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Hosokawa T, Tanami Y, Sato Y, Deie K, Kawashima H, Oguma E. Imaging Diagnosis for Intradiaphragmatic Pulmonary Sequestration: A Pilot Study. J Ultrasound Med 2024. [PMID: 38708926 DOI: 10.1002/jum.16475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/18/2024] [Accepted: 04/21/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVES Extrapulmonary sequestration (EPS) within the diaphragm (ID-EPS) is rare and requires additional procedures such as incision or detachment of the diaphragm from the lesion for diagnosis. This study aimed to describe the imaging findings and evaluate the diagnostic accuracy of ultrasonography and computed tomography (CT) for ID-EPS. MATERIAL AND METHODS Split diaphragm sign, shape of lesion edge, drainage vein into intra-abdomen on ultrasound and CT, and lesion characteristics on ultrasound were compared between patients with ID-EPS and with above-diaphragm EPS (AD-EPS) using Fisher's exact test. RESULTS Three and nine patients were diagnosed with ID-EPS and AD-EPS, respectively. Significant differences were observed between the two groups in the split diaphragm sign on ultrasound (presence/absence in patients with ID-EPS vs AD-EPS, 2/1 vs 0/9, P = .046), shape of lesion edge on ultrasound/CT (round/beak in patients with ID-EPS vs AD-EPS, 3/0 vs 0/9, P = .005 on both CT and ultrasound), lesion characteristics on ultrasound (presence/absence of cystic area within lesion in patients with ID-EPS vs AD-EPS, 0/3 vs 7/2, P = .046), and the drainage vein into the abdomen on CT (presence/absence in patients with ID-EPS vs AD-EPS; 2/1 vs 0/9, P = .046). No drainage veins were visualized in the abdomen on ultrasonography and no significant differences in the presence/absence of the split-diagram sign on CT (presence/absence in patients with ID-EPS vs AD-EPS and ID-EPS; 0/3 vs 0/9, P > .999; 1/2 vs 0/9, P = .250) were observed between the two groups. CONCLUSION A combination of postnatal ultrasonography and CT was useful in predicting EPS located within the diaphragm.
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Affiliation(s)
- Takahiro Hosokawa
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yutaka Tanami
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yumiko Sato
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Kyoichi Deie
- Department of Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroshi Kawashima
- Department of Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Eiji Oguma
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
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2
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Pham LH, Hamdaoui Y, Zeron G, El-Bershawi A, Alazzeh A. Separating Out Pulmonary Sequestration. Cureus 2024; 16:e53190. [PMID: 38425603 PMCID: PMC10901696 DOI: 10.7759/cureus.53190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2024] [Indexed: 03/02/2024] Open
Abstract
Pulmonary sequestration (PS) is a rare congenital anomaly that accounts for 1% to 6% of all pulmonary malformations at birth. It is characterized by a focal area of pulmonary tissue that does not have direct communication with the tracheobronchial tree and does not get blood supply from the pulmonary circulation. We present the case of a 28-year-old female with a history of recurrent pulmonary infections who was found to have intralobar sequestration and underwent curative surgical excision. Because pulmonary sequestration is commonly misdiagnosed, as it can mimic other conditions on chest X-rays, this case illustrates the importance of recognizing pulmonary sequestration as a separate entity and diagnosing/treating it appropriately. The patient presented to the hospital with a one-week history of upper chest pain. Chest radiograph showed mild hyperinflated right lung. Computed tomography angiogram (CTA) revealed an 8.9 x 8.3 cm area of hyper-lucency and decreased normal lung architecture in the right lower lobe with an aberrant arterial blood supply suggestive of intralobar pulmonary sequestration. The patient was referred to cardiothoracic surgery and underwent preoperative outpatient pulmonary function testing, which was unremarkable. The patient subsequently underwent successful robotic resection of the right lower lobe sequestration and the pathology report confirmed PS. A diagnosis of pulmonary sequestration is commonly missed, as it can mimic other conditions on chest X-rays. It can present as a solitary nodule or mass, cystic lesion, consolidation, or an air-fluid level. The period between symptom onset and diagnosis is typically more than five years. While digital subtraction angiography is considered the gold standard for imaging, CTA is now preferred because it allows for clear visualization of lung parenchyma and vascular assisting in surgical planning. For our patient, CTA demonstrated a prominent tubular vessel, which showed less enhancement than the opacified pulmonary artery and pulmonary veins, suggestive of an abnormal vascular supply for the right lower lobe sequestration. Management of intralobar sequestration is curative surgical excision. Both video-assisted thoracoscopic surgery (VATS) and posterolateral thoracotomy are viable options for resection. It should be noted that in symptomatic patients, it is recommended to proceed with surgical resection. However, in asymptomatic individuals with intralobar sequestration (ILS), surgical resection is not required but could be considered as prophylaxis to prevent recurrent infections. Asymptomatic individuals with extralobar sequestration (ELS), on the other hand, should undergo serial monitoring as non-operative management is appropriate. This case highlights the importance of including pulmonary sequestration, especially intralobar sequestration in the differential diagnosis of recurrent localized pulmonary infections, especially in a patient who is otherwise healthy. Although rare, it is important to consider this congenital anomaly when evaluating patients with recurrent localized pulmonary infections, chest pain, or hemoptysis.
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Affiliation(s)
- Linda H Pham
- Internal Medicine, HCA Riverside, Riverside, USA
| | - Yassine Hamdaoui
- Internal Medicine, University Sidi Mohamed Ben Abdallah Faculty of Medicine and Pharmacy of Fes, Fes, MAR
| | | | | | - Ahmad Alazzeh
- Pulmonary Critical Care, HCA Riverside, Riverside, USA
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3
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Tekinhatun M, Alver KH. Bilateral pulmonary sequestrations: Distinct types sharing a common celiac artery origin, presented with pneumonia and associated findings in a pediatric case. Pediatr Pulmonol 2024; 59:218-220. [PMID: 37877734 DOI: 10.1002/ppul.26735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/01/2023] [Accepted: 10/14/2023] [Indexed: 10/26/2023]
Abstract
A 14-year-old boy presented with shortness of breath, cough, and mild chest pain, with a history of intermittent milder symptoms. Physical examination and initial tests showed mild iron deficiency anemia, elevated C-reactive protein, and normal vital signs. Chest radiograph revealed abnormalities in the left lower zone, leading to contrast-enhanced chest CT. The CT scan revealed bilateral intrapulmonary sequestrations, both deriving blood supply from a common trunk originating from the celiac artery. The patient's symptoms initially attributed to a pulmonary infection improved with antibiotic therapy. Pulmonary sequestration is a congenital anomaly characterized by aberrant lung tissue lacking connections to bronchial tree or pulmonary arteries. It can lead to recurrent pulmonary infections and postinfectious sequelae. This case presented a unique bilateral sequestration, both originating from the celiac artery. Radiologists should be aware of sequestration types and associated anomalies, even in atypical locations. Blood supply can originate from various arteries, not just the aorta.
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Affiliation(s)
| | - Kadir Han Alver
- Radiology Department, Denizli State Hospital, Denizli, Turkey
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4
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He H, Wu Z, Hu Q, Peng M. Robotic-assisted thoracoscopic lobectomy for synchronous pulmonary sequestration and adenocarcinoma: A case report. Int J Med Robot 2023; 19:e2543. [PMID: 37381705 DOI: 10.1002/rcs.2543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/02/2023] [Accepted: 06/17/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Pulmonary sequestration (PS) is a congenital pulmonary malformation. Adenocarcinoma arising in PS is extremely rare. METHODS AND RESULTS We present the first reported case of synchronous intralobar PS and lung adenocarcinoma in the right lower lobe, which was successfully treated using robotic-assisted thoracic surgery (RATS). The robotic system allowed for easy identification, clipping, and dissection of the abnormal artery, highlighting its benefits over traditional surgical approaches. CONCLUSIONS This case underscores the importance of considering the possibility of coexisting lung cancer in patients with a clinical diagnosis of PS and demonstrates the safety and efficacy of RATS in managing this rare condition.
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Affiliation(s)
- Hao He
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zeyu Wu
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Qikang Hu
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Muyun Peng
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
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5
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Wu C, Fu J, Zhu X, Li H, Wu Y. Heart failure due to pulmonary sequestration in an infant. Pediatr Pulmonol 2023; 58:2947-2949. [PMID: 37431951 DOI: 10.1002/ppul.26596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/16/2023] [Accepted: 06/30/2023] [Indexed: 07/12/2023]
Affiliation(s)
- Chun Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jian Fu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xu Zhu
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
- Department of Ultrasonography, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Hongbo Li
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yuhao Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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6
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Bhavsar VD, Jaber JF, Rackauskas M, Ataya A. Intralobar pulmonary sequestration presenting as recurrent left lower lobe pneumonia. Proc AMIA Symp 2023; 36:767-769. [PMID: 37829237 PMCID: PMC10566425 DOI: 10.1080/08998280.2023.2258318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/06/2023] [Indexed: 10/14/2023] Open
Abstract
This case discusses the diagnosis and management of pulmonary sequestration. Typically discovered incidentally on imaging, it can be a cause of recurrent pulmonary infections causing severe morbidity to the patient. Surgical management is indicated when found to prevent the complications of recurrent infections, including pulmonary necrosis, abscess, or fistula formation.
