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Khandelwal S, Mittal A, Sharma S, Prasad A, Singh R, Shah A, Lageju N. Intralobar pulmonary sequestration: a rare cause of hemoptysis: a case report. Ann Med Surg (Lond) 2024; 86:3641-3645. [PMID: 38846891 PMCID: PMC11152832 DOI: 10.1097/ms9.0000000000002028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/14/2024] [Indexed: 06/09/2024] Open
Abstract
Overview and significance Pulmonary sequestration (PS) is a rare congenital anomaly characterized by aberrant formation of nonfunctional lung tissue with anomalous systemic blood supply. Despite its rarity, PS presents significant diagnostic and management challenges, often necessitating a multidisciplinary approach for optimal patient outcomes. This case report provides insights into the clinical presentation, diagnostic modalities, and management strategies for PS. Case summary The authors present a case of a 30-year-old male who complained of chronic cough and hemoptysis and was eventually diagnosed with intralobar PS by computed tomography (CT) imaging. The patient underwent a surgical procedure, specifically a lobectomy, to address the lung tissue. Clinical discussion The diagnosis of intralobar PS is confirmed by CT imaging, showing features of abnormalities, including irregular cystic communication. A large area with abnormal systemic arterial supply and variable venous fluid. This patient presented with symptoms consistent with PS, including chronic cough and hemoptysis, highlighting the importance of timely diagnosis and intervention to prevent life-threatening complications. Conclusion Lung sequestration has diagnostic challenges due to its variable clinical presentation and potential for misdiagnosis. However, advances in technology, such as CT angiography, make accurate diagnosis and precise surgical planning easier. Prompt intervention via lobectomy or transarterial embolization is important to reduce the risk of life-threatening complications associated with PS. These data highlight the importance of multidisciplinary collaboration between physicians, radiologists, and surgeons to effectively manage PS and improve patient outcomes.
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Affiliation(s)
| | - Aman Mittal
- Department of Radiology, SGT Medical College Hospital, Delhi
| | - Shruti Sharma
- Department of Radiology, Esic Medical College, Bengaluru, Karnataka
| | | | - Roshan Singh
- Kathmandu University School of Medical Sciences, Kathmandu, Nepal
| | - Anil Shah
- B.P. Koirala Institute of Health Sciences, Dharan
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Song JY, Park SG, Lee HY, Kim SR, Kim HG, Shin SH, Jeong BH, Lee K, Kim H, Kwon OJ, Han J, Kim J, Um SW. Comparison of clinical outcomes of pulmonary sequestration in adults between surgery and non-surgery groups. J Thorac Dis 2022; 14:3876-3885. [PMID: 36389312 PMCID: PMC9641354 DOI: 10.21037/jtd-22-631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/16/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Pulmonary sequestration (PS) is a rare congenital lung malformation that can be incidentally diagnosed in adulthood. The natural course of PS in adults is scarcely known. METHODS In this retrospective cohort study, medical records and imaging results of adult patients diagnosed with PS between 1994 and 2019 were reviewed. Diagnoses of PS were confirmed by histopathological findings in resected cases, while non-resected cases were diagnosed based on the presence of anomalous systemic arterial supply and abnormal lung parenchyma on enhanced chest computed tomography (CT). RESULTS Among 104 patients with PS, the median age at diagnosis was 40.5 years, and 69 (66.3%) patients were asymptomatic. Patients in the surgery group were significantly younger (38.6 vs. 45.3 years, respectively, P=0.016), were more likely to be symptomatic initially (51.6% vs. 28.6%, respectively, P=0.015), and had larger PS (90.0 vs. 66.3 mm, respectively, P<0.001) than the non-surgery group. Of the patients in the surgery group, 29.0% (18/62) experienced postoperative complications. In the surgically resected cases, infections were only detected in intralobar PS, not in extralobar PS. Among 25 subjects without initial symptoms in the non-surgery group, 24 (96.0%) remained asymptomatic at the last follow-up. CONCLUSIONS Adults with PS tended to undergo resection if they were young, symptomatic, and had large PS (a median diameter of 90.0 mm). Almost all subjects who were initially asymptomatic and did not undergo surgery remained asymptomatic at the last follow-up. Therefore, considering the indolent course of PS, initially asymptomatic adults with PS could be followed up without surgery.
