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Yu H, Kim H, Cheong H. Extralobar Pulmonary Sequestration: A Case of Incidental Autopsy Diagnosis. Am J Forensic Med Pathol 2024; 45:e94-e96. [PMID: 38228310 DOI: 10.1097/paf.0000000000000894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Affiliation(s)
| | | | - Harin Cheong
- From the Department of Forensic Medicine, College of Medicine, The Catholic University of Korea, Seoul
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2
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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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3
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Yoshinaga T, Yomota M, Toriyama K, Iso H, Mirokuji K, Kawai S, Narita K, Suzuki M, Horio H, Hosomi Y. Intralobar pulmonary sequestration presenting as multiple nodular pulmonary lesions and focal emphysema. Respirol Case Rep 2024; 12:e01276. [PMID: 38314102 PMCID: PMC10831775 DOI: 10.1002/rcr2.1276] [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: 11/17/2023] [Accepted: 12/22/2023] [Indexed: 02/06/2024] Open
Abstract
The features of intralobar pulmonary sequestration vary on computed tomography (CT). Many cases demonstrate a mass or cystic lesion within a lower lobe. We report herein a case of a 55-year-old, female patient presenting with right back pain. Contrast enhanced (CE) CT revealed multiple, nodular, pulmonary lesions suggesting recurrent infections with surrounding focal emphysema. Three-dimensional (3D) reconstruction demonstrated a sequestrated lung segment with a systemic, arterial blood supply. Based on these findings, intralobar pulmonary sequestration was diagnosed. Intralobar pulmonary sequestration can present as multiple, nodular, pulmonary lesions with focal emphysema rather than as a mass or cyst. CE-CT with 3D reconstruction is useful for diagnosing this condition. Patients with recurrent pulmonary infections have a high index of suspicion of intralobar pulmonary sequestration.
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Affiliation(s)
- Tadatsugu Yoshinaga
- Department of Respiratory MedicineTokyo Metropolitan Cancer and Infectious Diseases Center Komagome HospitalTokyoJapan
| | - Makiko Yomota
- Department of Respiratory MedicineTokyo Metropolitan Cancer and Infectious Diseases Center Komagome HospitalTokyoJapan
| | - Kazutoshi Toriyama
- Department of Respiratory MedicineTokyo Metropolitan Cancer and Infectious Diseases Center Komagome HospitalTokyoJapan
| | - Hirokazu Iso
- Department of Respiratory MedicineTokyo Metropolitan Cancer and Infectious Diseases Center Komagome HospitalTokyoJapan
| | - Kie Mirokuji
- Department of Respiratory MedicineTokyo Metropolitan Cancer and Infectious Diseases Center Komagome HospitalTokyoJapan
| | - Shoko Kawai
- Department of Respiratory MedicineTokyo Metropolitan Cancer and Infectious Diseases Center Komagome HospitalTokyoJapan
| | - Kosuke Narita
- Department of Respiratory MedicineTokyo Metropolitan Cancer and Infectious Diseases Center Komagome HospitalTokyoJapan
| | - Mikito Suzuki
- Department of Thoracic SurgeryTokyo Metropolitan Cancer and Infectious Diseases Center Komagome HospitalTokyoJapan
| | - Hirotoshi Horio
- Department of Thoracic SurgeryTokyo Metropolitan Cancer and Infectious Diseases Center Komagome HospitalTokyoJapan
| | - Yukio Hosomi
- Department of Respiratory MedicineTokyo Metropolitan Cancer and Infectious Diseases Center Komagome HospitalTokyoJapan
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4
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Agafonov GM, Petrov AS, Atyukov MA, Novikova OV, Zemtsova IY, Dvorakovskaya IV, Yablonsky PK. [Right upper lobe pulmonary sequestration as a rare cause of recurrent spontaneous pneumothorax]. Khirurgiia (Mosk) 2024:102-109. [PMID: 38258696 DOI: 10.17116/hirurgia2024011102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
A 19-year-old patient after previous wedge resection of the right upper pulmonary lobe a year ago urgently admitted with recurrent right-sided spontaneous pneumothorax. According to standard management of spontaneous pneumothorax, we performed diagnostic thoracoscopy and drainage of the right pleural cavity with regular X-ray examinations. However, these measures were ineffective. The patient was scheduled for surgery, and we intraoperatively observed an unusual cause of pneumothorax. Thus, we present spontaneous pneumothorax following right upper lobe pulmonary sequestration. The uniqueness of this case is associated with unusual manifestation and non-standard localization of rare lesion. A few cases of pneumothorax in similar patients are described in the world literature. The key limiting factor in diagnosis of such defects (identification of aberrant vessel supplying abnormal lung parenchyma) is the lack of routine CT angiography in patients diagnosed with pneumothorax. That is why CT changes were interpreted as postoperative ones, and the true cause was established only during redo surgery. A thorough inspection of the pleural cavity and alertness regarding unusual appearance of the right upper pulmonary lobe made it possible to suggest a non-standard diagnosis, avoid complications (bleeding from afferent vessel) and perform adequate lung resection.
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Affiliation(s)
- G M Agafonov
- Saint-Petersburg State University, St. Petersburg, Russia
| | - A S Petrov
- Saint-Petersburg State University, St. Petersburg, Russia
- Saint-Petersbursg City Clinical Hospital No. 2, St. Petersburg, Russia
| | - M A Atyukov
- Saint-Petersbursg City Clinical Hospital No. 2, St. Petersburg, Russia
| | - O V Novikova
- Saint-Petersburg State University, St. Petersburg, Russia
- Saint-Petersbursg City Clinical Hospital No. 2, St. Petersburg, Russia
| | - I Yu Zemtsova
- Saint-Petersburg State University, St. Petersburg, Russia
- Saint-Petersbursg City Clinical Hospital No. 2, St. Petersburg, Russia
| | - I V Dvorakovskaya
- Pavlov St. Petersburg First State Medical University, St. Petersburg, Russia
| | - P K Yablonsky
- Saint-Petersburg State University, St. Petersburg, Russia
- Saint-Petersbursg City Clinical Hospital No. 2, St. Petersburg, Russia
- Saint-Petersburg State Research Institute of Phthisiopulmonology, St. Petersburg, Russia
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5
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Flanagan SR, Vasavada P. Intralobar Pulmonary Sequestration: A Case Report. Cureus 2023; 15:e46794. [PMID: 37954799 PMCID: PMC10632745 DOI: 10.7759/cureus.46794] [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] [Accepted: 10/09/2023] [Indexed: 11/14/2023] Open
Abstract
Pulmonary sequestration is a congenital lung malformation characterized by a mass of nonfunctioning lung tissue that receives its arterial supply from an aberrant systemic artery. If symptomatic, most newborns present with respiratory distress. Recurrent infection is the most common presentation after the neonatal period. It is often diagnosed prenatally and is treated with elective surgical resection between ages six and twelve months. We present a case of an infant diagnosed with congenital pulmonary airway malformation prenatally revealed to be pulmonary sequestration at the age of six months, emphasizing the need for appropriate postnatal imaging.