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Affiliation(s)
| | - Johnny F. Jaber
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida Health, Gainesville, Florida, USA
| | - Mindaugas Rackauskas
- Division of Thoracic and Cardiovascular Surgery, University of Florida Health, Gainesville, Florida, USA
| | - Ali Ataya
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida Health, Gainesville, Florida, USA
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7
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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. Clin Respir J 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Marinucci BT, Menna C, Scanagatta P, Fiorelli S, Tiracorrendo M, Naldi G, Inserra A, Macchini F, Rendina EA, Ibrahim M. Do More with Less? Lobectomy vs. Segmentectomy for Patients with Congenital Pulmonary Malformations. J Clin Med 2023; 12:5237. [PMID: 37629279 PMCID: PMC10455964 DOI: 10.3390/jcm12165237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/29/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Congenital Pulmonary Malformations (CPMs) are rare benign lesions potentially causing infective complications and/or malignant transformation, requiring surgery even when asymptomatic. CPMs are rare in adulthood but potentially detected at any age. There is not a consensus on the correct extent of resection in both adults and paediatrics. This retrospective multicentric study aims to identify the appropriate surgical resection to prevent the recurrence of the related respiratory symptoms. METHODS Between 2010 and 2020, a total of 96 patients (adults and pediatrics) underwent surgery for CPMs in 4 centers. A 2:1 propensity score matching (considering sex and lesion side) was performed, identifying 2 groups: 50 patients underwent lobectomy (group A) and 25 sub-lobar resections (group B). Clinical and histopathological characteristics, early and late complications, and symptom recurrence were retrospectively analyzed and compared between the two groups by univariate and multivariate analysis. RESULTS Patients who underwent lobectomy had a statistically significant lower rate of recurrence (4% vs. 24% of group B, p = 0.014) and a lower rate of intraoperative complications (p = 0.014). Logistic regression identified sub-lobar resection (p = 0.040), intra- and post-operative complications (p = 0.105 and 0.022),and associated developed neoplasm (p = 0.062) as possible risk factors for symptom recurrence after surgery. CONCLUSIONS Pulmonary lobectomy seems to be the most effective surgical treatment for CPMs, guaranteeing the stable remission of symptoms and a lower rate of intra- and postoperative complications. To our knowledge, this is one of the largest studies comparing lobectomy and sub-lobar resections in patients affected by CPMs, considering the low incidence worldwide.
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Affiliation(s)
- Beatrice Trabalza Marinucci
- Thoracic Surgery Sant’Andrea Hospital, La Sapienza University, 00186 Rome, Italy; (C.M.); (M.T.); (E.A.R.); (M.I.)
| | - Cecilia Menna
- Thoracic Surgery Sant’Andrea Hospital, La Sapienza University, 00186 Rome, Italy; (C.M.); (M.T.); (E.A.R.); (M.I.)
| | - Paolo Scanagatta
- Thoracic Surgery—Morelli Hospital, ASST Valtellina e Alto Lario, 23100 Sondalo, Italy; (P.S.); (G.N.)
| | - Silvia Fiorelli
- Anesthesiology and Intensive Care, Sant’Andrea Hospital, La Sapienza University, 00186 Rome, Italy;
| | - Matteo Tiracorrendo
- Thoracic Surgery Sant’Andrea Hospital, La Sapienza University, 00186 Rome, Italy; (C.M.); (M.T.); (E.A.R.); (M.I.)
| | - Giuseppe Naldi
- Thoracic Surgery—Morelli Hospital, ASST Valtellina e Alto Lario, 23100 Sondalo, Italy; (P.S.); (G.N.)
| | - Alessandro Inserra
- General and Thoracic Surgery—Bambino Gesù Children’s Research Hospital IRCCS, 00165 Rome, Italy;
| | - Francesco Macchini
- Paediatric Surgery—Niguarda Hospital, ASST Grande Ospedale Niguarda, 20162 Milan, Italy;
| | - Erino Angelo Rendina
- Thoracic Surgery Sant’Andrea Hospital, La Sapienza University, 00186 Rome, Italy; (C.M.); (M.T.); (E.A.R.); (M.I.)
| | - Mohsen Ibrahim
- Thoracic Surgery Sant’Andrea Hospital, La Sapienza University, 00186 Rome, Italy; (C.M.); (M.T.); (E.A.R.); (M.I.)
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9
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Wang XX, Zhang HS, Sui YX, Liu J. Intralobular pulmonary sequestration of the right upper lobe supplied by ascending aorta. Interdiscip Cardiovasc Thorac Surg 2023; 37:ivad124. [PMID: 37522880 PMCID: PMC10409889 DOI: 10.1093/icvts/ivad124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/17/2023] [Accepted: 08/05/2023] [Indexed: 08/01/2023]
Abstract
Pulmonary sequestration (PS) is a rare congenital lung malformation that is more common in the left lower lobe. In 95% of cases, the artery supplying the sequestration usually originates from the thoracic and abdominal aorta. We report a rare intralobular PS case for a feeding artery from the ascending aorta. Angio-computed tomography should be performed for diagnosis once PS is suspected.
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Affiliation(s)
- Xiao-Xia Wang
- Department of Clinical Oncology, Weihai Central Hospital, The Affiliated Hospital of Qingdao University, Shandong, China
| | - Hong-Sheng Zhang
- Department of Radiology, Weihai Central Hospital, The Affiliated Hospital of Qingdao University, Shandong, China
| | - Yun-Xia Sui
- Department of Clinical Oncology, Weihai Central Hospital, The Affiliated Hospital of Qingdao University, Shandong, China
| | - Jie Liu
- Department of Radiology, Weihai Central Hospital, The Affiliated Hospital of Qingdao University, Shandong, China
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10
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Gładki M, Bednarek PR, Owecki W. Case report: A unique quadruple coexisting anomaly-scimitar syndrome, atrial septal defect, vascular ring, and pulmonary sequestration. Front Pediatr 2023; 11:1214900. [PMID: 37534199 PMCID: PMC10392937 DOI: 10.3389/fped.2023.1214900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 07/05/2023] [Indexed: 08/04/2023] Open
Abstract
The article describes a successful clinical outcome in the case of a 5-month old female with a diagnosis of incomplete vascular ring of aberrant right subclavian artery and ostium secundum atrial septal defect associated with partial anomalous pulmonary venous return of scimitar syndrome type, coexisting with right pulmonary sequestration. During hospitalization, surgical correction of the heart defect and resection of the lung sequestration were performed. To the best of our knowledge, described constellation of defects is a unique phenomenon, posing a challenge for complex treatment and disease management.
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Affiliation(s)
- Marcin Gładki
- Department of Pediatric Cardiac Surgery, Poznan University of Medical Sciences, Poznań, Poland
| | - Paweł R. Bednarek
- Scientific Group of Pediatric Cardiac Surgery, Poznan University of Medical Sciences, Poznań, Poland
| | - Wojciech Owecki
- Scientific Group of Pediatric Cardiac Surgery, Poznan University of Medical Sciences, Poznań, Poland
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11
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Abu Zahira I, Haddad RN, Meot M, Bonnet D, Malekzadeh-Milani S. Transcatheter Management of Pulmonary Sequestrations in Children-A Single-Center Experience. Children (Basel) 2023; 10:1197. [PMID: 37508694 PMCID: PMC10378210 DOI: 10.3390/children10071197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/26/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND A pulmonary sequestration (PS) is an area of bronchopulmonary tissue with aberrant arterial supply. Transcatheter occlusion of PSs is an appealing treatment option, but data on outcomes remain scarce. We aim to describe our experience with transcatheter management of PS in infants and children. METHODS Retrospective review of clinical data of all patients with suspected PS sent for diagnostic and/or interventional cardiac catheterization at our institution between January 1999 and May 2021. Procedural considerations, techniques, standard safety, and outcomes were assessed. RESULTS We identified 71 patients (52.1% males), with median age and weight of 4.9 months (IQR, 2.1-26.6) and 4.2 kg (IQR, 3.9-12.1), respectively. Sixty-one (86%) patients had associated congenital heart defects (CHDs). Forty-two (59%) patients had pulmonary arterial hypertension (PAH) at the time of diagnosis. Fifty-three (74.7%) patients underwent embolization of the PS feeding vessel using microcoils and/or vascular plugs, and eight (15.1%) of these were neonates who presented with severe PAH and cardiac failure. Two patients had large feeding vessels and were treated surgically. Sixteen (22.5%) patients with small feeding vessels received conservative management. At median follow-up of 36.4 months (IQR, 2.1-89.9), seven patients had died, 24 patients had CHD corrective surgeries, 26 patients had redo catheterizations, and five patients had persistent PAH. No PS surgical resection was needed, and no infection of the remaining lung tissue occurred. CONCLUSIONS Transcatheter assessment and treatment of PSs is a safe and effective procedure. Neonates with large PSs are severely symptomatic and improve remarkably after PS closure. PS embolization and surgical repair of associated CHDs generally leads to the normalization of pulmonary pressures.
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Affiliation(s)
- Ibrahim Abu Zahira
- M3C-Necker, Hôpital Universitaire Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), 75015 Paris, France
| | - Raymond N Haddad
- M3C-Necker, Hôpital Universitaire Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), 75015 Paris, France
| | - Mathilde Meot
- M3C-Necker, Hôpital Universitaire Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), 75015 Paris, France
| | - Damien Bonnet
- M3C-Necker, Hôpital Universitaire Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), 75015 Paris, France
- Faculté de Médecine, Université de Paris Cité, 15 Rue de l'École de Médecine, 75006 Paris, France
| | - Sophie Malekzadeh-Milani
- M3C-Necker, Hôpital Universitaire Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), 75015 Paris, France
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Shantagiri A, Prabhakar N, Bhatia A, Roy S, Sodhi KS, Mathew JL, Saxena AK. Congenital lung malformations-Spot one, hunt for others. Pediatr Pulmonol 2023; 58:1283-1285. [PMID: 36635982 DOI: 10.1002/ppul.26316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/25/2022] [Accepted: 01/12/2023] [Indexed: 01/14/2023]
Affiliation(s)
- Arpit Shantagiri
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Nidhi Prabhakar
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Anmol Bhatia
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Satarupa Roy
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Kushaljit Singh Sodhi
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Joseph L Mathew
- Department of Pediatrics, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Akshay Kumar Saxena
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education & Research, Chandigarh, India
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13
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Ren G, Wang B, Liu D. Adult congenital horseshoe lung with bilateral pulmonary sequestration: A case report. Acta Radiol Open 2023; 12:20584601231152640. [PMID: 36699098 PMCID: PMC9869191 DOI: 10.1177/20584601231152640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/06/2023] [Indexed: 01/21/2023] Open
Abstract
Horseshoe lung (HL) is an infrequent congenital lung anomaly. Its main feature is that the lower lungs on both sides extend behind the pericardium and fuse across the midline, usually accompanied by pulmonary dysplasia. It is reported that 80% of HL is relevant to the abnormal return of some pulmonary veins from the right lung to the inferior vena cava or right atrium (scimitar syndrome). Most patients are within 5 years old, most commonly within 1 year old, but HL may also have no apparent clinical symptoms or mild symptoms. This case is a 36-years-old adult female who developed left chest pain more than a month ago and continued to worsen for 10 days. The patient also had repeated pulmonary infection with cough and expectoration.