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Affiliation(s)
- Ju Yeun Song
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sung Goo Park
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ho Yun Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea
| | - Sae Rom Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Han Gyeol Kim
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sun Hye Shin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byeong-Ho Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyungjong Lee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hojoong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - O Jung Kwon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Joungho Han
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jhingook Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sang-Won Um
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea
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3
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Wu Y, Ye Z, He Z, He X, Hong X, Chen F, Xin S. Video-assisted thoracoscopic surgery lobectomy for giant intralobar pulmonary sequestration: A case report. Medicine (Baltimore) 2022; 101:e29284. [PMID: 35866794 PMCID: PMC9302343 DOI: 10.1097/md.0000000000029284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Pulmonary sequestration, which can be divided into 2 main types: intralobar pulmonary sequestration (IPS) and extralobar pulmonary sequestration, is an uncommon congenital condition for which surgical resection is usually indicated. Video-assisted thoracoscopic surgery, as compared with open thoracotomy, has increasingly become the preferred operative procedure in the treatment of PS, owing to less postoperative pain and faster recovery. This report describes a rare and challenging case with a giant IPS undergoing video-assisted thoracic lobectomy. PATIENT CONCERNS A 39-year old woman suffered from recurrent pneumonia for nearly 3 years. An enhanced computed tomography scan performed in our hospital revealed a 12.0 cm × 10.0 cm-sized IPS in the left lower lobe, supplied by an 8-mm aberrant artery originating from the descending thoracic aorta. DIAGNOSIS Histology of the resected lobe confirmed the diagnosis of giant intralobar pulmonary sequestration associated with infection. INTERVENTIONS Thoracoscopic left lower lobectomy was performed. OUTCOMES The patient has been discharged from the hospital on the ninth day after surgery with an uneventful recovery, she was in good health after a 1-year follow-up. LESSONS Although full of challenges, thoracoscopic lobectomy for giant IPS is a safe and feasible surgical procedure associated with reduced surgical trauma and postoperative pain as well as improved cosmetic results compared with traditional thoracotomy.
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Affiliation(s)
- Yongyong Wu
- Department of Cardiothoracic Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Zhongrui Ye
- Department of Cardiothoracic Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Zhongliang He
- Department of Cardiothoracic Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Xueming He
- Department of Cardiothoracic Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Xia Hong
- Department of Cardiothoracic Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Fei Chen
- Department of Cardiothoracic Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Shunxin Xin
- Department of Cardiothoracic Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, China
- *Correspondence: Shunxin Xin, Department of Cardiothoracic Surgery, Tongde Hospital of Zhejiang Province, No. 234 Gucui Road, Xihu District, Hangzhou 310004, Zhejiang Province, China (e-mail: )
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Ogunleye E, Olusoji O, Fajolu I, Iwuchukwu P. Ten years experience in surgical management of congenital lung malformations: A prospective, cross sectional study. JOURNAL OF CLINICAL SCIENCES 2022. [DOI: 10.4103/jcls.jcls_53_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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5
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Ceylan KC, Batihan G, Üçvet A, Gürsoy S. Surgery in congenital lung malformations: the evolution from thoracotomy to VATS, 10-year experience in a single center. J Cardiothorac Surg 2021; 16:131. [PMID: 34001173 PMCID: PMC8130166 DOI: 10.1186/s13019-021-01511-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 05/05/2021] [Indexed: 11/25/2022] Open
Abstract
Background Congenital lung malformation is an umbrella term and consist of various kind of parenchymal and mediastinal pathologies. Surgical resection is often required for diagnosis and curative treatment. We aimed to review our experience in surgical treatment for congenital lung disease and present the role of minimally invasive surgery. Methods Surgical resections performed for benign lesions of the lung and mediastinum between January 2009 and May 2019 were retrospectively analyzed. Patients who were found to have congenital lung malformation as a result of pathological examination were included in our study. Distribution characteristics of the patients according to congenital lung malformation subtypes, differences in surgical approach and postoperative results were investigated. Results A total of 94 patients who underwent surgical resection and were diagnosed with the bronchogenic cyst, sequestration, bronchial atresia, congenital cystic adenomatoid malformation (CCAM), or enteric cyst as a result of pathological examination were included the study. There were no significant differences between pathological subtypes in the postoperative length of hospital stay and drainage duration however, perioperative complication rate was higher in the sequestration group. In addition, in the first three days postoperatively, the mean pain score was found to be lower in the VATS group compared to thoracotomy. Conclusions Congenital lung malformations consist of a heterogeneous group of diseases and the surgical treatment in these patients can range from a simple cyst excision to pneumonectomy. Video-assisted thoracoscopic surgery should be considered as the first choice in the surgical treatment of these patients in experienced centers.
