open questions that require urgent attention.
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Affiliation(s)
- Federica Pederiva
- Paediatric Surgery, "F. Del Ponte" Hospital, ASST Settelaghi, Varese, Italy.
| | - Steven S Rothenberg
- Department of Paediatric Surgery, Rocky Mountain Hospital for Children, Denver, CO, USA
| | - Nigel Hall
- University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Hanneke Ijsselstijn
- Department of Paediatric Surgery and Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Kenneth K Y Wong
- Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Jan von der Thüsen
- Department of Pathology and Clinical Bioinformatics, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Pierluigi Ciet
- Departments of Radiology and Nuclear Medicine and Respiratory Medicine and Allergology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Radiology, University of Cagliari, Cagliari, Italy
| | - Reuven Achiron
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, The Chaim Sheba Medical Center Tel-Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adamo Pio d'Adamo
- Laboratory of Medical Genetics, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - J Marco Schnater
- Department of Paediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
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Aryal K, Regmi PR, Adhikari G, Karki R, Dhakal P. Intralobar pulmonary sequestration in 2 extremes of ages: A Case report. Radiol Case Rep 2023; 18:4145-4148. [PMID: 37745759 PMCID: PMC10511722 DOI: 10.1016/j.radcr.2023.08.089] [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: 06/14/2023] [Revised: 07/23/2023] [Accepted: 08/19/2023] [Indexed: 09/26/2023] Open
Abstract
Pulmonary sequestration is a relatively rare phenomenon characterized by nonfunctional lung tissue supplied by one or more systemic arteries without direct connection to the tracheobronchial tree. Intra-lobar pulmonary sequestration comprises 75% of the total pulmonary sequestrations. Most patients with pulmonary sequestrations are often diagnosed with a childhood chest infection, so pulmonary sequestration is considered a childhood disease. However, few cases are found in adults and the elderly, with or without symptoms, and imaging findings on computed tomography (CT) or magnetic resonance imaging (MRI) are variable due to infection and inflammation. Failure to diagnose and treat this condition may lead to recurrent pneumonia and fatal hemoptysis. In this case report, we present cases of pulmonary sequestration at extremes of ages, one at 12 and the other at 65.
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Affiliation(s)
- Krishnaraj Aryal
- Department of Radiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Pradeep Raj Regmi
- Department of Radiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Gauri Adhikari
- Department of Medicine, Nepalese Army Student of Health Science- College of Medicine, Kathmandu, Nepal
| | - Ruchi Karki
- Department of Medicine, KIST Medical College and Teaching Hospital, Imadol, Lalitpur, Nepal
| | - Prajwal Dhakal
- Department of Radiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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Mughrabi A, Fennelly J, Fandreyer F, Fleisher J. Unravelling the mystery of a rare infection: a challenging case of pulmonary sequestration with Mycobacterium avium complex and the importance of a thorough microbiological investigation. BMJ Case Rep 2023; 16:e255346. [PMID: 37699740 PMCID: PMC10503325 DOI: 10.1136/bcr-2023-255346] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 09/14/2023] Open
Abstract
Pulmonary sequestration is a rare congenital condition. It is a dysplastic lung tissue with a separate systemic blood supply and without a bronchial tree connection. The emergence of a superimposed infection can lead to its diagnosis, such as Staphylococcus aureus, Pseudomonas aeruginosa, Nocardia asteroids and Aspergillus sp pneumonia. Mycobacterium avium complex (MAC) superimposed disease is exceedingly rare. We report a case of a man in his third decade without known medical disorders presenting with a persistent cough. After an extensive microbiological workup, an MAC infection was diagnosed. An elevated carbohydrate antigen 19-9 (CA 19-9) was also noted. He was treated with antimycobacterial therapy and lobectomy resulting in clinical improvement and CA19-9 normalisation. This case illustrates the value of comprehensive microbiological investigations in patients with chronic respiratory symptoms and imaging findings that are not typical of bacterial pneumonia. Clinical studies remain needed to investigate the utility of CA 19-9 in a scoring system to guide MAC therapy.