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Affiliation(s)
- Guoli Ren
- Department of CT, Liaocheng People’s Hospital, Liaocheng, PR China,Guoli Ren, Department of CT, Liaocheng People’s Hospital, No. 48, Dongchang West Road, Dongchangfu District, Liaocheng 252000, PR China.
| | - Bo Wang
- Department of MRI, Liaocheng Hospital of Traditional Chinese Medicine, Liaocheng, PR China
| | - Daliang Liu
- Department of CT, Liaocheng People’s Hospital, Liaocheng, PR China
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14
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Wu Y, Xi L, Pan Z, Wu C, Li H. Torsed extralobar pulmonary sequestration associated with congenital lobar emphysema: a rare entity. Ther Adv Respir Dis 2023; 17:17534666231164535. [PMID: 36988433 PMCID: PMC10064460 DOI: 10.1177/17534666231164535] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
Pulmonary sequestration (PS) is a rare congenital malformation, which mainly contains two variants involving extralobar and intralobar sequestrations. Extralobar sequestrations (ELS) are isolated from the remaining lung tissue and have their visceral pleura. Herein, we report the first case of a torsed ELS associated with congenital lobar emphysema. We described a boy who mainly presented with abdominal and chest pain. A contrast-enhanced computed tomography (CT) scan revealed a mildly enhanced posterior mediastinal mass with left lower lobar emphysema. Thoracoscopic surgery identified a dark and hemorrhagic mass that was connected to the thoracic aorta by a twisted feeding vessel and had its visceral pleura. Pathological findings were consistent with an ELS that had undergone torsion and infarction. The postoperative recovery was uneventful. For the left lower lobar emphysema, he was required for a regular outpatient follow-up. In conclusion, although extremely rare, physicians should maintain a high index of suspicion for torsed ELS when a posterior mediastinal mass with abdominal or chest pain is presented in children.
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Affiliation(s)
- Yuhao Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders
| | - Linyun Xi
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders
| | - Zhengxia Pan
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders
| | - Chun Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders
| | - Hongbo Li
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders
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15
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Gursu HA, Ozelce B, Cetin Iİ. Successful occlusion of a feeding artery with Amplatzer Piccolo Occluder in a patient diagnosed with Scimitar syndrome. Cardiol Young 2022; 33:1-2. [PMID: 35475444 DOI: 10.1017/s1047951122001172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Scimitar syndrome is a congenital anomaly in which some or all of right pulmonary veins drain into inferior caval vein. It is associated with anomalous systemic arteries arising from descending aorta supplying to right lung. Transcatheter embolisation of this artery prevents complications. We present a 2.5-year-old girl in which anomalous artery was embolised using Amplatzer PiccoloTM Occluder, for first time.
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Affiliation(s)
- Hazım Alper Gursu
- University of Health Sciences, Ankara City Hospital, Pediatric Cardiology Department, Ankara, Turkey
| | - Bilal Ozelce
- Ankara City Hospital, Pediatric Cardiology Department, Ankara, Turkey
| | - Ibrahim İlker Cetin
- Yıldırım Beyazıt University, Ankara City Hospital, Pediatric Cardiology Department, Ankara, Turkey
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16
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Abstract
The condition of partial anomalous origin of a branch pulmonary artery from the descending aorta could be found in several diseases and should be carefully differentiated. We report an unusual case of anomalous systemic arterial supply to normal basal segments of the left lower lung and another case of intralobar pulmonary sequestration. These two cases were treated successfully by transarterial embolisation using the Amplatzer Vascular Plug. We also set up a diagnostic algorithm to differentiate these diseases from anomalous systemic arterial supply to the pulmonary region. It is possible to make the correct diagnosis using the step-by-step diagnostic algorithm and careful interpretation of chest computed tomography angiography.
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17
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Chen T, Yu J, Zhang N, Chen C, Fu L, Zeng Q. Intralobar Pulmonary Sequestration Presenting as Hemothorax Secondary to Spontaneous Pneumothorax: Case Report and Literature Review. Front Pediatr 2022; 10:937563. [PMID: 35844764 PMCID: PMC9279614 DOI: 10.3389/fped.2022.937563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Patients with pulmonary sequestration (PS), a rare congenital lung malformation, are mostly asymptomatic. Recurrent localized infection is a major complication, while sudden hemothorax is extremely rare. We present a case of intralobar PS presenting as hemothorax secondary to spontaneous pneumothorax and comprehensively review the relevant literature. CASE REPORT A 16-year-old male presented with chest pain after strenuous exercise. Chest X-ray showed a moderate pneumothorax. After admission and conservative treatment, he developed dizziness, amaurosis, and urinary incontinence. Bedside chest X-ray suggested a massive pleural effusion, and hemothorax was further identified via catheter drainage. Contrast-enhanced computed tomography was performed, and no abnormal blood vessels or leakage of contrast agent were observed. As the hemoglobin level continued to drop, exploratory thoracoscopic surgery was performed immediately. The abnormal systemic artery supplying the lung tissue was found to be ruptured; therefore, ligation of the abnormal artery with resection of the diseased lung tissue was performed. Pathological examination revealed non-specific manifestations of PS. He was followed up for 1 year without related complications. CONCLUSION Our case suggests that the abnormal supply vessels of PS are unstable, which may cause sudden hemothorax. Therefore, patients with PS should undergo surgery promptly after diagnosis. In patients with hemothorax, we should consider the diagnosis of PS; however, contrast-enhanced computed tomography or angiography cannot confirm the diagnosis in all cases. Surgical intervention is recommended in emergency settings.
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Affiliation(s)
- Tian Chen
- Department of Thoracic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jie Yu
- Department of Thoracic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Na Zhang
- Department of Thoracic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Chenghao Chen
- Department of Thoracic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Libing Fu
- Department of Pathology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Qi Zeng
- Department of Thoracic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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18
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Lv L, Zhai Y, Zhao H, Guo R, Xu H, Zhang S. Case Report: An extremely rare case of double extralobar pulmonary sequestration with anomalous supplying arteries originating from the abdominal aorta in the left thoracic cavity. Front Pediatr 2022; 10:926942. [PMID: 35935357 PMCID: PMC9354599 DOI: 10.3389/fped.2022.926942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
To the best of our knowledge, double or multiple extralobar pulmonary sequestrations (PSs) with anomalous arterial supply in the ipsilateral thoracic cavity have rarely been reported before. PS can be divided into two types: intralobar sequestration (ILS) and extralobar sequestration (ELS). We encountered a 5-month-old infant with double ELS in the left thoracic cavity that was incidentally detected during thoracoscopic surgery. Surgical exploration revealed two separate, well-circumscribed abnormal masses in the left thoracic cavity, and the patient was successfully treated using thoracoscopic surgery. Postoperative pathology confirmed that both masses were PS tissues. Accurate preoperative diagnosis using CT alone may be inadequate in this type of case. Therefore, thoracoscopy may be more suitable for diagnosing and treating unusual ELS.
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Affiliation(s)
- Longfei Lv
- Department of Thoracic and Oncological Surgery, Children's Hospital Affiliated to Shandong University, Jinan, China.,Department of Thoracic and Oncological Surgery, Jinan Children's Hospital, Jinan, China
| | - Yunpeng Zhai
- Department of Thoracic and Oncological Surgery, Children's Hospital Affiliated to Shandong University, Jinan, China.,Department of Thoracic and Oncological Surgery, Jinan Children's Hospital, Jinan, China
| | - Huashan Zhao
- Department of Thoracic and Oncological Surgery, Children's Hospital Affiliated to Shandong University, Jinan, China.,Department of Thoracic and Oncological Surgery, Jinan Children's Hospital, Jinan, China
| | - Rui Guo
- Department of Thoracic and Oncological Surgery, Children's Hospital Affiliated to Shandong University, Jinan, China.,Department of Thoracic and Oncological Surgery, Jinan Children's Hospital, Jinan, China
| | - Hongxiu Xu
- Department of Thoracic and Oncological Surgery, Children's Hospital Affiliated to Shandong University, Jinan, China.,Department of Thoracic and Oncological Surgery, Jinan Children's Hospital, Jinan, China
| | - Shisong Zhang
- Department of Thoracic and Oncological Surgery, Children's Hospital Affiliated to Shandong University, Jinan, China.,Department of Thoracic and Oncological Surgery, Jinan Children's Hospital, Jinan, China
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19
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Abstract
Surgical excision of pulmonary sequestration is a definite treatment, but dissection of the arterial supply from systemic circulation and determination of the boundary are always challenging. We reported a case utilising pre-operative three-dimensional reconstruction and indocyanine green injection to make the procedure minimally invasive, precise and safe.