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Affiliation(s)
- Shawn R Flanagan
- Diagnostic Radiology, Liberty University College of Osteopathic Medicine, Lynchburg, USA
| | - Pauravi Vasavada
- Pediatric Radiology, University Hospitals Cleveland Medical Center, Cleveland, USA
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6
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Beverstock A, Griesman D, Coren C, Leavens-Maurer J, Noyola E. Epigastric Pain and Pleural Effusion in a 12-Year-Old. Clin Pediatr (Phila) 2023; 62:664-668. [PMID: 36475387 DOI: 10.1177/00099228221142475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Andrew Beverstock
- Department of Pediatrics, NYU Langone Hospital Long Island, Mineola, NY, USA
| | - Dana Griesman
- Department of Pediatrics, NYU Langone Hospital Long Island, Mineola, NY, USA
| | - Charles Coren
- Department of Surgery, NYU Langone Hospital Long Island, Mineola, NY, USA
| | - Jill Leavens-Maurer
- Department of Pediatrics, NYU Langone Hospital Long Island, Mineola, NY, USA
| | - Estela Noyola
- Department of Pediatrics, NYU Langone Hospital Long Island, Mineola, NY, USA
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7
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Oreglio C, Tocchioni F, Ghionzoli M, Buccoliero A, Morabito A, Morini F. Intradiaphragmatic pulmonary sequestrations: a surgical challenge. Case series. Front Surg 2023; 10:1181007. [PMID: 37304185 PMCID: PMC10248170 DOI: 10.3389/fsurg.2023.1181007] [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: 03/06/2023] [Accepted: 05/05/2023] [Indexed: 06/13/2023] Open
Abstract
Bronchopulmonary sequestrations (BPSs) are rare congenital anomalies characterized by non-functioning embryonic lung tissue receiving anomalous blood supply. They are most commonly located within the thorax (supradiaphragmatic) or into the abdominal cavity (infradiaphragmatic). Intradiaphragmatic extralobar BPs (IDEPS) are an exceptionally rare finding, representing a diagnostic and operative challenge. We report three cases of IDEPS and their surgical management, describing our experience and approach to such rare clinical entities. From 2016 to 2022, we treated 3 cases of IDEPS. Surgical techniques, histopathological findings and clinical outcomes were retrospectively evaluated for each case and compared. Three different surgical techniques were used to approach each lesion, from open thoracotomy to a combined laparoscopic and thoracoscopic approach. Histopathological analysis of the specimens revealed hybrid pathological features, proper of both congenital pulmonary airway malformation (CPAM) and extralobar pulmonary sequestration. IDEPS represent a surgical challenge for pediatric surgeons, given their complex surgical planning. In our experience, the thoracoscopic approach is safe and feasible when performed by trained surgeons, even though a combined thoracoscopic-laparoscopic approach allows for optimal vessels control. The presence of CPAM elements within the lesions supports their surgical removal. Additional studies are required to better characterize IDEPS and their management.
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Affiliation(s)
- Chiara Oreglio
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
- Department of Pediatric and Neonatal Surgery, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Francesca Tocchioni
- Department of Pediatric and Neonatal Surgery, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Marco Ghionzoli
- Department of Pediatric and Adolescent Surgery, University of Pisa, Pisa, Italy
- Department of Surgical, Medical, Molecular Pathology and of the Critic Area, University of Pisa, Pisa, Italy
| | | | - Antonino Morabito
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
- Department of Pediatric and Neonatal Surgery, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Francesco Morini
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
- Department of Pediatric and Neonatal Surgery, Meyer Children’s Hospital IRCCS, Florence, Italy
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8
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Gao Y, Xu W, Li W, Chen Z, Li Q, Liu Z, Liu H, Dai L. Epidemiology and prevalence of pulmonary sequestration in Chinese population, 2010-2019. BMC Pulm Med 2023; 23:8. [PMID: 36624419 PMCID: PMC9830928 DOI: 10.1186/s12890-023-02308-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Pulmonary sequestration (PS) is the second common congenital lung malformation and has been known for over 150 years. However, there is a scarcity of epidemiological studies on it. This study aimed to characterize the epidemiology of pulmonary sequestration in Chinese population in the recent decade by using a nationwide database. METHODS Using data from the Chinese Birth Defects Monitoring Network during 2010-2019, the prevalence rates for PS were calculated by birth year, maternal age, residence area, geographical region, and infant sex. Variations in prevalence and changes over time were further examined. Other variables of interest for analysis included the pregnancy outcomes of affected infants, the prenatal diagnosis, and the co-occurring anomalies of PS cases. RESULTS During the study period, we identified an average prevalence rate of 0.31, 0.11, and 0.42 per 10,000 live and still births for the isolated, non-isolated, and overall PS, respectively. An upward trend was observed for each category of PS. The prevalence rates varied significantly by maternal age (< 20 years, 0.34/10,000; 20-24 years, 0.33/10,000; 25-29 years, 0.45/10,000; 30-34 years, 0.46/10,000; ≥ 35 years, 0.36/10,000), residence area (urban vs. rural, 0.51/10,000 vs. 0.30/10,000), geographical region (western, 0.33/10,000; eastern, 0.49/10,000; central, 0.43/10,000), and by infant sex (male vs. female, 0.45/10,000 vs. 0.38/10,000). Non-isolated PS cases were more likely born prematurely than isolated cases (15.29% vs. 7.83%). 40.28% and 33.80% of non-isolated cases were accompanied by additional respiratory, and circulatory system malformations, respectively. CONCLUSIONS The study presents for the first time the prevalence of pulmonary sequestration in Chinese population. The rising prevalence and relatively poor perinatal outcome of affected fetuses or newborns indicate the necessity to improve perinatal management of PS.
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Affiliation(s)
- Yuyang Gao
- grid.13291.380000 0001 0807 1581National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, No.17 Section 3 Renminnanlu, Chengdu, 610041 Sichuan China ,grid.13291.380000 0001 0807 1581Pediatric Department, The Joint Laboratory for Pulmonary Development and Related Diseases, West China Institute of Women and Children’s Health, West China Second University Hospital, Sichuan University, No.17 Section 3 Renminnanlu, Chengdu, 610041 Sichuan China
| | - Wenli Xu
- grid.13291.380000 0001 0807 1581National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, No.17 Section 3 Renminnanlu, Chengdu, 610041 Sichuan China ,grid.13291.380000 0001 0807 1581Pediatric Department, The Joint Laboratory for Pulmonary Development and Related Diseases, West China Institute of Women and Children’s Health, West China Second University Hospital, Sichuan University, No.17 Section 3 Renminnanlu, Chengdu, 610041 Sichuan China
| | - Wenyan Li
- grid.13291.380000 0001 0807 1581National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, No.17 Section 3 Renminnanlu, Chengdu, 610041 Sichuan China
| | - Zhiyu Chen
- grid.13291.380000 0001 0807 1581National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, No.17 Section 3 Renminnanlu, Chengdu, 610041 Sichuan China
| | - Qi Li
- grid.13291.380000 0001 0807 1581National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, No.17 Section 3 Renminnanlu, Chengdu, 610041 Sichuan China
| | - Zhen Liu
- grid.13291.380000 0001 0807 1581National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, No.17 Section 3 Renminnanlu, Chengdu, 610041 Sichuan China
| | - Hanmin Liu
- Pediatric Department, The Joint Laboratory for Pulmonary Development and Related Diseases, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, No.17 Section 3 Renminnanlu, Chengdu, 610041, Sichuan, China. .,National Health Commission Key Laboratory of Chronobiology, Sichuan University, Chengdu, Sichuan, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China. .,NHC Key Laboratory of Chronobiology, Sichuan University, Chengdu, Sichuan, China.