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Affiliation(s)
- Kenan C Ceylan
- Department of Thoracic Surgery, University of Health Sciences Dr Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital Izmir, 35110, Yenişehir, Gaziler Street, 331, Izmir, Turkey
| | - Güntuğ Batihan
- Department of Thoracic Surgery, University of Health Sciences Dr Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital Izmir, 35110, Yenişehir, Gaziler Street, 331, Izmir, Turkey.
| | - Ahmet Üçvet
- Department of Thoracic Surgery, University of Health Sciences Dr Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital Izmir, 35110, Yenişehir, Gaziler Street, 331, Izmir, Turkey
| | - Soner Gürsoy
- Department of Thoracic Surgery, University of Health Sciences Dr Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital Izmir, 35110, Yenişehir, Gaziler Street, 331, Izmir, Turkey
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Matsuoka S, Eguchi T, Takeda T, Miura K, Hamanaka K, Shimizu K. Three-dimensional computed tomography and indocyanine green-guided technique for pulmonary sequestration surgery. Gen Thorac Cardiovasc Surg 2020; 69:621-624. [PMID: 33074471 DOI: 10.1007/s11748-020-01511-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022]
Abstract
Patients with pulmonary sequestration are at risk of life-threatening bleeding during lung resection. To perform safe and adequate lung resection in patients with pulmonary sequestration, we utilized the following combination of techniques: (1) three-dimensional computed tomographic (3D-CT) imaging for preoperative planning and intraoperative identification of blood vessels, including aberrant arteries, and (2) intraoperative intravenous administration of indocyanine green (ICG). We describe our surgical technique through three cases who underwent lung resection for pulmonary sequestration using 3D-CT and fluorescence navigation with ICG. Intraoperative identification and division of the aberrant arteries, draining veins, and resection margins of the lungs were successfully completed.
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Affiliation(s)
- Shunichiro Matsuoka
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi Matsumoto, Nagano, 390-8621, Japan
| | - Takashi Eguchi
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi Matsumoto, Nagano, 390-8621, Japan
| | - Tetsu Takeda
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi Matsumoto, Nagano, 390-8621, Japan
| | - Kentaro Miura
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi Matsumoto, Nagano, 390-8621, Japan
| | - Kazutoshi Hamanaka
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi Matsumoto, Nagano, 390-8621, Japan
| | - Kimihiro Shimizu
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi Matsumoto, Nagano, 390-8621, Japan.
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Díaz De Hoyos JJ, Luján Ramos VP, Jaimes Santamaría LV, Santos Arrieta AM, García Maestre LK, Gutiérrez Puente EE. Secuestro pulmonar intralobar y aspergilosis pulmonar: reporte de un caso. REVISTA COLOMBIANA DE CIRUGÍA 2020. [DOI: 10.30944/20117582.519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
El secuestro pulmonar es un tipo de malformación congénita pulmonar poco frecuente, con presentación clínica variable y de usual diagnóstico durante la infancia. Puede coexistir con otras patologías pulmonares, principalmente de tipo infecciosas y su manejo definitivo es mediante un procedimiento quirúrgico.