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Affiliation(s)
- Kuan-Hsun Lian
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Mong-Wei Lin
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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20
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Ojha S, Srivastava P, Poonia A, Bansal R. Thoracoscopic excision of double- pulmonary sequestration in left haemithorax, without anomalous blood supply (supply from pulmonary artery) in a neonate: First case. J Minim Access Surg 2021; 17:556-558. [PMID: 34558432 PMCID: PMC8486054 DOI: 10.4103/jmas.jmas_218_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/30/2020] [Accepted: 11/24/2020] [Indexed: 12/04/2022] Open
Abstract
Pulmonary sequestration (PS) is a rare anomaly. PS is a mass of abnormal pulmonary tissue that does not communicate with the tracheobronchial tree and is supplied by an anomalous systemic artery. Although aberrant systemic arterial supply is considered the key element to diagnose PS, rarely it can have arterial supply from the pulmonary artery as a spectrum of sequestration. Here, we present an unusual case of double (upper and lower) extralobar sequestration, present unilaterally (left haemithorax) in a neonate, without anomalous blood supply (supply from the left pulmonary artery and drainage into the superior and inferior pulmonary veins), not reported in literature earlier, to the best of our knowledge. In the present case, a child presented with respiratory discomfort at birth, requiring surgery due to inability to wean off respiratory support. It is important to be aware of this variant of sequestration spectrum. In a 18 days old child, both pulmonary sequestrations were resected thoracoscopically, making it a rare case, not described earlier in literature.
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Affiliation(s)
- Sunita Ojha
- Department of Neonatal and Pediatric Surgery, Santokba Durlabhji Memorial Hospital and Research Institute, Jaipur, Rajasthan, India
| | - Prabhar Srivastava
- Department of Pediatric, Santokba Durlabhji Memorial Hospital and Research Institute, Jaipur, Rajasthan, India
| | - Anil Poonia
- Department of Pediatric, Santokba Durlabhji Memorial Hospital and Research Institute, Jaipur, Rajasthan, India
| | - Rajiv Bansal
- Department of Neonatal and Pediatric Surgery, Santokba Durlabhji Memorial Hospital and Research Institute, Jaipur, Rajasthan, India
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21
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Chowdhury UK, Anderson RH, Sankhyan LK, George N, Pandey NN, Chauhan AS, Arora Y, Goja S. Surgical management of the scimitar syndrome. J Card Surg 2021; 36:3770-3795. [PMID: 34396590 DOI: 10.1111/jocs.15857] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 07/18/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM We sought to address the varied anatomical details, the diagnostic challenges, associated cardiopulmonary anomalies, the techniques, and outcomes of management, including re-interventions of scimitar syndrome. METHODS A total of 92 published investigations of scimitar syndrome were reviewed. Diagnostic information was provided by clinical presentations, radiographic findings, transthoracic and transesophageal echocardiography, computed-tomographic angiography, magnetic resonance imaging, angiocardiography, and ventilation/perfusion scans. These investigations served to elucidate the origin, course, and termination of the scimitar vein, the intracardiac anatomy, the presence of associated defects, and the patterns of any accompanying pulmonary lesions prior to surgical intervention. RESULTS Of the patients described, up to four-fifths presented during infancy, with cardiac failure, increased pulmonary flow, and pulmonary hypertension. Associated cardiac and extracardiac defects, particularly hypoplasia of the right lung, are present in up to three-quarters of cases. Overall operative mortality has been cited between 4.8% and 5.9%. Mortality was highest in patients with preoperative pulmonary hypertension, and those undergoing surgery in infancy. Despite timely surgical intervention, post-repair obstruction of the scimitar vein, intra-atrial baffle obstruction, or stenosis of the inferior caval vein were reported in up to two-thirds of cases. The venous obstruction could not be related to any particular surgical technique. On long term follow-up, one sixth of patients reported persistent dyspnoea and recurrent respiratory infections. CONCLUSIONS Any infants presenting with heart failure, right-sided heart, and hypoplastic right lung should be evaluated to exclude the syndrome. An increased appreciation of variables will contribute to improved surgical management.
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Affiliation(s)
- Ujjwal K Chowdhury
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Robert H Anderson
- Institute of Biomedical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - Lakshmi K Sankhyan
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, India
| | - Niwin George
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Niraj N Pandey
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Abhinav S Chauhan
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Yatin Arora
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Shikha Goja
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
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22
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Pechetov AA, Makov MA, Volchansky DA, Ragimov SV. [VATS resection of basal pyramid segments in sequestration of the left lower lobe]. Khirurgiia (Mosk) 2021:90-93. [PMID: 34270200 DOI: 10.17116/hirurgia202107190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Lung sequestration is a congenital malformation represented by a non-functioning pulmonary parenchyma supplied via an aberrant artery of systemic circulation. This malformation makes up 1-6% of all congenital lung abnormalities. In 1946, Pryce M.D. proposed the term «lung sequestration» for the disease first described by the Austrian pathologist C. Rokitansky in 1856. Lung sequestration becomes quire common due to development and availability of X-ray diagnostic methods. An aberrant artery can arise from the great vessels (thoracic and abdominal aorta) and smaller arteries (coronary, intercostal arteries). To date, there are 2 forms of lung sequestration (intralobar and extralobar). We report one of the options for surgical treatment of lung sequestration.
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Affiliation(s)
- A A Pechetov
- Vishnevsky Research Center of Surgery, Moscow, Russia
| | - M A Makov
- Vishnevsky Research Center of Surgery, Moscow, Russia
| | | | - Sh V Ragimov
- Vishnevsky Research Center of Surgery, Moscow, Russia
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23
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Shimbo G, Takiguchi M. CT morphology of anomalous systemic arterial supply to normal lung in dogs. Vet Radiol Ultrasound 2021; 62:657-665. [PMID: 34250680 DOI: 10.1111/vru.13008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 05/16/2021] [Accepted: 05/20/2021] [Indexed: 11/28/2022] Open
Abstract
Anomalous systemic arterial supply to the normal lung (ASANL) is a rare congenital anomaly in humans, in which the systemic arteries supply the basal segments of the lower lobe. It has a normal bronchial connection, but lacks a normal pulmonary artery. This anomaly has not been previously reported in the veterinary literature. The objectives of this retrospective descriptive study were to characterize the CT findings and clinical features of ASANL , and to determine the breed predisposition in a population of referral canine cases. Thoracic CT images, in which the caudal lung lobes were fully inflated and the pulmonary artery could be traced to the periphery, were reviewed. A total of 1,950 dogs were enrolled, and the aberrant vasculature equivalent to ASANL in humans was detected in 48 dogs. Shetland Sheepdogs (7/48, odds ratio [OR] = 8.0, P < 0.00001), Miniature Dachshunds (19/48, OR = 3.9, P < 0.00001), and Labrador Retrievers (6/48, OR = 4.5, P = 0.0009) were over-represented. The affected lung lobes were the right caudal lobe (24/48, 50%), the left caudal lobe (21/48, 43.8%), and bilateral caudal lobes (3/48, 6.3%). The aberrant vessels originated from the left gastric artery (14/48), descending thoracic aorta (8/48), celiac artery (6/48), and splenic artery (1/48). In the remaining 19 cases, the origin of the aberrant vessels could not be determined. Although the clinical significance of ASANL in dogs remains unclear, surgeons should be aware of this finding prior to lobectomy of the caudal lung lobes to avoid intraoperative systemic arterial bleeding.
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Affiliation(s)
- Genya Shimbo
- Veterinary Teaching Hospital, Graduate school of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Mitsuyoshi Takiguchi
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate school of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
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24
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Prasad D, Pennell C, Arthur LG, Prasad R. Preoperative Embolization Facilitates Segmental Resection of Pulmonary Sequestration in an Infant. European J Pediatr Surg Rep 2021; 9:e1-e4. [PMID: 33532170 PMCID: PMC7840227 DOI: 10.1055/s-0040-1721043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 08/18/2020] [Indexed: 11/25/2022] Open
Abstract
The most common congenital lung malformations are congenital pulmonary airway malformations and pulmonary sequestrations. Many surgeons advocate resection to prevent complications of infection, malignancy, and pneumothorax. The standard of care is lobectomy, but segmentectomy and embolization alone have been reported. These methods avoid the complications of lobectomy but are not widely practiced due to concerns about incomplete resection or involution of the lesion. We present a novel approach to the treatment of a pulmonary sequestration in a 7-month-old male using preoperative embolization followed by a sublobar pulmonary resection. The embolization clearly demarcated the affected lung intraoperatively, thereby facilitating complete removal of the lesion with a segmental lung resection rather than complete lobectomy.
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Affiliation(s)
- Dilan Prasad
- Department of Pediatric General, Thoracic, and Minimally Invasive Surgery, Saint Christopher's Hospital for Children, Philadelphia, Pennsylvania, United States
| | - Christopher Pennell
- Department of Pediatric General, Thoracic, and Minimally Invasive Surgery, Saint Christopher's Hospital for Children, Philadelphia, Pennsylvania, United States
| | - Lindsay Grier Arthur
- Department of Pediatric General, Thoracic, and Minimally Invasive Surgery, Saint Christopher's Hospital for Children, Philadelphia, Pennsylvania, United States
| | - Rajeev Prasad
- Department of Pediatric General, Thoracic, and Minimally Invasive Surgery, Saint Christopher's Hospital for Children, Philadelphia, Pennsylvania, United States
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25
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Huang JX, Chen Q, Hong SM, Hong JJ, Cao H. Uniportal Video-Assisted Thoracoscopic Resection and Lobectomy for Infants With Pulmonary Sequestration: Case Series and Initial Experience. Front Pediatr 2021; 9:798342. [PMID: 34976901 PMCID: PMC8719340 DOI: 10.3389/fped.2021.798342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The present study aimed to evaluate the safety and feasibility of uniportal video-assisted thoracoscopic surgery (U-VATS) for infants with pulmonary sequestration (PS). Methods: From January 2019 to July 2020, 19 infants with PS were admitted to a provincial hospital in the Fujian Province of China. A 1.5-cm utility port was created in the fifth intercostal space at the anterior axillary line. A rigid 30° 5-mm optic thoracoscope was used for vision, and two or three instruments were utilized through the port. Surgical options include standard lobectomy, wedge resection, and resection of the extralobar sequestration. Only one intercostal space was entered, and a chest tube was inserted through the same skin incision if necessary. Results: The procedure was successful in all patients with an average operation duration of 58.3 ± 31.5 min. The length of post-operative hospital stay was 5.4 ± 1.5 days, and no post-operative deaths or serious complications were observed. The mean post-operative drainage volume was 164.6 ± 45.9 mL, and the mean post-operative thoracic tube indwelling duration was 5.5 ± 1.0 days. No intraoperative conversion, surgical mortality, or major complications were identified among the patients. Conclusion: Our preliminary experience presented a series of U-VATS lobectomy, wedge resection, and resection of the PS for infants with satisfactory perioperative results.