| | - Li Dai
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, No.17 Section 3 Renminnanlu, Chengdu, 610041, Sichuan, China. .,Pediatric Department, The Joint Laboratory for Pulmonary Development and Related Diseases, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, No.17 Section 3 Renminnanlu, Chengdu, 610041, Sichuan, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China. .,Med-X Center for Informatics, Sichuan University, Chengdu, Sichuan, China. .,NHC Key Laboratory of Chronobiology, Sichuan University, Chengdu, Sichuan, China.
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9
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Sadasivan Nair P, Merry C, White A. Intralobar pulmonary sequestration in an adult: a case report. J Cardiothorac Surg 2023; 18:5. [PMID: 36609288 PMCID: PMC9821356 DOI: 10.1186/s13019-023-02127-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 01/02/2023] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Pulmonary sequestration is a rare congenital lung anomaly, presenting mostly in childhood and adolescence. CASE PRESENTATION We report the case of a 26-year-old male patient presenting with pleuritic left sided chest pain and haemoptysis. Computed tomography of the chest showed features of intralobar pulmonary sequestration involving the left lower lobe, with arterial supply arising from the descending thoracic aorta above the diaphragm and normal venous drainage. Video assisted thoracic surgery was planned to perform a left lower lobectomy. Considering the risk of bleeding from the large artery supplying the sequestered segment, a posterolateral thoracotomy incision was made and left lower lobectomy was completed, with successful division of the arterial feeder. The patient was discharged home without complications. Pathologic examination of the specimen grossly revealed partial division of the lobe by two fissures with extensive adhesions into an upper and lower portion with no clear demarcation and a large vessel which enters the lower portion at the posterior inferior aspect, separate from the hilum with a diameter 10 mm. Microscopically, both portions of the lobe showed normally alveolated lung tissue with patchy recent intra-alveolar haemorrhage and evidence of chronic inflammation in the sequestered segment. There was no evidence of malignancy. CONCLUSION This case highlights the rare presentation of pulmonary sequestration in adulthood and the importance of imaging to identify anomalous arterial supply to the sequestered segment in the left lower lobe of the lung. The use of safe surgical techniques to control the anomalous systemic arterial feeding vessel cannot be overemphasized.
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Affiliation(s)
- Prasanth Sadasivan Nair
- grid.1623.60000 0004 0432 511XDepartment of Cardiothoracic Surgery, The Alfred, 55 Commercial Road, Prahran, Melbourne, VIC 3004 Australia
| | - Christopher Merry
- grid.1623.60000 0004 0432 511XDepartment of Cardiothoracic Surgery, The Alfred, 55 Commercial Road, Prahran, Melbourne, VIC 3004 Australia
| | - Alexander White
- grid.1623.60000 0004 0432 511XDepartment of Cardiothoracic Surgery, The Alfred, 55 Commercial Road, Prahran, Melbourne, VIC 3004 Australia
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10
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Weingartz L, Peine B, Humble J, Meyer Z, Torres R, Cox C. Case report: Asymptomatic bronchopulmonary sequestration in an adult with dual celiac and aortic supply. Radiol Case Rep 2022; 17:4218-4222. [PMID: 36105834 PMCID: PMC9464785 DOI: 10.1016/j.radcr.2022.08.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/09/2022] [Accepted: 08/13/2022] [Indexed: 11/30/2022] Open
Abstract
A rare congenital malformation of the respiratory tract, bronchopulmonary sequestration generally presents in childhood and adolescence with recurrent pneumonia or in adulthood as an incidental finding on thoracic imaging. Manifesting as intrapulmonary or extrapulmonary types, bronchopulmonary sequestration characteristically receives blood supply from the systemic rather than pulmonary circulation. We present a 45-year-old male patient who received a provisional diagnosis of bronchopulmonary sequestration following an incidental finding on routine imaging. This case describes the way in which a provisional diagnosis may be made based upon imaging as well as underscoring the importance of alleviating the burden of additional imaging studies.
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11
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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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12
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Elhattab A, Elsaied A, Wafa T, Jugie M, Delacourt C, Sarnacki S, Aly K, Khen-Dunlop N. Thoracoscopic surgery for congenital lung malformations: Does previous infection really matter? J Pediatr Surg 2021; 56:1982-1987. [PMID: 33573805 DOI: 10.1016/j.jpedsurg.2021.01.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/13/2021] [Accepted: 01/19/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND/ PURPOSE Elective resection of congenital lung malformations (CLMs) is still debatable. The two main risks are malignant transformation and recurrent pulmonary infections. Our study aimed to assess the effect of previous pulmonary infection on the intraoperative and postoperative courses of thoracoscopic surgery for CLMs. METHODS This is a retrospective study including all thoracoscopic lung resections for CLMs between 2010 and 2019. Ninety patients were included. There was a history of previous pulmonary infection in 28 patients (group A) and no such history in 62 patients (group B). RESULTS The median age at operation for group A was 20.4 months (IQR:14.9-41.4) versus 15.1 months (IQR:9.7-20.8) in group B (p = 0.006). There were 10 conversions (35.7%) in group A and 8 (12.9%) in group B (p = 0.02). The operative time was significantly shorter in group B (p<0.002). In group A, 32.1% of patients experienced postoperative fever versus 11.3% of group B (p = 0.03), with higher antibiotics requirement (28.6% versus 6.5% respectively, p = 0.007). However, no significant differences were found in terms of postoperative complications (p = 0.99). CONCLUSION Earlier intervention for CLMs before the development of pulmonary infection carries higher chances for the success of the thoracoscopic approach with shorter operative time and more uneventful postoperative courses.