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Affiliation(s)
- Abdallah Mughrabi
- Department of Internal Medicine, St. Elizabeth's Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | | | | | - Jorge Fleisher
- Division of Infectious Diseases, Department of Medicine, St. Elizabeth's Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachussets, USA
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Liu X, Wu R, Zhu S, Gu L, Tang Z. Imaging and pathological characteristics, treatment, and prognosis of pulmonary sequestration-A retrospective study of 13 cases. THE CLINICAL RESPIRATORY JOURNAL 2023; 17:865-873. [PMID: 37533295 PMCID: PMC10500327 DOI: 10.1111/crj.13672] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVE This study aimed to summarize and analyze the characteristics of pulmonary sequestration to improve our understanding of this disease. METHODS Between January 2019 and April 2023, the clinical data of 13 patients with pulmonary sequestration underwent surgical treatment at the First Affiliated Hospital of Gannan Medical University. RESULTS The male-to-female ratio was 4:9, the age was 0.5 to 60 years, and the average age was 38 ± 19 years. There were 10 and 3 cases of intralobar and extralobar pulmonary sequestration, respectively. Chest enhanced computed tomography (CT) and three-dimensional vascular reconstruction showed that the abnormal blood vessels were derived from the descending thoracic aorta in nine cases and from other blood vessels in four cases. Three patients underwent thoracoscopic lobectomy, two underwent thoracoscopic segmentectomy, and eight underwent thoracoscopic wedge resection. All the patients successfully completed the surgery and were discharged postoperatively. CONCLUSIONS Some patients with pulmonary sequestration exhibit no obvious symptoms. Patients with clinical symptoms are easily confused for pneumonia, bronchial cysts, lung abscesses, and lung tumors; therefore, patients with pulmonary sequestration are prone to missed diagnosis and misdiagnosis. Currently, enhanced chest CT combined with three-dimensional vascular reconstruction can accurately show the course, branches, and relationship with the mass of the feeding artery. Routine pathological examination is helpful to further clarify the diagnosis of pulmonary sequestration. Minimally invasive thoracoscopic surgery is the preferred treatment for patients with pulmonary sequestration. Surgical resection is safe and feasible, and satisfactory results are typically obtained.
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Affiliation(s)
- Xiangjin Liu
- First Clinical Medical CollegeThe Gannan Medical UniversityGanzhouChina
| | - Rongqian Wu
- First Clinical Medical CollegeThe Nanchang UniversityNanchangChina
| | - Shenyu Zhu
- Department of Thoracic SurgeryThe First Affiliated Hospital of Gannan Medical UniversityGanzhouChina
| | - Liang Gu
- Department of Thoracic SurgeryThe First Affiliated Hospital of Gannan Medical UniversityGanzhouChina
| | - Zhixian Tang
- Department of Thoracic SurgeryThe First Affiliated Hospital of Gannan Medical UniversityGanzhouChina
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Jamhuri NS, Hasnol Aidi A, Mohamad Ali NI, Bahtiar MSA. Pulmonary sequestration: An uncommon presentation with acute chest pain. Respir Med Case Rep 2022; 41:101799. [PMID: 36583060 PMCID: PMC9792879 DOI: 10.1016/j.rmcr.2022.101799] [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: 10/02/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
This is a case of 18-year-old teenager presented with acute left sided chest pain for five days. This was associated with intermittent cough, and loss of weight in two weeks. Diagnosis was made by computed tomography of thorax plus angiogram that showed infected left intralobar pulmonary sequestration with lung abscess. Sputum culture grew Pseudomonas aeruginosa. He completed 14 days of antibiotic and subjected to feeding artery embolization. The aim of this case report is to highlight on the uncommon presentation and the need of high index of suspicion of pulmonary sequestration with support by imaging findings.
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Affiliation(s)
- Nur Syazwani Jamhuri
- Corresponding author. Department of Internal Medicine, Kulliyyah of Medicine, IIUM Kuantan Campus, Bandar Indera Mahkota, 25200, Kuantan Pahang, Malaysia.
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Debating the embolization of a large aberrant systemic artery for pulmonary sequestration using an Amplatzer duct occluder: a case report and literature review. Cardiol Young 2022; 32:331-336. [PMID: 34321118 DOI: 10.1017/s1047951121002924] [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] [Indexed: 11/06/2022]
Abstract
Here, we report two rare cases of pulmonary sequestration that were fed by large systemic arteries and embolized with a large Amplatzer duct occluder and their 3-year follow-up, and we discuss the efficacy and safety of the embolization of a large aberrant systemic artery to pulmonary sequestration using an Amplatzer duct occluder. A 9-year-old boy complained of chest pain for 1 month, and a 6-year-old boy initially complained of recurrent cough for 3 months. A series of examinations was launched to evaluate any possible malformation or abnormalities in the patients. Chest CT and CTA identified a right lower pulmonary sequestration with infection. After admission, transcatheter device occlusion was planned after essential antibiotic treatment, and postoperative infection prevention and anti-inflammatory treatment were given. In the following 2 years of follow-up, neither of the children had recurrent chest pain, cough or other related symptoms. However, the CT follow-up demonstrated that a residual mass was visible in both patients. The same chest scan section revealed slight reductions in lung lesions from 38.344 cm2 to 37.119 cm2 (3% reduction) and 14.243 cm2 to 13.178 cm2 (7.5% reduction) for each patient. No follow-up data demonstrated the long-term clinical outcomes of the residual lesion. We do not recommend that embolization be performed for large pulmonary sequestration lesions with an aberrant artery larger than 6 mm that is planned to receive a device larger than 10 mm, as their outcomes showed a higher possibility of rebuilding the vascularization network feeding the pulmonary sequestration, indicating a higher risk for long-term complications.