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Affiliation(s)
- Jin-Xi Huang
- Department of Cardiothoracic Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Qiang Chen
- Department of Cardiothoracic Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Song-Ming Hong
- Department of Cardiothoracic Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Jun-Jie Hong
- Department of Cardiothoracic Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Hua Cao
- Department of Cardiothoracic Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
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26
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Abstract
RATIONALE Pulmonary sequestration (PS) presenting with elevated serum tumor markers is rare, and it might be misdiagnosed as malignancy. PATIENT CONCERNS A 26-year-old asymptomatic male patient was admitted because the x-ray showed an intrathoracic lesion. Meanwhile, the serum neuron-specific enolase (NSE) was elevated. Three-dimensional computed tomography angiography revealed an isolated feeding vessel arising from the aorta. DIAGNOSES Extralobular PS was confirmed by computed tomography angiography and postoperative pathological staining. INTERVENTIONS Two-port thoracoscopic resection of the sequestrated lobe was performed. OUTCOMES The serum NSE decreased to within the normal range and persisted during the follow up of 10 months. LESSONS A thorough work-up should be considered for the PS patients presenting with abnormal serum NSE. Detailed knowledge regarding the relationship between NSE and PS necessitates further studies.
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Affiliation(s)
- Feng-Wei Kong
- Department of General Surgery, Xuzhou Infectious Disease Hospital
| | - Wei-Min Wang
- Department of General Surgery, Xuzhou Infectious Disease Hospital
| | - Longbo Gong
- Department of Surgery, Xuzhou Central Hospital, Xuzhou, China
| | - Wenbin Wu
- Department of Surgery, Xuzhou Central Hospital, Xuzhou, China
| | - Miao Zhang
- Department of Surgery, Xuzhou Central Hospital, Xuzhou, China
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27
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Ichino M, Macchini F, Morandi A, Persico N, Fabietti I, Zanini A, Leva E. Combined Pre- and Postnatal Minimally Invasive Approach to Complicated Pulmonary Sequestrations. European J Pediatr Surg Rep 2020; 8:e62-e67. [PMID: 32963928 PMCID: PMC7500973 DOI: 10.1055/s-0040-1713901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 05/16/2020] [Indexed: 11/28/2022] Open
Abstract
Pulmonary sequestration (PS) is mostly asymptomatic but there is a proportion of fetuses that develop hydrops, leading to fetal or neonatal death. Fetal treatments are available, but postnatal management of the residual lesions is not uniformly defined. We present two cases of combined pre- and postnatal minimally invasive approach to complicated extra-lobar PS. Patient 1 presented with complicated PS at 31 weeks of gestation. Ultrasound-guided laser coagulation of the anomalous artery was successful. The patient was born asymptomatic at 38 weeks. Neonatal magnetic resonance imaging (MRI) showed a residual mass, confirmed by computed tomography (CT) at 6 months. No systemic artery was described, but perfusion was present. We decided for thoracoscopic resection. A residual artery was identified and sealed. Patient 2 presented with complicated PS at 25 weeks of gestation, underwent laser coagulation of the anomalous artery and was born asymptomatic at 38 weeks. Neonatal MRI showed persistence of the lesion, confirmed by CT scan at 4 months. We proceeded with thoracoscopic resection. A residual vessel was ligated. The patients 1 and 2 are now 24 and 21 months old, respectively, and healthy. Prenatal treatment of complicated PS is a life-saving procedure. Postnatal thoracoscopic resection of the residual lesion is feasible and safe; we believe it is the best course of treatment to grant the complete excision of the malformation.
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Affiliation(s)
- Martina Ichino
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano, Lombardia, Italy
| | - Francesco Macchini
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano, Lombardia, Italy
| | - Anna Morandi
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano, Lombardia, Italy
| | - Nicola Persico
- Department of Obstetrics and Gynecology "L. Mangiagalli", Fetal Medicine and Surgery Service, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano, Lombardia, Italy.,Department of Clinical Science and Community Health, Università degli Studi di Milano, Milano, Lombardia, Italy
| | - Isabella Fabietti
- Department of Obstetrics and Gynecology "L. Mangiagalli", Fetal Medicine and Surgery Service, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano, Lombardia, Italy
| | - Andrea Zanini
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano, Lombardia, Italy
| | - Ernesto Leva
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano, Lombardia, Italy
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Abstract
RATIONALE Pulmonary sequestration is a congenital abnormality of the lower airway. It is characterized by a nonfunctioning mass of lung tissue that lacks normal communication with the tracheobronchial tree or pulmonary arteries and always receives its arterial blood supply from the systemic circulation. Most cases of extralobar pulmonary sequestrations (ELSs) are asymptomatic and found incidentally or in prenatal ultrasound screening. PATIENT CONCERNS A 10-year-old boy had severe chest pain and vomiting for 2 days. DIAGNOSES ELS was diagnosed, and torsion of the ELS had developed as a complication. INTERVENTIONS In video-assisted thoracoscopic surgery, the ELS was resected. OUTCOMES The clinical symptoms were relieved the 2nd day after surgery and did not recur over a follow-up period of 3 months. LESSONS In young patients with sudden abdominal pain or chest pain, in whom computed tomography shows a well-defined mass of homogeneous soft-tissue density in the thorax, ELS with torsion should be suspected. The presence of a feeding artery greatly supports the diagnosis of ELS, and the absence of this classic finding may indicate torsion of the pulmonary sequestration.
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Aftab G, Agrawal A, Nuguru S, Frenia D. Intra pulmonary Sequestration: A Rare Occurrence. Cureus 2020; 12:e8463. [PMID: 32642370 PMCID: PMC7336597 DOI: 10.7759/cureus.8463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Pulmonary sequestration is a rare occurrence. Here, we present a case of a 45-year-old female who, on CT scan of the chest, was found to have a left lower lobe consolidation. Despite antibiotic treatment, the consolidation remained persistent. On repeat imaging with CT scan with contrast, it was found that the consolidation was pulmonary sequestration. The patient was referred to cardiothoracic surgery to remove pulmonary sequestration through video-associated thoracoscopic surgery.
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Affiliation(s)
- Ghulam Aftab
- Pulmonary Medicine, Saint Peter's University Hospital/Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - Ankit Agrawal
- Internal Medicine, Saint Peter's University Hospital/Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - Shashank Nuguru
- Pulmonary Critical Care, Saint Peter's University Hospital, New Brunswick, USA
| | - Douglas Frenia
- Pulmonary Critical Care, Saint Peter's University Hospital, New Brunswick, USA
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30
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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31
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Jadhav S, Sanagar S, Munde H, Jadhav M, Kutty J. Pulmonary Sequestration: An Unusual Cause for Massive Hemoptysis in an Adult Woman. Cureus 2019; 11:e6145. [PMID: 31886079 PMCID: PMC6907725 DOI: 10.7759/cureus.6145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Pulmonary sequestration is a congenital anomaly characterized by nonfunctional lung parenchymal tissue receiving blood supply from systemic arteries instead of pulmonary arteries. It is a rare entity, and diagnosis is often missed given the condition’s presentation mimics other pulmonary diseases. Pulmonary sequestration leads to recurrent episodes of pneumonia, frequent hospital admissions, and, very rarely, fatal hemoptysis. Sometimes, pulmonary sequestration is diagnosed in adulthood when the patient presents with severe symptoms. We report the case of a 34-year-old woman with intralobar sequestration whose symptoms manifested in adulthood as occasional hemoptysis for two months followed by one episode of massive hemoptysis. Our case highlights the need for timely surgical intervention and thorough preoperative evaluation with imaging for optimal patient outcomes.
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Affiliation(s)
- Sanjeev Jadhav
- Cardiothoracic and Vascular Surgery, Apollo Hospitals, Navi Mumbai, IND
| | - Sachin Sanagar
- Cardiothoracic and Vascular Surgery, Apollo Hospitals, Navi Mumbai, IND
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32
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Hashimoto H, Matsumoto J, Kusakabe M, Usui G, Hiyama N, Yamaguchi H, Horiuchi H, Morikawa T. Arteritis and Plexiform Lesion in Intralobar Pulmonary Sequestration: The First Case With Such Two Distinct Complex Lesions Associated With Local Pulmonary Hypertension. Int J Surg Pathol 2019; 28:321-324. [PMID: 31694419 DOI: 10.1177/1066896919886663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In intralobar pulmonary sequestrations, vascular changes similar to those in pulmonary hypertension (PH) are generally observed, such as intimal proliferation and plexiform lesions. However, to our knowledge, a sequestrated lung manifesting vascular changes with both arteritis and a plexiform lesion has never been reported. A 25-year-old man was diagnosed with intralobar pulmonary sequestration. Pathologically, both arteritis and a plexiform lesion were observed in the sequestrated lung. Systemic vasculitis syndrome was clinically excluded, and the pathological findings appeared to be associated with local PH. Arteritis is an extremely rare finding; only one case of arteritis associated with local PH has been reported in intralobar sequestration. In this case, the artery near the plexiform lesion had milder inflammation and fibrosis, suggesting that the arteritis formed prior to the plexiform lesion. This is the first case of arteritis and a plexiform lesion co-occurring in intralobar pulmonary sequestration associated with local PH. This case may shed light on the formation of plexiform lesions and their association with arteritis.
