Imaging in bronchopulmonary sequestration

Antenatal and postnatal management of congenital cystic adenomatoid malformation

Congenital thoracic malformations (CTMs) are a heterogeneous group of rare disorders that may involve the airways or lung parenchyma. The authors have focused on the condition that causes the most controversy, namely, congenital cystic adenomatoid malformation (CCAM). The reported incidence is 3.5 and 0.94 per 10,000 live births for CTMs and CCAMs respectively. Ultrasound is the antenatal imaging modality of choice for screening for CCAMs whilst magnetic resonance imaging is complimentary for morphological and volumetric evaluation of the foetal lung. Most CCAMs are detected antenatally with only a small proportion presenting postnatally. Only a few CCAMs cause foetal problems, with foetal hydrops being the best predictor of death. Although many CCAMs regress during pregnancy, most remain detectable postnatally by CT scans. Surgical excision of symptomatic lesions is relatively straightforward, but management of asymptomatic lesions is controversial. Some surgeons adopt a "wait and see" approach operating only on those patients who develop symptoms, but others operate on asymptomatic patients usually within the first year of life. Due to the potential of malignant transformation, children should have long term follow up. There is an urgent need to delineate the natural history of antenatally detected CCAMs to guide future management.

Thoracoscopic segmentectomy: one vessel may hide a second one

We report the case of an asymptomatic neonate prenatally diagnosed with a left basal pulmonary sequestration. The preoperative chest computed tomography with contrast showed 2 aberrant arteries arising from the distal thoracic aorta and supplying the intralobar left inferior lung malformation. Strategy and treatment by thoracoscopic segmentectomy are presented.

Tumor carcinoide e sequestro pulmonar

O sequestro pulmonar é definido como uma massa de tecido pulmonar separada da árvore traqueobrônquica e irrigada por uma artéria sistêmica anômala. Sua associação com neoplasias pulmonares é rara. Relatamos o caso de uma paciente de 39 anos com o diagnóstico de tumor carcinoide localizado no brônquio intermediário, associado a alterações caracterizadas como bronquiectasias em lobo inferior direito. A paciente foi submetida à toracotomia para ressecção da área acometida e, durante a cirurgia, apresentou hemorragia importante decorrente da transecção da artéria anômala que nutria o sequestro pulmonar intralobar localizado em lobo inferior direito, não identificado nos exames pré-operatórios.

[Usefulness of chest CT in the diagnosis of pulmonary sequestration]

Pulmonary sequestration is a rare congenital anomaly, characterized by nonfunctional embryonic pulmonary tissue. Pulmonary sequestration accounts for 0.15-6.40% of all congenital pulmonary malformations. This anomaly, which is classified as intralobar or extralobar, involves the lung parenchyma and its vascularization. We report the case of a 56-year-old male presenting with hemoptysis. A chest X-ray showed an area of opacity behind the cardiac silhouette in the base of the left hemithorax. Chest CT scans with intravenous contrast revealed pulmonary sequestration. The patient underwent surgery, in which the anomalous tissue was successful resected. The postoperative evolution was favorable, and the patient was discharged to outpatient treatment.