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9
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Hai VA, Giang NT, Anh LV, Pho DC, Van Nam N. Aberrant artery embolization prior to pulmonary sequestration surgery: A case series report. Int J Surg Case Rep 2022; 91:106747. [PMID: 35007987 PMCID: PMC8749283 DOI: 10.1016/j.ijscr.2021.106747] [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: 11/17/2021] [Revised: 12/28/2021] [Accepted: 12/31/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives Pulmonary sequestration is a rare congenital malformation, and part of its treatment requires the removal of the aberrant artery by surgical means. Materials and methods Five patients treated at Military Hospital 103 - Department of Thoracic Disease were diagnosed with PS via CT scan, MS-CT, and DSA, and histopathological data were evaluated retrospectively between January and December 2019. Results In all patients, surgery is the preferred option, with two cases of video-assisted thoracoscopic surgery (one lobectomy and one wedge resection), and three cases of hybrid video-assisted thoracoscopic surgery (adhesive inflammation was observed, the bronchus is challenging to reveal, to resect, and tend to bleed when resecting). The average length of stay following surgery is 11.6 ± 8.1 days. The mean duration of postoperative follow-up is 13.8 ± 3.3 months, all patients had a good quality of life, and no respiratory problems such as hemoptysis or pneumonia were detected. Conclusion The excellent outcomes obtained in all patients in our study during the follow-up period (13.8 ± 3.3 months) established the appropriate indication and treatment. However, these are preliminary findings; a longer study period with a larger sample size is required to draw more valid conclusions. Pulmonary sequestration is a rare congenital malformation. Aberrant artery embolization prior to pulmonary sequestration surgery is potential for excellent outcomes. The excellent outcomes obtained in all patients established the appropriate indication and treatment
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Affiliation(s)
- Vu Anh Hai
- Department of Thoracic Surgery, Military Hospital 103, Vietnam Military Medical University, Viet Nam
| | - Nguyen Truong Giang
- Department of Cardiothoracic Surgery, Military Hospital 103, Vietnam Military Medical University, Viet Nam
| | - Le Viet Anh
- Department of Thoracic Surgery, Military Hospital 103, Vietnam Military Medical University, Viet Nam
| | - Dinh Cong Pho
- Department of Military Science, Vietnam Military Medical University, Viet Nam
| | - Nguyen Van Nam
- Department of Thoracic Surgery, Military Hospital 103, Vietnam Military Medical University, Viet Nam.
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Phelps MC, Sanchirico PJ, Pfeiffer DC. Intralobar pulmonary sequestration: incidental finding in an asymptomatic patient. Radiol Case Rep 2020; 15:1891-1894. [PMID: 32874379 PMCID: PMC7452027 DOI: 10.1016/j.radcr.2020.07.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/19/2020] [Accepted: 07/20/2020] [Indexed: 11/21/2022] Open
Abstract
We describe a case of a 58-year-old male who presented to the emergency room with symptoms related to an appendicitis. A computed tomography scan with contrast confirmed the diagnosis of acute appendicitis but also revealed a mass medially in the base of the inferior lobe of the right lung. The mass measured 6.7 cm AP × 3.7 cm transverse. It had multiple lobulations and the anterior aspect was of very low density, possibly representing accumulated mucoid material. The mass had an arterial connection from the descending thoracic aorta and a venous drainage into the right pulmonary vein, classical features of intralobar pulmonary sequestration. The physical exam was unremarkable, and the patient had no history of pulmonary symptoms. This case helps increase awareness of intralobar pulmonary sequestration, a rare condition that may be asymptomatic.
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Affiliation(s)
- Megan C. Phelps
- WWAMI Medical Education Program (MD), University of Washington School of Medicine, Seattle, WA, USA
| | | | - David C. Pfeiffer
- WWAMI Medical Education Program and Department of Biological Sciences, University of Idaho, 875 Perimeter Drive, Moscow, ID 83844-3051, USA
- Corresponding author.
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Zaccarini DJ, El-Zammar O. Pulmonary intralobar sequestration associated with aspergillosis and aspiration. Clin Case Rep 2020; 8:1880-1883. [PMID: 33088511 PMCID: PMC7562881 DOI: 10.1002/ccr3.3039] [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: 02/20/2020] [Revised: 04/07/2020] [Accepted: 05/15/2020] [Indexed: 11/07/2022] Open
Abstract
The pathogenesis of intralobar pulmonary sequestration is not completely understood, either representing a congenital or acquired process. The presence of fungal organisms and aspiration has both clinical and etiologic significance.