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Affiliation(s)
- Hirotsugu Hashimoto
- NTT Medical Center Tokyo, Tokyo, Japan.,Tokyo Healthcare University, Tokyo, Japan
| | | | | | | | | | | | | | - Teppei Morikawa
- NTT Medical Center Tokyo, Tokyo, Japan.,Tokyo Healthcare University, Tokyo, Japan
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Abstract
INTRODUCTION Pulmonary sequestration (PS) is a rare congenital lung malformation. The classical treatment of the disease has been conventional surgery with resection of abnormal parenchyma. Recently, the endovascular embolization has been proposed for the treatment of this disease. Here we present 2 cases of PS successfully treated with thoracic endograft. PATIENT CONCERNS Two patients with abnormal consolidation in the left lower lobe were admitted in our hospital. DIAGNOSIS Chest computed tomography angiography (CTA) showed abnormal consolidation in the left lower lobe, which received systemic blood supply from the descending aorta in both patients. So the diagnosis of PS was confirmed. INTERVENTIONS Endovascular treatment with thoracic endograft was successfully performed. OUTCOMES The patients recovered well and were completely free of symptoms. And the CTA follow-up showed the abnormal pulmonary parenchyma shrunk significantly. CONCLUSIONS Endovascular treatment with thoracic endograft is a promising treatment option for PS.
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34
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Abstract
RATIONALE The presence of a mediastinal neurilemmoma accompanied by intrapulmonary sequestration is a rare occurrence. The clinical symptoms of a neurilemmoma depend on the site of the tumor. Diagnosis of pulmonary sequestration mainly depends on the presence of aberrant feeding arteries. PATIENT CONCERNS A 78-year-old woman was admitted to our hospital with a mediastinal space-occupying lesion of 50 years. Computed tomography and magnetic resonance imaging showed 2 roundish low-density shadows in the left posterior mediastinum. DIAGNOSIS The pathological findings of the upper cystic mass support the diagnosis of neurilemmoma. A branch of aorta was found supplying blood to the lower mass; it was considered a pulmonary sequestration. INTERVENTIONS Left-sided thoracotomy was planned to remove the chest space-occupying lesions. Two masses were completely removed. Severe adhesion between the left lower lobe and the diaphragm was successfully separated, the aberrant feeding vessel was properly managed, and the lower lobe was resected completely. OUTCOMES The patient experienced remission of symptoms, had no significant postoperative complications, and was discharged from the hospital. LESSONS Special attention should be paid to neurological involvement of the neurilemmoma and the fragile feeding arteries of the intrapulmonary sequestration. Early diagnosis and treatment are important in such cases.
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Affiliation(s)
- Yang Yue
- Department of Thoracic Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin
| | - Hua Xin
- Department of Thoracic Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin
| | - Bao-Cen Xu
- Department of Thoracic Surgery, People's Hospital of Xing’an League, Ulanhot City, Inner Mongolia autonomous region, China
| | - Le-Ning Zhang
- Department of Thoracic Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin
| | - Wei Zhao
- Department of Thoracic Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin
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35
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Dong Q, Zhao JP, Zhang L, Morelli J, Zhang ZK, Zhang P. STARD-compliant article: Comparison of pulmonary sequestrations with thoracic and abdominal aortic arterial supply. Medicine (Baltimore) 2019; 98:e16220. [PMID: 31277133 PMCID: PMC6635279 DOI: 10.1097/md.0000000000016220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Pulmonary sequestrations (PS) are typically supplied by a vessel originating from thoracic aorta, or abdominal aorta. Differences in imaging features between these PS subtypes have not been described.To analyze the imaging features of PS with arterial supply from the thoracic and abdominal aorta.Retrospectively, 23 pathologically proven cases of pulmonary sequestration were analyzed and compared based on the site of feeding artery origin.In 21 cases (21/23), the PS was soft tissue density. 1 (1/23) PS was purely cystic and another heterogeneous with both cystic and solid components (1/23). In 16/23 cases, the feeding vessel(s) arose from the thoracic aorta (male:female ratio 1:7) and in 7/23 cases from the abdominal aorta (male:female ratio 4:3). Feeding vessels from the thoracic aorta were duplicated in 7/16 cases. PS location (P <.05) and size (P <.001) differed based on the origin of the feeding vessel (thoracic aorta: 14/16 left lower lobe, mean volume 962.97 mL; abdominal aorta: 3/7 left lower lobe, mean volume 1120.89 mL). The feeding arteries themselves differed in size depending on their site of origin (thoracic aorta: mean diameter 7.0mm ± 2.7 mm, mean length 44.6mm ± 10.9 mm; abdominal aorta: mean diameter 3.3mm ± 0.6 mm, mean length 103.6mm ± 34.5 mm).PS size and distribution differ depending upon the site of feeding vessel origin as does the size of the feeding vessel itself.
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Affiliation(s)
- Qian Dong
- Department of Radiology, The third Hospital of Hebei Medical University, Hebei Province Biomechanical Key Laborary of Orthopedics, Shijiazhuang, Hebei, China
| | - Jing Pin Zhao
- Department of Radiology, The third Hospital of Hebei Medical University, Hebei Province Biomechanical Key Laborary of Orthopedics, Shijiazhuang, Hebei, China
| | - Li Zhang
- Department of Radiology, The third Hospital of Hebei Medical University, Hebei Province Biomechanical Key Laborary of Orthopedics, Shijiazhuang, Hebei, China
| | - John Morelli
- Department of Radiology, St. Johns Medical Center, Tulsa, OK
| | - Ze Kun Zhang
- Department of Radiology, The third Hospital of Hebei Medical University, Hebei Province Biomechanical Key Laborary of Orthopedics, Shijiazhuang, Hebei, China
| | - Ping Zhang
- Department of Radiology, The third Hospital of Hebei Medical University, Hebei Province Biomechanical Key Laborary of Orthopedics, Shijiazhuang, Hebei, China
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36
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Deng Y, Zhou R, Li H, Zhao Y, Wu C. Undiagnosed Pulmonary Sequestration Causing Systemic Circulation Hypoperfusion During Ventricular Septal Defect Repair in an Infant. J Cardiothorac Vasc Anesth 2019; 34:461-464. [PMID: 31345720 DOI: 10.1053/j.jvca.2019.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/13/2019] [Accepted: 06/16/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Yanfang Deng
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Ronghua Zhou
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Huiping Li
- Department of Respiratory and Critical Care Medicine, Shenzhen People's Hospital, Shenzhen Institute of Respiratory Disease, The Second Clinical College of Jinan University, Shenzhen, China
| | - Yuean Zhao
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Chaoran Wu
- Department of Anesthesiology, Shenzhen People's Hospital, The Second Clinical College of Jinan University, Shenzhen, China.
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37
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Patil S, Sachdeva S, Bakhru S, Dalvi B, Koneti NR. Isolated agenesis of the right pulmonary veins with pulmonary sequestration. Ann Pediatr Cardiol 2019; 12:135-137. [PMID: 31143039 PMCID: PMC6521654 DOI: 10.4103/apc.apc_55_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report two cases of agenesis of the right pulmonary veins (PVs) associated with sequestration of the right lung with systemic to pulmonary collateral. Both the children were referred for evaluation of recurrent lower respiratory tract infections. Transthoracic echocardiographic evaluation showed reversal of flow in the right pulmonary artery (PA) and absent right PVs. Cardiac catheterization confirmed the diagnosis of agenesis of the right PVs. Transcatheter closure of collaterals was performed in view of significant shunt from systemic to PA. Both the patients are asymptomatic on follow-up.
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Affiliation(s)
- Shilpa Patil
- Department of Paediatric Cardiology, Care Hospital, Hyderabad, Telangana, India
| | - Sakshi Sachdeva
- Department of Paediatric Cardiology, Care Hospital, Hyderabad, Telangana, India
| | - Shweta Bakhru
- Department of Paediatric Cardiology, Care Hospital, Hyderabad, Telangana, India
| | - Bharat Dalvi
- Glenmark Cardiac Center, Mumbai, Maharashtra, India
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38
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Belczak SQ, da Silva IT, Bernardes JC, de Macedo FB, Lucato LL, Rodrigues B, Zeque BS. Pulmonary sequestration and endovascular treatment: a case report. J Vasc Bras 2019; 18:e20180110. [PMID: 31191630 PMCID: PMC6542322 DOI: 10.1590/1677-5449.011018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 10/17/2018] [Indexed: 11/22/2022] Open
Abstract
Pulmonary sequestration is a congenital anomaly defined as a nonfunctioning mass of lung parenchyma. Presence of an independent pleural envelope classifies it as intralobar, accounting for approximately 75% of the cases, while absence classifies cases as extralobar, accounting for the remaining 25%. Diagnosis is made through radiography and confirmed by computed tomography, magnetic resonance, or angiography. The traditional treatment is open surgical repair, but endovascular techniques have been used, with good results. We report the case of a 29-year-old-woman presenting with recurrent pneumonia for 5 years. A CT scan of the chest revealed poor vascular formation in the lower region of the right lung. The pulmonary sequestration was treated by embolization of the anomalous branch.