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Affiliation(s)
- Ahmad Elhattab
- Department of Pediatric Surgery, AP-HP, Necker-Enfants malades Hospital, Paris, France; Department of Pediatric Surgery, Mansoura University Children's Hospital, Mansoura, Egypt
| | - Adham Elsaied
- Department of Pediatric Surgery, Mansoura University Children's Hospital, Mansoura, Egypt
| | - Tamer Wafa
- Department of Pediatric Surgery, Mansoura University Children's Hospital, Mansoura, Egypt
| | - Myriam Jugie
- Intensive care Unit, AP-HP, Necker-Enfants malades Hospital, Paris, France
| | - Christophe Delacourt
- Department of Pediatric Pulmonology, AP-HP, Necker-Enfants malades Hospital, Paris, France; Université de Paris, Paris, France
| | - Sabine Sarnacki
- Department of Pediatric Surgery, AP-HP, Necker-Enfants malades Hospital, Paris, France; Université de Paris, Paris, France
| | - Kamal Aly
- Department of Pediatric Surgery, Mansoura University Children's Hospital, Mansoura, Egypt
| | - Naziha Khen-Dunlop
- Department of Pediatric Surgery, AP-HP, Necker-Enfants malades Hospital, Paris, France; Université de Paris, Paris, France
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13
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Jaiswal LS, Neupane D. Pulmonary sequestration presenting as a massive haemoptysis in adult: A case report. Int J Surg Case Rep 2021; 86:106341. [PMID: 34488138 PMCID: PMC8424506 DOI: 10.1016/j.ijscr.2021.106341] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/19/2021] [Accepted: 08/21/2021] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Pulmonary sequestration is a rare congenital lung malformation characterized by non-functioning mass of pulmonary tissue that lacks normal communication with bronchial tree and receives one or more aberrant systemic arterial supply. It usually presents in children with recurrent chest infections. It is uncommon in adult and remains asymptomatic or present with recurrent chest infections, rarely with more severe symptoms like a massive haemoptysis as in seen in our case. CASE PRESENTATION A 22-year-old male presented with a chief complain of multiple episodes of massive haemoptysis. After evaluation with chest x-ray, CT chest and angiogram, he was diagnosed to have intralobar pulmonary sequestration. He underwent successful thoracotomy and left lower lobectomy. He is asymptomatic after one year of follow up. DISCUSSION Pulmonary sequestration is rare in adult and can present with various symptoms like chest pain, cough, sputum production, recurrent infection and rarely haemoptysis. Intralobar sequestration of left lower lobe is the most common as seen in our case. The diagnosis can be made by Computed Tomogram chest with angiogram. Surgical intervention is the definitive curative treatment. Post-operative outcome is excellent with early patient satisfaction and promising outcome in long term follow-up. CONCLUSION Bronchopulmonary sequestration can rarely present in adults presenting with massive haemoptysis. CT chest is the best modality for diagnosis. Early surgical intervention is definitive treatment with good long term outcome.
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Affiliation(s)
- Lokesh Shekher Jaiswal
- Department of Surgery (Division of Cardiothoracic and Vascular Surgery), B. P. Koirala Institute of Health Sciences, Dharan, Nepal.
| | - Durga Neupane
- B. P. Koirala Institute of Health Sciences, Dharan, Nepal
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14
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Ghalib S, Chopra A, Fantauzzi JP, Nabagiez JP, Tiwari A. A Young Woman With Recurrent Episodes of Fever and Cough. Chest 2021; 160:e25-e28. [PMID: 34246384 DOI: 10.1016/j.chest.2021.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 12/30/2020] [Accepted: 01/11/2021] [Indexed: 11/15/2022] Open
Abstract
CASE PRESENTATION A 19-year-old woman presented to pulmonary clinic with recurrent episodes of fevers and productive cough over the last 2 years. She was diagnosed with several episodes of respiratory infection that required antibiotic therapy. Her symptoms improved transiently after antibiotic therapy. However, symptoms continued to recur every 1 to 2 months. She denied any close TB contacts or travel outside the United States. She was a nonsmoker and had no history of immunodeficiency. There was no history of cystic fibrosis or any foreign body aspiration.
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Affiliation(s)
- Sana Ghalib
- Division of Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY.
| | - Amit Chopra
- Division of Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY
| | | | - John P Nabagiez
- Division of Thoracic Surgery, Albany Medical Center, Albany, NY
| | - Anupama Tiwari
- Division of Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY
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15
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Tanka M, Kristo A, Alushani D, Kasmi I, Leka N. A rare case report of simultaneous occurrence of a pediatric pleuropulmonary blastoma and an intralobar pulmonary sequestration. Radiol Case Rep 2021; 16:1727-1731. [PMID: 34007392 PMCID: PMC8111470 DOI: 10.1016/j.radcr.2021.04.040] [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: 03/24/2021] [Revised: 04/19/2021] [Accepted: 04/19/2021] [Indexed: 11/24/2022] Open
Abstract
We are presenting a rare case with the simultaneous occurrence of pleuropulmonary blastoma and an intra lobar pulmonary sequestration. Although there have been cases reported previously with pleuropulmonary blastoma associated with congenital pulmonary malformations, the association with an intra lobar pulmonary sequestration is very rare. The patient, a female, 6-month-old child arrived at our pediatric service with the clinic of cough, respiratory distress, and fever after being treated for 2 weeks for left lung bronchopneumonia according clinical signs and radiographic description but without clinical improvements. Contrast enhanced CT images showed the simultaneous presence of 2 different lesions in the left lung, a heterogeneous mass in the superior lobe without delineation with mediastinal structure compatible with a pleuropulmonary blastoma and a consolidation in the inferior lobe with bronchogram present and a systemic vessel feeding compatible with an intra lobar pulmonary sequestration, both confirmed by histologic examinations after the surgical intervention. Although it is very rare, the simultaneous presence of these distinct embryogenic lesions may occur and radiologist should be aware as the imaging diagnosis may be very helpful for the further management of the patient.
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Affiliation(s)
- Marjeta Tanka
- Pediatric Department, Imagery Service, University Hospital Center "Mother Tereza", Tirana, Albania
| | - Anila Kristo
- Morphology Department, Faculty of Medicine, University of Medicine, Tirana, Albania
| | - Dritan Alushani
- Pediatric Department, Surgery Service, UHC Mother Tereza, Tirana, Albania
| | - Irena Kasmi
- Pediatric Department, UHC "Mother Tereza", Tirana, Albania
| | - Nikollaq Leka
- Morphology Department, Faculty of Medicine, University of Medicine, Tirane, Albania
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16
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Abstract
Bronchopulmonary sequestration is a rare congenital pulmonary abnormality of the lower airways, which includes an abnormal and non-functioning lung tissue not communicating with the tracheobronchial tree and having aberrant blood supply from systemic circulation with variable venous drainage. The incidence of sequestration is around 0.15%–6.4% of all congenital lung malformations. Common presenting features are cough and expectoration. Misdiagnosed cases may present with recurrent infections and haemoptysis. CT of the chest with contrast is the imaging modality of choice. This is a case report of a 32-year-old woman who presented with cough and haemoptysis. CT of the chest showed a multiloculated mass-like lesion in the left lower lobe with a feeding artery from coeliac plexus and venous drainage via the normal left pulmonary vein. Based on CT chest findings, diagnosis of intralobar pulmonary sequestration was made. The patient was reviewed by cardiothoracic surgeons and underwent surgical resection of the sequestrated lung. Common presenting features are cough and expectoration. Misdiagnosed cases may present with recurrent infections and haemoptysis. CT of the chest with contrast is the imaging modality of choice.