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Affiliation(s)
| | - Ola El-Zammar
- Pathology SUNY Upstate University Hospital Syracuse NY USA
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12
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Kim HJ, Shin KE, Park JS, Lee H, Lee JW, Chin S, Shin HK. Intralobar pulmonary sequestration with cystic degeneration mimicking a bronchogenic cyst in an elderly patient: A case report and literature review. Medicine (Baltimore) 2020; 99:e19347. [PMID: 32118772 PMCID: PMC7478580 DOI: 10.1097/md.0000000000019347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Pulmonary sequestration (PS) is a rare congenital malformation defined as nonfunctioning lung tissue supplied by systemic circulation. It is uncommonly diagnosed in adults. Herein, we describe a clinical case of PS with cystic degeneration mimicking a bronchogenic cyst in an elderly patient. PATIENT CONCERNS A huge cystic mass was incidentally found in a 65-year-old man on chest computed tomography (CT) scans during preoperative workup for a hand laceration. A 15-cm-sized round cystic mass was detected in the right lower lobe. DIAGNOSIS After reviewing the chest CT scan, we decided to perform contrast-enhanced chest magnetic resonance imaging (MRI) and CT-guided lung aspiration biopsy. On MRI, the lesion had the appearance of a cystic mass with hemorrhagic clots, such as an intrapulmonary bronchogenic cyst. The aspirated specimen was nondiagnostic; thus, we decided to surgically remove the mass. INTERVENTIONS Upon right lower lobectomy, the mass was diagnosed as a PS. A thin systemic artery supplying the cystic mass was visualized during surgery. OUTCOMES The patient is undergoing regular follow-up at the outpatient clinic. CONCLUSIONS PS should be considered as a differential diagnosis in patients with a cystic lung mass. Identification of a systemic artery on radiologic imaging is important in the diagnosis of PS before preoperative workup to prevent unpredicted massive bleeding during surgery.
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Affiliation(s)
| | | | | | | | | | | | - Hwa Kyun Shin
- Department of Thoracic and Vascular Surgery, Soonchunhyang University Hospital Bucheon, Bucheon, South Korea
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Sakai M, Ozawa Y, Konishi T, Watanabe A, Shiigai M. Endostapling the aberrant artery filled with embolized coils for intralobar pulmonary sequestration: a report of two cases. J Thorac Dis 2018; 10:E304-E308. [PMID: 29850174 DOI: 10.21037/jtd.2018.04.21] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Intrapulmonary sequestration is a rare congenital bronchopulmonary malformation. Surgery is generally standard treatment, and thoracoscopic resection has been accepted recently. Some patients have inflammatory change of the sequestrated lung and adhesion to the adjacent organs. In those cases, it is difficult to identify the aberrant artery. In thoracoscopic surgery cases, fatal intraoperative hemorrhage from the aberrant artery has been reported. We describe two patients with infected intralobar pulmonary sequestration who were treated by endostapling the aberrant artery filled with embolized coils. A 28-year-old man who had complained of right back pain and high fever was admitted to our hospital. The chest computed tomography (CT) scan showed infected intralobar pulmonary sequestration with consolidation and fluid collection in the right lower lobe. An aberrant artery entered the consolidation from the celiac trunk. After coil embolization, thoracoscopic right lower lobectomy was performed with endostapling of the aberrant artery, which had a diameter of 10 mm and was filled with metallic coils. A 51-year-old woman who had complained of repeated pneumonia was admitted to our hospital. The chest CT scan showed infected intralobar pulmonary sequestration with consolidation and fluid collection in the basal segment of the right lower lobe. After coil embolization, thoracoscopic right lower lobectomy was performed with endostapling of the aberrant artery arising from the right inferior phrenic artery, which had a diameter of 5 mm and was filled with coils. Both patients' clinical courses were uneventful postoperatively. Pathological examinations confirmed intralobar pulmonary sequestration with pneumonia. Endostapling with coils for treating the aberrant artery in pulmonary sequestration is a simple and safe technique of thoracoscopic resection. A coil-embolized artery can be identified easily in the inflamed, scarred pulmonary ligament, and intraoperative bleeding from the aberrant artery can be prevented.
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Affiliation(s)
- Mitsuaki Sakai
- Department of Thoracic Surgery, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | - Yuichiro Ozawa
- Department of Thoracic Surgery, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | - Takahiro Konishi
- Department of Radiology, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | - Azusa Watanabe
- Department of Radiology, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | - Masashige Shiigai
- Department of Radiology, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
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