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Affiliation(s)
- Sergio Quilici Belczak
- Centro Universitário São Camilo, São Paulo, SP, Brasil.,Instituto de Aprimoramento e Pesquisa em Angiorradiologia e Cirurgia Endovascular - IAPACE, São Paulo, SP, Brasil
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39
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Annunziata F, Bush A, Borgia F, Raimondi F, Montella S, Poeta M, Borrelli M, Santamaria F. Congenital Lung Malformations: Unresolved Issues and Unanswered Questions. Front Pediatr 2019; 7:239. [PMID: 31249823 PMCID: PMC6584787 DOI: 10.3389/fped.2019.00239] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 05/28/2019] [Indexed: 12/30/2022] Open
Abstract
Advances in prenatal and postnatal diagnosis, perioperative management, and postoperative care have dramatically increased the number of scientific reports on congenital thoracic malformations (CTM). Nearly all CTM are detected prior to birth, generally by antenatal ultrasound. After delivery, most infants do well and remain asymptomatic for a long time. However, complications may occur beyond infancy, including in adolescence and adulthood. Prenatal diagnosis is sometimes missed and detection may occur later, either by chance or because of unexplained recurrent or persistent respiratory symptoms or signs, with difficult implications for family counseling and substantial delay in surgical planning. Although landmark studies have been published, postnatal management of asymptomatic children is still controversial and needs a resolution. Our aim is to provide a focused overview on a number of unresolved issues arising from the lack of an evidence-based consensus on the management of patients with CTM. We summarized findings from current literature, with a particular emphasis on the vigorous controversies on the type and timing of diagnostic procedures, treatments and the still obscure relationship between CTM and malignancies, a matter of great concern for both families and physicians. We also present an algorithm for the assessment and follow-up of CTM detected either in the antenatal or postnatal period. A standardized approach across Europe, based on a multidisciplinary team, is urgently needed for achieving an evidence-based management protocol for CTM.
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Affiliation(s)
- Federica Annunziata
- Division of Paediatrics, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Andrew Bush
- Department of Paediatrics and Paediatric Respiratory Medicine, Imperial College and Royal Brompton Hospital, London, United Kingdom
| | - Francesco Borgia
- Divisions of Cardiology and Cardiothoracic Surgery, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Francesco Raimondi
- Division of Paediatrics, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Silvia Montella
- Division of Paediatrics, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Marco Poeta
- Division of Paediatrics, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Melissa Borrelli
- Division of Paediatrics, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Francesca Santamaria
- Division of Paediatrics, Department of Translational Medical Sciences, Federico II University, Naples, Italy
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40
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Li X, He W, Li J, Ouyang R, Chen P, Peng H, Zong D. Pulmonary sequestration associated with increased serum tumor markers and elevated standard uptake value level in PET/CT: A case report and literature review. Medicine (Baltimore) 2018; 97:e11714. [PMID: 30075576 PMCID: PMC6081182 DOI: 10.1097/md.0000000000011714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Pulmonary sequestration (PS) is a congenital pulmonary malformation wherein a piece of tissue that ultimately develops into lung tissue is not attached to the pulmonary arterial blood supply, sometimes it is difficult to diagnosis with no specific laboratory tests, discover an abnormal blood supply from aorta by imaging tests is a key step in diagnose. PATIENT CONCERNS A 54-year-old male smoker presented with cough, expectoration and blood in the sputum. DIAGNOSES Computed tomography (CT) shows lesion in right lung, moderate standard uptake value (SUV) elevation of position-emission tomography/computed tomography (PET/CT) in a part of the lesion, and an increased (1,3)-β-D-glucan assay (G test), Galactomannan enzyme immune-assay (GM test) and tumor marker level, biopsy of lung in different times produced inconclusive results, then finally diagnose of pulmonary sequestration is made by observing an abnormal blood supply from the thoracic aorta and volume change of mass. INTERVENTIONS The patient refused lower lobectomy which is the main treatment of PS. He was discharged with oral hemostatic and was advised to undergo regular medical checkups. OUTCOMES The patient has been followed for a year under an outpatient regimen. Symptoms of the cough and expectoration were relieved, however, blood in the sputum remains unchanged. LESSONS It suggests the need for criteria for a thorough diagnostic work-up. It put emphasis on the importance of considering PS as part of the diagnosis of a lesion in the lung disease and underscore the blood supply of mass. Bronchoscopy or pulmonary lobectomy and follow up of the patient are important for patients diagnosed with pulmonary sequestration.
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Affiliation(s)
| | - Wenlong He
- Department of Respiratory Medicine, the Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Jinhua Li
- Department of Respiratory Medicine, the Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Ruoyun Ouyang
- Department of Respiratory Medicine, the Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Ping Chen
- Department of Respiratory Medicine, the Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Hong Peng
- Department of Respiratory Medicine, the Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Dandan Zong
- Department of Respiratory Medicine, the Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
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41
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Fabbri N, Tamburini N, Galeotti R, Quarantotto F, Maniscalco P, Rinaldi R, Salviato E, Cavallesco G. A rare case of intralobar pulmonary sequestration: combined endovascular and video-assisted thoracoscopic approach. AME Case Rep 2018; 2:19. [PMID: 30264015 DOI: 10.21037/acr.2018.04.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 03/21/2018] [Indexed: 11/06/2022]
Abstract
Pulmonary sequestration is a congenital malformation characterized by cystic, non-functioning embryonic lung tissue supplied by an abnormal systemic artery. It's a rare disease widely variable in clinical presentation and severity, depending mostly on the degree of lung involvement and location in the thoracic cavity. Most patients have recurrent infections and inflammatory conditions in the affected lobe. Surgical resection continues to be the gold standard of therapy and in this context anatomical resection is the procedure of choice and yields excellent long-term results. There are few studies reporting the use of combined endovascular and thoracoscopic approaches for pulmonary sequestration. We describe a case of intralobar pulmonary sequestration located in the lower lobe of the right lung, which was treated with video-assisted thoracoscopic surgery (VATS) after endovascular embolization of systemic artery arising from celiac trunk.
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Affiliation(s)
- Nicolò Fabbri
- Department of Morphology, Experimental Medicine and Surgery, Section of Chirurgia 1, Section of Pathology, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Nicola Tamburini
- Department of Morphology, Experimental Medicine and Surgery, Section of Chirurgia 1, Section of Pathology, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Roberto Galeotti
- Department of Radiology, Section of Interventional Radiology, Section of Pathology, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Francesco Quarantotto
- Department of Morphology, Experimental Medicine and Surgery, Section of Chirurgia 1, Section of Pathology, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Pio Maniscalco
- Department of Morphology, Experimental Medicine and Surgery, Section of Chirurgia 1, Section of Pathology, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Rosa Rinaldi
- Department of Experimental and Diagnostic Medicine, Section of Pathology, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Elisabetta Salviato
- Department of Radiology, Section of Interventional Radiology, Section of Pathology, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Giorgio Cavallesco
- Department of Morphology, Experimental Medicine and Surgery, Section of Chirurgia 1, Section of Pathology, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
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42
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Singh VK, Dhua AK, Jana M, Bhatnagar V. Esophageal Lung-Clinical Images. J Indian Assoc Pediatr Surg 2018; 23:109-110. [PMID: 29681706 PMCID: PMC5898202 DOI: 10.4103/jiaps.jiaps_167_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Esophageal lung (EL) is a highly rare anomaly, wherein the bronchus of a lung connects directly with the esophagus. Repeated lower respiratory tract infection (LRTI) is the hallmark of this condition. We present the clinical images of a 5-month-old boy who presented with repeated LRTI since birth. On evaluation, EL was diagnosed. Excision of the lung with abnormally communicating bronchus and primary repair of the esophagus was curative.
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Affiliation(s)
| | | | - Manisha Jana
- Department of Radiology, AIIMS, New Delhi, India
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43
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Yasmin R, Stærk DR, Kalhauge A, Hansen HJ, Olsen TE, Maroun LL. Role of CT angiography in bilateral pulmonary sequestration: a case report. Acta Radiol Open 2018. [PMID: 29531794 PMCID: PMC5843107 DOI: 10.1177/2058460118757577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Bilateral pulmonary sequestration (PS) is a very rare congenital malformation. We describe a case of bilateral intralobar pulmonary sequestration (ILS) in a newborn. Both sequestrations received arterial supply from separate branches of the descending aorta and venous drainage was into ipsilateral inferior pulmonary veins. Prenatal ultrasonography showed cystic changes in the lungs. Computed tomography angiography (CTA) with supplemental two-dimensional (2D) and three-dimensional (3D) images was performed to clearly define the pathology and revealed bilateral intralobar pulmonary sequestration with aberrant blood supply. The child underwent successful video-assisted thoracoscopic surgical (VATS) lobectomy on the left side and thoracoscopic wedge resection on the right side. There were no complications. CTA with supplemental 2D and 3D images plays a vital role in revealing the exact pathology in congenital pulmonary malformations associated with anomalous vasculature.
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Affiliation(s)
- Rizwana Yasmin
- 1Department of Radiology, Rigshospitalet, Copenhagen, Denmark
| | - Dorte R Stærk
- 1Department of Radiology, Rigshospitalet, Copenhagen, Denmark
| | - Anna Kalhauge
- 1Department of Radiology, Rigshospitalet, Copenhagen, Denmark
| | - Henrik J Hansen
- 2Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Tina E Olsen
- 3Department of Pathology, Rigshospitalet, Copenhagen, Denmark
| | - Lisa L Maroun
- 3Department of Pathology, Rigshospitalet, Copenhagen, Denmark
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44
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Miyagi H, Honda S, Hamada H, Minato M, Ara MW, Taketomi A. One-Stage Laparoscopic Surgery for Pulmonary Sequestration and Hiatal Hernia in a 2-Year-Old Girl. European J Pediatr Surg Rep 2018; 6:e11-e14. [PMID: 29318104 PMCID: PMC5758358 DOI: 10.1055/s-0037-1612611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 11/02/2017] [Indexed: 11/30/2022] Open
Abstract
We herein report a case of one-stage laparoscopic surgery for extralobar pulmonary sequestration (EPS) and hiatal hernia. Our patient was a 2-year-old girl who was diagnosed as a mediastinal mass lesion. Postnatal computed tomography revealed that the mediastinal mass was an EPS. Two weeks after birth, the patient developed gastroesophageal reflux (GER), and esophagography showed a hiatal hernia. At 2 years of age, she underwent one-stage laparoscopic Nissen's fundoplication for GER with resection of the EPS in the posterior mediastinum. The sequestrated lung was grasped via the esophageal hiatus; three aberrant blood vessels were dissected to allow removal of the sequestration through the umbilical port site. The esophageal hiatus was repaired and Nissen's fundoplication was performed laparoscopically. The patient's postoperative course was uneventful, with no recurrence of GER symptoms for 1 year. We conclude that one-stage laparoscopic surgery is useful for patients with EPS and hiatal hernia.