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Affiliation(s)
- Muhammad Shafiq
- Respiratory Medicine, Basildon and Thurrock University Hospitals, Mid and South Essex NHS Foundation Trust, Basildon, UK
| | - Amjad Ali
- Respiratory Medicine, Basildon and Thurrock University Hospitals, Mid and South Essex NHS Foundation Trust, Basildon, UK
| | - Ujaas Dawar
- Respiratory Medicine, Basildon and Thurrock University Hospitals, Mid and South Essex NHS Foundation Trust, Basildon, UK
| | - Niranjan Setty
- Respiratory Medicine, Basildon and Thurrock University Hospitals, Mid and South Essex NHS Foundation Trust, Basildon, UK
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17
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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] [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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18
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Zeng B, Zou J, Yang W, Liu Z, Xie C, Cheng C. A Modified VATS Procedure for Treating Adult Intralobar Pulmonary Sequestration. Thorac Cardiovasc Surg 2020; 69:194-196. [PMID: 33202478 DOI: 10.1055/s-0040-1708870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Video-assisted thoracoscopic surgery (VATS) makes it possible to treat intralobar sequestration (ILS) more minimally invasive compared with conventional open surgery. However, this procedure is challenging to expose and isolate the aberrant arteries of ILS and the risk of bleeding is high. Herein, we developed a modified VATS procedure in which the aberrant vessels are treated in the last step of lobectomy, rather than at the beginning. In this way, we can expose the aberrant vessels easier and reduce the risk of massive blood loss, also simplifying the surgical procedure.
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Affiliation(s)
- Bo Zeng
- Department of Thoracic Surgery, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China
| | - Jianyong Zou
- Department of Thoracic Surgery, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China
| | - Weixiong Yang
- Department of Thoracic Surgery, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China
| | - Zhenguo Liu
- Department of Thoracic Surgery, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China
| | - Chunying Xie
- Department of Thoracic Surgery, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China
| | - Chao Cheng
- Department of Thoracic Surgery, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China
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19
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Ruano R, Ibirogba ER, Wyatt MA, Balakrishnan K, Qureshi MY, Kolbe AB, Dearani JA, Boesch RP, Segura L, Arendt KW, Bendel-Stenzel E, Salik SS, Klinkner DB. Sequential Minimally Invasive Fetal Interventions for Two Life-Threatening Conditions: A Novel Approach. Fetal Diagn Ther 2020; 48:70-77. [PMID: 33080593 DOI: 10.1159/000510635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/03/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In utero interventions are performed in fetuses with "isolated" major congenital anomalies to improve neonatal outcomes and quality of life. Sequential in utero interventions to treat 2 anomalies in 1 fetus have not yet been described. CASE PRESENTATION Here, we report a fetus with a large left-sided intralobar bronchopulmonary sequestration (BPS) causing mediastinal shift, a small extralobar BPS, and concomitant severe left-sided congenital diaphragmatic hernia (CDH). At 26-week gestation, the BPS was noted to be increasing in size with a significant reduction in right lung volume and progression to fetal hydrops. The fetus underwent ultrasound-guided ablation of the BPS feeding vessel leading to complete tumor regression. However, lung development remained poor (O/E-LHR: 0.22) due to the left-sided CDH, prompting fetal endoscopic tracheal occlusion therapy at 28-week gestation to allow increased lung growth. After vaginal delivery, the newborn underwent diaphragmatic repair with resection of the extralobar sequestration. He was discharged home with tracheostomy on room air at 9 months. DISCUSSION/CONCLUSION Sequential in utero interventions to treat 2 severe major anomalies in the same fetus have not been previously described. This approach may be a useful alternative in select cases with otherwise high morbidity/mortality. Further studies are required to confirm our hypothesis.
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Affiliation(s)
- Rodrigo Ruano
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA, .,Center for Regenerative Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA,
| | - Eniola R Ibirogba
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Michelle A Wyatt
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Karthik Balakrishnan
- Department of Otorhinolaryngology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - M Yasir Qureshi
- Department of Cardiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Amy B Kolbe
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Joseph A Dearani
- Division of Cardiovascular Surgery, Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - R Paul Boesch
- Division of Pediatric Pulmonology, Department of Pediatrics, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Leal Segura
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Katherine W Arendt
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Ellen Bendel-Stenzel
- Division of Neonatology, Department of Pediatrics, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Shana S Salik
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Denise B Klinkner
- Division of Pediatric Surgery, Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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20
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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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21
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Reyna JC, Zagory JA, Yallapragada S, Santiago-Munoz P, Schindel DT. Impact of Additional Anomalies on Postnatal Outcomes in Congenital Lung Malformations. J Surg Res 2020; 256:611-617. [PMID: 32810660 DOI: 10.1016/j.jss.2020.07.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/29/2020] [Accepted: 07/11/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Approximately 20% of fetuses diagnosed with congenital lung malformations (CLMs) are found to have additional anomalies. We aim to determine if additional anomalies have an impact on postnatal outcomes for patients with CLMs. METHODS After institutional review board approval, we performed a retrospective review of live-born patients with CLMs from 2008 to 2018. All patients were prenatally diagnosed with CLMs. Clinical information pertaining to additional congenital anomalies and outcomes was collected from the electronic health record and analyzed. RESULTS Of the 88 patients who had a prenatal diagnosis of CLMs, 20.5% had additional anomalies. Ten of the 18 patients (56%) were considered to have a major anomaly in addition to CLMs. Outcomes for patients electing nonoperative management of CLMs were similar between those with and without an additional anomaly. Although patients with an additional anomaly were more likely to have perinatal respiratory complications (44% versus 17%, P = 0.03), the number of preoperative clinic and emergency department visits, age at surgery, minimally invasive approach to surgical resection of CLM, estimated blood loss, length of hospital stay, intubation, duration of intubation, 30-day postoperative complications, and long term sequelae were not statistically different. This held true when stratified for major versus minor anomalies. CONCLUSIONS Twenty percent of fetuses diagnosed with CLM in our population have additional anomalies. Newborns with additional anomalies have a higher risk of pre-excision pulmonary complications. However, the overall outcomes of all patients with CLMs are similar.
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Affiliation(s)
- Juan C Reyna
- Pediatric Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jessica A Zagory
- Pediatric Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | - David T Schindel
- Pediatric Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
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22
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Trabalza Marinucci B, Maurizi G, Vanni C, Cardillo G, Poggi C, Pardi V, Inserra A, Rendina EA. Surgical treatment of pulmonary sequestration in adults and children: long-term results. Interact Cardiovasc Thorac Surg 2020; 31:71-77. [PMID: 32300793 DOI: 10.1093/icvts/ivaa054] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/11/2020] [Accepted: 01/30/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Few experiences comparing paediatric and adult patients treated for pulmonary sequestration (PS) have been reported. Surgical treatment is considered the best choice, but the time of surgery is still controversial. We present our experience in this setting, comparing characteristics, histological results and outcome of paediatric and adult patients undergoing PS resection. METHODS Between 1998 and 2017, a total of 74 patients underwent lobectomy or sublobar resection for PS. Sixty patients were children (group A: ≤16 years old) and 14 were adults (group B: >16 years old). Preoperative diagnosis was radiological. PS was intralobar (42 cases) and extralobar (32 cases). The operation was a muscle-sparing lateral thoracotomy or video-assisted thoracoscopic surgery. Preoperative characteristics, histological results and short-/long-term results of the 2 groups were retrospectively analysed and compared. RESULTS Thirty-seven percent of the patients in group A presented with respiratory symptoms and 79% in group B (P = 0.44). Most symptomatic patients were treated with a lobectomy. In group A, 2 patients (3%) had a malignant transformation of the lesion. Patients with a prenatal diagnosis treated after the age of 1 year became more symptomatic than those operated on before the age of 1 year (57% vs 23%; P = 0.08). No differences were found in postoperative complications. Long-term stable remission of respiratory symptoms was obtained in 91% of patients in group A and 100% in group B. Adulthood (P = 0.03) and the association with congenital cystic adenomatoid malformation (P = 0.03) were negative prognostic factors for the development of respiratory symptoms. CONCLUSIONS Surgical treatment of PS is safe and feasible. Despite the small number of patients included, study results indicated that an early operation during childhood may prevent the subsequent development of respiratory symptoms. Surgical treatment is also recommended to prevent the rare transformation into malignancy.