Se presenta el caso de una paciente adulta con secuestro pulmonar, asociado a una infección fúngica, manejada con cirugía mínimamente invasiva.
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8
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Phelps MC, Sanchirico PJ, Pfeiffer DC. Intralobar pulmonary sequestration: incidental finding in an asymptomatic patient. Radiol Case Rep 2020; 15:1891-1894. [PMID: 32874379 PMCID: PMC7452027 DOI: 10.1016/j.radcr.2020.07.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/19/2020] [Accepted: 07/20/2020] [Indexed: 11/21/2022] Open
Abstract
We describe a case of a 58-year-old male who presented to the emergency room with symptoms related to an appendicitis. A computed tomography scan with contrast confirmed the diagnosis of acute appendicitis but also revealed a mass medially in the base of the inferior lobe of the right lung. The mass measured 6.7 cm AP × 3.7 cm transverse. It had multiple lobulations and the anterior aspect was of very low density, possibly representing accumulated mucoid material. The mass had an arterial connection from the descending thoracic aorta and a venous drainage into the right pulmonary vein, classical features of intralobar pulmonary sequestration. The physical exam was unremarkable, and the patient had no history of pulmonary symptoms. This case helps increase awareness of intralobar pulmonary sequestration, a rare condition that may be asymptomatic.
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Affiliation(s)
- Megan C. Phelps
- WWAMI Medical Education Program (MD), University of Washington School of Medicine, Seattle, WA, USA
| | | | - David C. Pfeiffer
- WWAMI Medical Education Program and Department of Biological Sciences, University of Idaho, 875 Perimeter Drive, Moscow, ID 83844-3051, USA
- Corresponding author.
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9
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Galego MA, Pereira N, Guimarães S, Amado J, Silva AC. Ischaemic Heart Disease Induced by Intralobar Pulmonary Sequestration. Arch Bronconeumol 2019; 55:547-549. [PMID: 31230845 DOI: 10.1016/j.arbres.2019.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 02/25/2019] [Accepted: 03/11/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Maria Antónia Galego
- Department of Pulmonology, Unidade Local de Saúde de Matosinhos E.P.E., Matosinhos, Portugal.
| | - Nídia Pereira
- Department of Internal Medicine, Unidade Local de Saúde de Matosinhos E.P.E., Matosinhos, Portugal
| | - Susana Guimarães
- Department of Anatomical Pathology, Centro Hospitalar de São João E.P.E., Porto, Portugal
| | - Joana Amado
- Department of Pulmonology, Unidade Local de Saúde de Matosinhos E.P.E., Matosinhos, Portugal
| | - Ana Catarina Silva
- Department of Radiology, Unidade Local de Saúde de Matosinhos E.P.E., Matosinhos, Portugal
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Polaczek M, Baranska I, Szolkowska M, Zych J, Rudzinski P, Szopinski J, Orlowski T, Roszkowski-Sliz K. Clinical presentation and characteristics of 25 adult cases of pulmonary sequestration. J Thorac Dis 2017; 9:762-767. [PMID: 28449484 DOI: 10.21037/jtd.2017.03.107] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pulmonary sequestration (PS) is a rare congenital abnormality of lung tissue. Only few series of adult cases are reported. The aim was to describe clinical characteristics in adult cases of PS and to compare outcomes in different clinical situations. METHODS Using MSD engine we searched for cases of PS that have been diagnosed between Jan 1st, 2005 and Dec 31st, 2015. Clinical data was retrospectively gathered. Statistica v.12 (StatSoft, Inc.) was used for statistical analyses. RESULTS We found 25 cases (18 females, 7 males), which underwent surgery and were histologically proven. There were 22 cases of intralobar PS. 7 cases were asymptomatic, 12 had infectious history (including 3 cases of lung abscess and pleural empyema), 4 presented with hemoptysis, 2 with chest pain. The average age to undergo surgery was 38.24, in the asymptomatic group 34, in symptomatic 39.89. In the latter the symptoms preceded the surgery for 2.45-year. Great majority of sequestrations was located in lower lobes (96%), 52% on the left. Symptomatic cases were at higher than expected risk of surgical complications, comparing to asymptomatic (chi2, P=0.04). In most cases there were surgical and histological signs of infection, only in 9 cases etiological factor was determined: in 5 cases it was A. fumigatus. A 0.53-day longer post-surgical hospital stay was observed in the symptomatic group, no statistical significance was found (U-test, P=0.45). CONCLUSIONS Surgical treatment of symptomatic cases of PS is characterized by slightly longer post-surgical hospital stay and higher risk of surgical complications. Fungal infections are the most likely to occur in PS.