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Affiliation(s)
- Hisayuki Miyagi
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita-ku, Kita 15, Nishi 7, Sapporo, Japan
| | - Shohei Honda
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita-ku, Kita 15, Nishi 7, Sapporo, Japan
| | - Hiromi Hamada
- Department of Pediatric Surgery, Hokkaido Medical Center for Child Health and Rehabilitation, Teine-ku, Kanayama 1-1, Sapporo, Japan
| | - Masashi Minato
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita-ku, Kita 15, Nishi 7, Sapporo, Japan
| | - Momoko W Ara
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita-ku, Kita 15, Nishi 7, Sapporo, Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita-ku, Kita 15, Nishi 7, Sapporo, Japan
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Sakanoue I, Hamakawa H, Imai Y, Takahashi Y. Thoracoscopic Surgery for a Congenital Bronchoesophageal Fistula With Pulmonary Sequestration in an Adult Woman. Semin Thorac Cardiovasc Surg 2017; 29:433-435. [PMID: 29195580 DOI: 10.1053/j.semtcvs.2017.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2017] [Indexed: 11/11/2022]
Abstract
A congenital bronchoesophageal fistula with pulmonary sequestration is rare in adults. Here, we report the case of an adult woman having congenital bronchoesophageal fistula with intralobar pulmonary sequestration who successfully underwent thoracoscopic resection and showed a good postoperative course.
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Affiliation(s)
- Ichiro Sakanoue
- Department of Thoracic Surgery, Kobe City Medical Center General Hospital, Kobe, Japan.
| | - Hiroshi Hamakawa
- Department of Thoracic Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yukihiro Imai
- Department of Clinical Pathology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yutaka Takahashi
- Department of Thoracic Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
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46
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Gupta R, Patadia D, Belligund P. An atypical presentation of pulmonary sequestration. J Res Med Sci 2017; 22:127. [PMID: 29259638 PMCID: PMC5721488 DOI: 10.4103/jrms.jrms_234_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 08/13/2017] [Accepted: 09/20/2017] [Indexed: 11/04/2022]
Abstract
Pulmonary sequestration (PS) is a rare congenital malformation of the lower respiratory tract and is commonly complicated by recurrent infections and presents with respiratory failure. We report an atypical clinical presentation of postprandial abdominal pain and cramps in a patient with intralobar PS.
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Affiliation(s)
- Raghav Gupta
- SUNY Downstate Medical Center, Brooklyn, New York, USA.,Department of Pulmonary and Critical Care Medicine, VA Hospital, Brooklyn, New York, USA
| | - Deep Patadia
- SUNY Downstate Medical Center, Brooklyn, New York, USA.,Department of Internal Medicine, VA Hospital, Brooklyn, New York, USA
| | - Pooja Belligund
- SUNY Downstate Medical Center, Brooklyn, New York, USA.,Department of Pulmonary and Critical Care Medicine, VA Hospital, Brooklyn, New York, USA
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47
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Hardee S, Tuzovic L, Silva CT, Cowles RA, Copel J, Morotti RA. Congenital Cystic Lung Lesions: Evolution From In-utero Detection to Pathology Diagnosis-A Multidisciplinary Approach. Pediatr Dev Pathol 2017; 20:403-410. [PMID: 28812458 DOI: 10.1177/1093526617698604] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Congenital cystic lung lesions are a group of rare pathologies that are usually diagnosed in the prenatal period. The majority of these lesions are diagnosed at pathology examination as congenital pulmonary airway malformations (CPAM) and bronchopulmonary sequestration (BPS). These lesions are typically managed by surgical intervention within the first year of life and have an excellent prognosis. We examined the evolution of imaging appearances from prenatal diagnosis to postnatal work-up of these lesions and correlate imaging and pathological findings. An 8-year retrospective review of the perinatal and pathology database of a single tertiary care center identified 42 cases of congenital cystic lung lesions of which 36 had known prenatal ultrasound and prenatal course available. Final pathologic diagnoses were 15 CPAM (41%), 7 BPS (19%), and 9 hybrid BPS and CPAM lesions (25%). Five cases with bronchial atresia were also identified (either in isolation or associated with CPAM or BPS). The overall characteristics of these lesions by prenatal ultrasound, postnatal imaging, and ultimate histopathologic diagnosis are described.
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Affiliation(s)
- Steven Hardee
- 1 Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Lea Tuzovic
- 2 Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Cicero T Silva
- 3 Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
| | - Robert A Cowles
- 4 Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Joshua Copel
- 2 Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA.,5 Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
| | - Raffaella A Morotti
- 1 Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
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Yusef D, Hamouri S, Odeh Y. Concurrent pulmonary sequestration and pulmonary hydatid cyst in a child: A case report. Pediatr Pulmonol 2017; 52:E46-E48. [PMID: 28440965 DOI: 10.1002/ppul.23692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 02/26/2017] [Indexed: 11/09/2022]
Abstract
Pulmonary sequestration (PS) happens when an area of the lung receives its arterial blood supply from systemic circulation, resulting in a non-functional lesion (Intralobar or extralobar). Hydatid cyst results from infection of the tapeworm Echinococcus. We report a case of hydatid cyst existed concurrently with intralobar PS. A 12-year-old girl presented with recurrent hemoptysis of 2 years duration. Serology for Echinococcus granulosus was positive. CT chest suggested intralobar PS in the right middle lobe, which was surgically removed. In conclusion, recurrent localized pulmonary infections should raise the suspicion of intralobar PS which may rarely coexist with hydatid cyst.
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Affiliation(s)
- Dawood Yusef
- Pediatric Infectious Diseases, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid, Jordan
| | - Shadi Hamouri
- Department of General Surgery and Urology, Jordan University of Science and Technology, Irbid, Jordan
| | - Yousef Odeh
- Pediatric Department, Jordan University of Science and Technology, Irbid, Jordan
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Shibuya S, Nakamura T, Miyazaki E. Anatomical Segmentectomy with a Hybrid VATS Approach in a Patient with Intralobar Pulmonary Sequestration after Severe Pneumonia: A Case Report. European J Pediatr Surg Rep 2017; 5:e21-e25. [PMID: 28680790 PMCID: PMC5496814 DOI: 10.1055/s-0037-1603592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 04/24/2017] [Indexed: 10/25/2022] Open
Abstract
Anatomical segmentectomy is an advantageous procedure because it spares healthy lung that has potential to show compensatory growth after lung resection and decreases the risk of air leak and residual resection, which becomes a problem in wedge resection. However, anatomical segmentectomy has not become a common procedure in pediatrics because it requires more complicated procedure than lobectomy or wedge resection, especially in patients with a history of pulmonary infection. In this case report, anatomical basal segmentectomy was safely performed with magnified vision by a hybrid video-assisted thoracic surgery (VATS) approach in a 6-year-old girl with intralobar pulmonary sequestration after severe pneumonia. The result suggests that the indications for hybrid VATS segmentectomy can expand further to include segmental lesions in children.
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Affiliation(s)
- Soichi Shibuya
- Department of Pediatric General and Urogenital Surgery, Juntendo University, Tokyo, Japan.,Department of Pediatric Surgery, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Toru Nakamura
- Department of Thoracic Surgery, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Eiji Miyazaki
- Department of Pediatric Surgery, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
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Mahmood H, Plumb A, Vega R, Windsor A. Incidental finding - the discovery of a bronchopulmonary foregut malformation through investigations for Crohn's disease. J Radiol Case Rep 2017; 11:10-19. [PMID: 28567181 PMCID: PMC5439451 DOI: 10.3941/jrcr.v11i4.3002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pulmonary sequestration (PMS) is a rare bronchopulmonary malformation. It has an incidence of between 0.15% to 1.7%. Likewise, cystic adenomatoid malformation (CCAM) is another relatively rare category of a bronchopulmonary malformation with a reported incidence of between 1 in 25,000 to 1 in 35,000. Moreover, a bronchopulmonary malformation with features allied to both of these forms is considered an even rarer entity. In general, bronchopulmonary malformations present with a range of non-specific symptoms. Radiological features can be non-specific yet distinctive when related to clinical features. Ultimately, definitive diagnosis depends upon histological assessment of lung tissue. We present an adult female with radiological features of both pulmonary sequestration and cystic adenomatoid malformation. This was an incidental finding unrelated to the patients presenting complaint. This case highlights the importance of using a structured and systematic approach when interpreting medical imagery.
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Affiliation(s)
- Humza Mahmood
- Princess Alexandra Hospital, Hamstel Road, Harlow, CM20 1QX, UK
| | - Andrew Plumb
- Department of Radiology, University College Hospital, 235 Euston Road, Fitzrovia, London, NW1 2BU, UK
| | - Roser Vega
- Department of Gastrointestinal services, University College Hospital, 235 Euston Road, Fitzrovia, London, NW1 2BU, UK
| | - Alastair Windsor
- Department of Gastrointestinal services, University College Hospital, 235 Euston Road, Fitzrovia, London, NW1 2BU, UK
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