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Affiliation(s)
| | - Giulio Maurizi
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Camilla Vanni
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Giuseppe Cardillo
- Department of Thoracic Surgery, San Camillo Forlanini Hospital, Rome, Italy
| | - Camilla Poggi
- Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Valerio Pardi
- Department of General and Thoracic Surgery, Bambino Gesù Children's Research Hospital IRCCS, Rome, Italy
| | - Alessandro Inserra
- Department of General and Thoracic Surgery, Bambino Gesù Children's Research Hospital IRCCS, Rome, Italy
| | - Erino A Rendina
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University, Rome, Italy
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23
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Aftab G, Agrawal A, Nuguru S, Frenia D. Intrapulmonary 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] [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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24
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Sun Y, Shao F, Zhang Q, Wang Z. Feasibility investigation of uniportal video-assisted thoracoscopic anatomical lung resection for pulmonary sequestration. J Cardiothorac Surg 2020; 15:93. [PMID: 32404207 PMCID: PMC7222582 DOI: 10.1186/s13019-020-01126-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/28/2020] [Indexed: 11/23/2022] Open
Abstract
Background Uniportal video-assisted thoracic surgery (UVATS) technique has been increasingly used for many thoracic diseases. Whether UVATS has equivalent or better perioperative outcomes for pulmonary sequestration (PS) patients remains controversial. Our study aimed to evaluate the feasibility of UVATS in anatomical lung resection for pulmonary sequestration. Methods A total of 24 patients with PS including fifteen males and nine females with the mean age of 40 (range, 18–65) years old, who had received completely UVATS anatomical lung resection for PS in Nanjing Chest Hospital between January 2016 and December 2018 were retrospectively reviewed. Related clinical data were retrieved from hospital records and analyzed. Results All 24 patients had been treated with the UAVTS approach successfully without aberrant artery ruptured or massive hemorrhage, and no patients died during the perioperative period. Overall mean surgery time was 102 mins (range, 55–150 min), the mean blood loss was 94 ml (range, 10-300 ml), the mean days of chest tube maintained were 4 days (range,1-10 days), and the mean postoperative hospitalization days was 6 days (range,2-11 days). All patients were cured, without cough, fever, hemoptysis, and so on, associated with PS, occurring during the average follow-up of 17 months (range, 3-35 months). Conclusions Our preliminary results revealed that anatomical lung resection by UVATS is a safe and feasible mini-invasive technique for PS patients, which might be associated with less postoperative pain, reduced paresthesia, better cosmetic results, and faster recovery.
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Affiliation(s)
- Yungang Sun
- Department of Thoracic Surgery, Nanjing Chest Hospital, Nanjing Brain Hospital Affiliated to Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029, China.,Pulmonary Nodule Diagnosis and Treatment Research Center, Nanjing Medical University, Nanjing, China
| | - Feng Shao
- Department of Thoracic Surgery, Nanjing Chest Hospital, Nanjing Brain Hospital Affiliated to Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029, China. .,Pulmonary Nodule Diagnosis and Treatment Research Center, Nanjing Medical University, Nanjing, China.
| | - Qiang Zhang
- Department of Thoracic Surgery, Nanjing Chest Hospital, Nanjing Brain Hospital Affiliated to Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029, China.,Pulmonary Nodule Diagnosis and Treatment Research Center, Nanjing Medical University, Nanjing, China
| | - Zhao Wang
- Department of Thoracic Surgery, Nanjing Chest Hospital, Nanjing Brain Hospital Affiliated to Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029, China.,Pulmonary Nodule Diagnosis and Treatment Research Center, Nanjing Medical University, Nanjing, China
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25
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Sha JM, Zhao H, Lin ZB. Anomalous Systemic Arterial Supply to the Lung: To Which Category Should This Belong? Heart Lung Circ 2020; 29:1292-1300. [PMID: 32349946 DOI: 10.1016/j.hlc.2019.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 06/23/2019] [Accepted: 08/04/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The nomenclature of both intralobar pulmonary sequestration (ILS) and aortic origin of a pulmonary artery (AOPA) remains controversial. According to this review, both ILS and AOPA have an anomalous systemic arterial supply to all or part of the lung with venous drainage into the pulmonary veins, which leads to pulmonary hypertension, congestive heart failure, and fatal pulmonary haemorrhage. The purpose of this review was to consider whether these two rare congenital anomalies have similar anatomical, clinical and pathological characteristics. METHODS This review was conducted by researching relevant literature using PubMed and MEDLINE databases to January 2019. All researched literature was related to the anatomical, associated anomalies, pathophysiology and clinical features of the extralobar pulmonary sequestration (ELS), ILS, and AOPA, and the therapeutic method for ILS and AOPA. RESULTS Through research literature, it was found that ILS and AOPA may differ in terms of embryonic origin, but some of the anatomical, histopathological, physiological and clinical features of these two congenital malformations are similar. However, ELS and ILS have significant differences in their anatomical, histopathological, physiological, and clinical features. CONCLUSIONS This study proposes that ILS and AOPA could be classified as one single condition - systemic arterialisation of the lung - and further divided into three subtypes, namely: types I, II and III. This new classification nomenclature permits the appropriate change of novel surgical techniques, which obviate the need for lobectomy or segmentectomy in specific cases, thereby minimising fatal postoperative complications.