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Affiliation(s)
- Mateusz Polaczek
- Third Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland.,Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Warsaw, Poland
| | - Inga Baranska
- Radiology Department, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Malgorzata Szolkowska
- Pathology Department, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Jacek Zych
- Third Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Piotr Rudzinski
- Surgery Department, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Janusz Szopinski
- Third Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Tadeusz Orlowski
- Surgery Department, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Kazimierz Roszkowski-Sliz
- Third Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
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11
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Extralobar pulmonary sequestration in neonates: The natural course and predictive factors associated with spontaneous regression. Eur Radiol 2016; 27:2489-2496. [DOI: 10.1007/s00330-016-4594-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 08/26/2016] [Accepted: 08/30/2016] [Indexed: 12/29/2022]
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12
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Wagenaar AE, Tashiro J, Satahoo SS, Sola JE, Neville HL, Hogan AR, Perez EA. Resection of pediatric lung malformations: National trends in resource utilization & outcomes. J Pediatr Surg 2016; 51:1414-20. [PMID: 27292597 DOI: 10.1016/j.jpedsurg.2016.04.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 04/24/2016] [Accepted: 04/28/2016] [Indexed: 12/24/2022]
Abstract
PURPOSE We sought to determine factors influencing survival and resource utilization in patients undergoing surgical resection of congenital lung malformations (CLM). Additionally, we used propensity score-matched analysis (PSMA) to compare these outcomes for thoracoscopic versus open surgical approaches. METHODS Kids' Inpatient Database (1997-2009) was used to identify congenital pulmonary airway malformation (CPAM) and pulmonary sequestration (PS) patients undergoing resection. Open and thoracoscopic CPAM resections were compared using PSMA. RESULTS 1547 cases comprised the cohort. In-hospital survival was 97%. Mortality was higher in small vs. large hospitals, p<0.005. Survival, pneumothorax (PTX), and thoracoscopic procedure rates were higher, while transfusion rates and length of stay (LOS) were lower, in children ≥3 vs. <3months (p<0.001). Multivariate analysis demonstrated longer LOS for older patients and Medicaid patients (all p<0.005). Total charges (TC) were higher for Western U.S., older children, and Medicaid patients (p<0.02). PSMA for thoracoscopy vs. thoracotomy in CPAM patients showed no difference in outcomes. CONCLUSION CLM resections have high associated survival. Children <3months of age had higher rates of thoracotomy, transfusion, and mortality. Socioeconomic status, age, and region were independent indicators for resource utilization. Extent of resection was an independent prognostic indicator for in-hospital survival. On PSMA, thoracoscopic resection does not affect outcomes.
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Affiliation(s)
- Amy E Wagenaar
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jun Tashiro
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Shevonne S Satahoo
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Juan E Sola
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Holly L Neville
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Anthony R Hogan
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eduardo A Perez
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
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13
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Sun X, Xiao Y. Pulmonary sequestration in adult patients: a retrospective study. Eur J Cardiothorac Surg 2015; 48:279-82. [PMID: 25361546 DOI: 10.1093/ejcts/ezu397] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 09/17/2014] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Pulmonary sequestration (PS) is a rare congenital malformation. This study presents the characteristics of PS in adult patients, including pulmonary function and concurrent infection, which have not been well documented previously. METHODS Patients ≥16 years old with a discharge diagnosis of PS from Peking Union Medical College Hospital between January 1990 and December 2013 were retrospectively analysed. Age, sex, clinical symptoms, chest computed tomography (CT) results, results of pulmonary function tests, diagnostic methods, type and localization of sequestration, origin of arterial supply, complications due to infection and treatment information were retrieved from hospital records and analysed. RESULTS Seventy-two patients were included in this study (mean age 36.6 ± 11.8 years). Clinical symptoms included cough, expectoration, haemoptysis, intermittent fever and chest pain. The most common CT findings were soft tissue opacity, cystic lesion, cavitary lesion and bronchiectasis. Intralobar and extralobar sequestrations were present in 92.8 and 7.2% of the patients, respectively. PS located in the left lower lobe was 2.1 times more frequent than that in the right lower lobe. PS was diagnosed by computed tomography angiography (CTA) in only 37.5% of patients; the remaining patients were undiagnosed before surgery. Obstructive ventilation dysfunction was found in 8.8% of patients. Pulmonary aspergillosis was detected in 9.7% of patients, and Pseudomonas aeruginosa was the leading pathogen (as determined by tissue cultures). PS was resected via thoracotomy in 87.0% of patients and via video-assisted thoracoscopic surgery (VATS) in 13.0%. CONCLUSIONS PS is a rare disease, and missed diagnosis and misdiagnosis are very common in PS patients. CTA and other angiography techniques should be used when there is suspicion of PS. Some PS patients have mild to moderate derangement of pulmonary ventilation, and PS might be associated with concurrent aspergillosis. VATS and posterolateral thoracotomy are both feasible methods for PS resection.
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Affiliation(s)
- Xuefeng Sun
- Department of Pulmonary Medicine, Peking Union Medical College Hospital, Beijing, China
| | - Yi Xiao
- Department of Pulmonary Medicine, Peking Union Medical College Hospital, Beijing, China
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14
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Aydoğdu K, Sayılır E, İncekara F, Fındık G, Kaya S. Video-assisted thoracic surgery for pulmonary sequestration. Asian Cardiovasc Thorac Ann 2015; 23:1100-2. [PMID: 25957092 DOI: 10.1177/0218492315586480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Bronchopulmonary sequestration is a rare developmental abnormality. Most cases are asymptomatic and found incidentally. The definitive treatment for bronchopulmonary sequestration is surgical excision. An 18-year-old man was admitted to our clinic with longstanding cough, fever, and dense sputum. Chest computed tomography identified cystic bronchiectasis in common areas of the left lower lobe, and parenchymal destruction with air-fluid levels. A left lower lobectomy was performed via a video-thoracoscopic approach.
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Affiliation(s)
- Koray Aydoğdu
- Department of Thoracic Surgery, Atatürk Chest Diseases and Thoracic Surgery Research and Training Hospital, Ankara, Turkey
| | - Ebru Sayılır
- Department of Thoracic Surgery, Atatürk Chest Diseases and Thoracic Surgery Research and Training Hospital, Ankara, Turkey
| | - Funda İncekara
- Department of Thoracic Surgery, Atatürk Chest Diseases and Thoracic Surgery Research and Training Hospital, Ankara, Turkey
| | - Göktürk Fındık
- Department of Thoracic Surgery, Atatürk Chest Diseases and Thoracic Surgery Research and Training Hospital, Ankara, Turkey
| | - Sadi Kaya
- Department of Thoracic Surgery, Atatürk Chest Diseases and Thoracic Surgery Research and Training Hospital, Ankara, Turkey
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Mahmodlou R, Sepehrvand N, Hatami S. Pulmonary sequestration: A rare case in a patient with acute chest pain and palpitation mimicking the acute coronary syndrome. Lung India 2015; 32:76-8. [PMID: 25624605 PMCID: PMC4298928 DOI: 10.4103/0970-2113.148459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Pulmonary sequestration (PS), a non-functioning lung tissue, which lacks the normal communication with the tracheobronchial tree and receives the blood supply from the systemic circulation, is a rare congenital malformation that comprises 0.5-6% of all congenital pulmonary malformations. The presentation of PS with chest pain is very rare. In this article, we are aimed to report the case of a patient with chief complaints of retrosternal chest pain and palpitation, which was suspected to be of cardiac origin. Primary evaluations including exercise tolerance test, 48-hour holter monitoring, coronary angiography ruled out any cardiac problem. Further evaluations with Thoracic CT scan revealed a cystic mass in the retrocardiac region of the lung. Thoracotomy surgery was done and the patient was finally diagnosed to be extralobar pulmonary sequestration.