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Affiliation(s)
- Ji-Ming Sha
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Anhui Medical University, Anhui, China.
| | - Hui Zhao
- Department of Respiratory Medicine, The Second Affiliated Hospital of Anhui Medical University, Anhui, China
| | - Ze-Bang Lin
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Anhui Medical University, Anhui, China
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Robson VK, Shieh HF, Wilson JM, Buchmiller TL. Non-operative management of extralobar pulmonary sequestration: a safe alternative to resection? Pediatr Surg Int 2020; 36:325-331. [PMID: 31707604 DOI: 10.1007/s00383-019-04590-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE This retrospective cohort study compares the natural history of patients with extralobar sequestrations (ELS) who do not undergo intervention with those who undergo resection to assess the safety of non-operative management. METHODS 126 patients with pulmonary sequestrations or congenital pulmonary airway malformations born between 1999 and 2016 were identified. 49 patients had ELS on postnatal imaging, but two were excluded for associated congenital diaphragmatic hernia. Demographic and clinical data were retrospectively reviewed, with phone follow-up for non-operative patients with no records for > 1 year. Statistical analysis was by Fisher's exact test or Wilcoxon signed-rank test (two-tailed p < 0.05). RESULTS 40% (19/47) were managed non-operatively and 60% (28/47) underwent resection. Non-operative patients were less likely to have an intrathoracic ELS: 47% (9/19) vs. 75% (21/28), p = 0.07. No symptoms were attributable directly to the ELS. Non-operative patients had median follow-up 3.2 years, during which time 88% (15/17) of ELS decreased in size on serial imaging. For patients who underwent resection, there was 100% concordance between imaging and intraoperative findings. There was no evidence of inflammation, infection or malignancy on final pathology, though 57% (16/28) of resected lesions had foci of non-aerated cysts. CONCLUSIONS Although further longitudinal study is required, this study supports the safety of non-operative ELS management.
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Affiliation(s)
- Victoria K Robson
- Department of Medicine and Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Hester F Shieh
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Fegan 3rd Floor, Boston, MA, 02115, USA
| | - Jay M Wilson
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Fegan 3rd Floor, Boston, MA, 02115, USA
| | - Terry L Buchmiller
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Fegan 3rd Floor, Boston, MA, 02115, USA.
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Kim HJ, Shin KE, Park JS, Lee H, Lee JW, Chin S, Shin HK. Intralobar pulmonary sequestration with cystic degeneration mimicking a bronchogenic cyst in an elderly patient: A case report and literature review. Medicine (Baltimore) 2020; 99:e19347. [PMID: 32118772 PMCID: PMC7478580 DOI: 10.1097/md.0000000000019347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Pulmonary sequestration (PS) is a rare congenital malformation defined as nonfunctioning lung tissue supplied by systemic circulation. It is uncommonly diagnosed in adults. Herein, we describe a clinical case of PS with cystic degeneration mimicking a bronchogenic cyst in an elderly patient. PATIENT CONCERNS A huge cystic mass was incidentally found in a 65-year-old man on chest computed tomography (CT) scans during preoperative workup for a hand laceration. A 15-cm-sized round cystic mass was detected in the right lower lobe. DIAGNOSIS After reviewing the chest CT scan, we decided to perform contrast-enhanced chest magnetic resonance imaging (MRI) and CT-guided lung aspiration biopsy. On MRI, the lesion had the appearance of a cystic mass with hemorrhagic clots, such as an intrapulmonary bronchogenic cyst. The aspirated specimen was nondiagnostic; thus, we decided to surgically remove the mass. INTERVENTIONS Upon right lower lobectomy, the mass was diagnosed as a PS. A thin systemic artery supplying the cystic mass was visualized during surgery. OUTCOMES The patient is undergoing regular follow-up at the outpatient clinic. CONCLUSIONS PS should be considered as a differential diagnosis in patients with a cystic lung mass. Identification of a systemic artery on radiologic imaging is important in the diagnosis of PS before preoperative workup to prevent unpredicted massive bleeding during surgery.
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Affiliation(s)
| | | | | | | | | | | | - Hwa Kyun Shin
- Department of Thoracic and Vascular Surgery, Soonchunhyang University Hospital Bucheon, Bucheon, South Korea
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Cherian SV, Kumar A, Ocazionez D, Estrada -Y- Martin RM, Restrepo CS. Developmental lung anomalies in adults: A pictorial review. Respir Med 2019; 155:86-96. [PMID: 31326738 DOI: 10.1016/j.rmed.2019.07.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 06/03/2019] [Accepted: 07/05/2019] [Indexed: 11/16/2022]
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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] [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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Zhang N, Zeng Q, Chen C, Yu J, Zhang X. Distribution, diagnosis, and treatment of pulmonary sequestration: Report of 208 cases. J Pediatr Surg 2019; 54:1286-1292. [PMID: 30291025 DOI: 10.1016/j.jpedsurg.2018.08.054] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 07/28/2018] [Accepted: 08/07/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE This study was performed to explore the clinical features, typing, distribution, and treatment of pulmonary sequestration (PS), with the aim of improving the awareness and treatment of this condition. METHODS Clinical data regarding surgical procedures, outcomes, and prognosis of 208 pediatric patients with PS who were treated in our center from January 2005 to October 2017 were retrospectively analyzed. RESULTS PS was confirmed by ultrasonography, enhanced computed tomography (CT), and/or magnetic resonance imaging (MRI) before surgery, and the surgeries were smoothly performed in all 208 patients (138 males, 70 females; age, 1 month to 14 years; mean age, 19.70 ± 48.82 months). The operative time ranged from 10 to 230 min (mean, 70 ± 48.75 min), and the intraoperative blood loss volume ranged from 1 to 200 ml (mean, 5 ± 18 ml). PS was located in multiple sites of the thoracic cavity and was also found in some rare locations such as the neck and abdomen. The feeding arteries of the PS mainly arose from the thoracic aorta or abdominal aorta, and a few of them originated from other vessels in the systemic circulation. The venous drainage differed between intralobar and extralobar PS: in patients with intralobar PS, the venous drainage was mainly via the pulmonary veins, especially the lower pulmonary veins; in patients with extralobar PS, the venous drainage was via the azygos vein and hemiazygos vein or reached the right atrium via the vena cava. The infection rate in children with intralobar sequestration was 71.17% (79/111), and that in children with extralobar sequestration was 31.37% (16/51). CONCLUSION PS has increasingly been detected by prenatal ultrasonography, and enhanced CT and MRI are the main techniques for diagnosing PS. Once confirmed, PS should be surgically resected. We choose an age of 6 to 12 months for surgical resection. Minimally invasive video-assisted thoracic surgery has many advantages in the treatment of PS and can be the treatment of choice for this condition. TYPE OF STUDY Treatment Study. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Na Zhang
- Department of Thoracic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China
| | - Qi Zeng
- Department of Thoracic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China.
| | - Chenghao Chen
- Department of Thoracic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China
| | - Jie Yu
- Department of Thoracic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China
| | - Xu Zhang
- Department of Thoracic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China
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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] [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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Shah MA, Shah I. Not all hemoptysis is tuberculosis - It could be intralobar bronchopulmonary sequestration. Lung India 2019; 36:72-73. [PMID: 30604710 PMCID: PMC6330792 DOI: 10.4103/lungindia.lungindia_425_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Miti Aatish Shah
- Department of Pediatrics, Pediatric TB Clinic, B J Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Ira Shah
- Department of Pediatrics, Pediatric TB Clinic, B J Wadia Hospital for Children, Mumbai, Maharashtra, India
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Greenspon A, Samuels L, Greenspon L. Extralobar Sequestration Complicated by a Cystic Hamartoma in an Adult. Ann Thorac Surg 2018; 108:e43-e44. [PMID: 30529677 DOI: 10.1016/j.athoracsur.2018.10.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/05/2018] [Accepted: 10/25/2018] [Indexed: 10/27/2022]
Abstract
A 49-year-old woman presented after a respiratory infection with an abnormal chest roentgenogram demonstrating a cystic calcified mass at the base of the right lung. A chest computed tomographic angiogram demonstrated that the blood supply arose from the abdominal aorta. This extralobar sequestration was surgically resected using video-assisted thoracoscopy without complication. The pathology report showed a cystic hamartoma. This case highlights the importance of preoperative evaluation of the blood supply of suspected sequestrations and the very rare disorder that was found.