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Affiliation(s)
- Rahim Mahmodlou
- Department of Surgery, Urmia University of Medical Sciences, Urmia, Iran
| | - Nariman Sepehrvand
- Students' Research Committee, Urmia University of Medical Sciences, Urmia, Iran
| | - Sanaz Hatami
- Students' Research Committee, Urmia University of Medical Sciences, Urmia, Iran
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Zhang H, Tian J, Chen Z, Ma X, Yu G, Zhang J, Jiang G, Wang L. Retrospective study of prenatal diagnosed pulmonary sequestration. Pediatr Surg Int 2014; 30:47-53. [PMID: 24258515 PMCID: PMC5814128 DOI: 10.1007/s00383-013-3434-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe the prenatal findings, treatments and outcomes of fetuses with pulmonary sequestrations (PS), which were retrospectively studied. METHODS From May 2010 to January 2013, 292 women were referred to the Guangdong Women and Children Hospital, Guangzhou because obstetric ultrasound had demonstrated fetal lung lesions. In 68 fetuses, the echogenic lung masses were pulmonary sequestrations deriving arterial blood supply from clearly identifiable systemic arteries rather than the pulmonary artery. We examined records of the 68 fetuses and measured the lesions and congenital cystic adenomatoid malformation volume ratio (CVR), provided prenatal counseling and treatment, documented the CVR, location of lesion, gestational age at diagnosis, need for fetal intervention, perinatal clinical course (including the development of hydrops, effusions, and neonatal respiratory distress), gestational age at delivery, postnatal ultrasound and CT, operation treatment, survival and pathology. RESULTS There were 68 PS in our study. All of 56 cases with CVR ≤ 1.6, survived without prenatal hydrops or postnatal respiratory symptoms. In 12 cases with CVR >1.6, 7 cases (58.3 %, 7/12) had hydrops, 10 cases (83.3 %, 10/12) survived, 2 cases (16.7 %, 2/12) of induced abortion, 8 cases (66 %, 8/12) were postnatal symptomatic. There was statistical significant difference in the incidence rate of hydrops and postnatal respiratory symptoms between the PS with CVR ≤ 1.6 and that with CVR >1.6. 66 cases postnatal survived, two cases of induced abortion. 64 cases had no prenatal treatment, two cases underwent thoracoamniotic shunt. The mean gestational age at birth was 38 weeks (range 34-40 weeks). 21 asymptomatic cases had no surgery. 45 cases (8 symptomatic and 37 asymptomatic) underwent surgical resections, 43 cases without postoperative complications, two cases of postoperative pneumothorax, no wound infection. Postoperative follow-up showed good growth in all surgery cases. CONCLUSION PS specific absence of hydrop was a congenital disorder with an excellent prognosis. CVR >1.6 was associated with fetal hydrops and postnatal symptoms. However, absolute CVR value cannot be used to select fetuses for fetal treatment before the development of hydrops. Surgery of PS in neonates or infants presented a good outcome.
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Affiliation(s)
- Haichun Zhang
- Southern Medical University, Guangzhou, Guangdong, China
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