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Affiliation(s)
- Andrew Greenspon
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Louis Samuels
- Department of Cardiothoracic Surgery, Albert Einstein Health Network and Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lee Greenspon
- Department of Pulmonary and Critical Care Medicine, Lankenau Medical Center, Wynnewood, Pennsylvania.
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34
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Lin TH, Huang WL, Chang CC, Yen YT, Lai WW, Tseng YL, Chen YY. Uniportal video-assisted thoracoscopic surgery lobectomy and segmentectomy for pulmonary sequestration. J Thorac Dis 2018; 10:3722-3728. [PMID: 30069370 DOI: 10.21037/jtd.2018.05.151] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Pulmonary sequestration is a rare disease whose development begins in the embryonic stage. Surgery is the definitive treatment for eliminating respiratory symptoms and preventing complications. Reports of uniportal video-assisted thoracoscopic surgery (VATS) lobectomy and segmentectomy for pulmonary sequestration are limited in the literature. This study analyzes the perioperative results of the uniportal approach and compared them with those of the multiportal approach for pulmonary sequestration. Methods We collected a VATS series in a single institute from 2007 to 2017. Adult patients diagnosed with pulmonary sequestration and who had received surgical intervention were included. The use of uniportal VATS began from 2016. The perioperative outcomes for uniportal and multiportal approaches were compared. Results A total of 19 patients (7 in the uniportal group and 12 in the multiportal group) were included. VATS segmentectomy was performed significantly more in the uniportal group (P=0.033). Shorter operative time, less intraoperative blood loss, shorter pleural drainage time, and shorter postoperative hospital stay were found for the uniportal group; however, the differences compared with the multiportal group were not significant. There was also no significant difference in perioperative parameters among patients who underwent wedge resection, segmentectomy and lobectomy, respectively. All patients were symptom-free in the follow-up. Conclusions The perioperative results for a series of uniportal VATS anatomical resections for pulmonary sequestration were found to be better than those obtained with the multiportal approach. Although a challenging procedure, uniportal VATS segmentectomy can be performed safely for pulmonary sequestration to preserve more healthy pulmonary parenchyma.
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Affiliation(s)
- Tzu-Hung Lin
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Wei-Li Huang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Chao-Chun Chang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Yi-Ting Yen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Wu-Wei Lai
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Yau-Lin Tseng
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Ying-Yuan Chen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
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35
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Gupta R, Patadia D, Belligund P. An atypical presentation of pulmonary sequestration. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 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] [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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Abstract
Congenital lung malformations comprise a group of anatomical abnormalities of the respiratory tree including congenital cystic malformations, bronchopulmonary sequestrations, bronchogenic cyst, bronchial atresia, and congenital lobar emphysema. These anomalies are detected with increasing frequency by pre-natal sonography, but may also present for the first time with symptoms in childhood or later life. When symptomatic, there is little controversy that resection is indicated, which is usually curative. When a lesion is asymptomatic there is greater debate regarding the benefit of resection versus continued observation. This article provides an overview of the spectrum of disorders, the management options available and the long-term outcomes associated with each treatment option.
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Affiliation(s)
- Nigel J Hall
- University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton General Hospital, Mailpoint 816, Tremona Rd, Southampton SO16 6YD, UK; Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK.
| | - Michael P Stanton
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK
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Rossi JB. Atypical pulmonary sequestration causing respiratory distress in a 2-month-old male infant. Pediatr Surg Int 2017; 33:807-811. [PMID: 28243740 DOI: 10.1007/s00383-017-4072-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2017] [Indexed: 10/20/2022]
Abstract
Pulmonary sequestrations are non-functional masses of lung tissue lacking normal communication with the tracheobronchial tree and systemic-circulation-derived blood supply. The disconnection between the normal airway and pulmonary arterial supply prevents pulmonary sequestrations from participating in respiration while their aberrant circulation increases the potential for hemodynamic imbalance. Extralobar sequestrations are prenatally diagnosed, congenital lesions that may become symptomatic before or after birth, whereas intralobar sequestrations are usually identified during adulthood. This report describes a 2-month-old boy with respiratory distress caused by an anomaly characterized by a systemic artery feeding a large segment of the left lower lobe lacking normal ventilation due to absent bronchial connections. This segment that was surrounded by its own visceral pleura, and separated from the normal lower lobe by a fissure, drained through a large vessel into the left inferior pulmonary vein, causing left-to-left shunting and high output failure. Symptoms disappeared immediately following thoracoscopic division of the aberrant vessels and excision of only the sequestered segment. This case accentuates the hemodynamic imbalance set off by a left-to-left shunt across an atypical sequestration that although intralobar was separated by an accessory fissure from the normal parenchyma and also the benefits of video-assisted thoracoscopic surgery.
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Affiliation(s)
- Julio Bauza Rossi
- San Jorge Children's Hospital, San Juan, Puerto Rico. .,Universidad Central del Caribe School of Medicine, Bayamón, Puerto Rico. .,, 55 Dorado Beach East, Dorado, 00646-2049, Puerto Rico.
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Zener R, Bottoni D, Zaleski A, Fortin D, Malthaner RA, Inculet RI, Mujoomdar A. Transarterial embolization of intralobar pulmonary sequestration in a young adult with hemoptysis. J Thorac Dis 2017; 9:E188-E193. [PMID: 28449501 DOI: 10.21037/jtd.2017.02.82] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Intralobar pulmonary sequestration is a rare congenital malformation characterized by the presence of dysplastic lung that does not communicate with the tracheobronchial tree, and has aberrant systemic arterial supply. While most are asymptomatic, they rarely can present with hemoptysis, which has been traditionally managed with surgical resection of the sequestration. We report a case of an 18-year-old male who presented with acute large-volume hemoptysis on a background of recurrent minor episodes of hemoptysis, due to intralobar sequestration. He was successfully treated with transarterial embolization with a combination of polyvinyl alcohol (PVA) particles, gelfoam and coils. Transarterial embolization can be effective in managing emergent hemoptysis from pulmonary sequestration.
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Affiliation(s)
- Rebecca Zener
- Department of Medical Imaging, Western University, Victoria Hospital, London Health Sciences Centre, London, Ontario N6A 5W9, Canada
| | - David Bottoni
- Division of Thoracic Surgery, Western University, Victoria Hospital, London Health Sciences Centre, London, Ontario N6A 5W9, Canada
| | - Andrew Zaleski
- Department of Medical Imaging, Western University, Victoria Hospital, London Health Sciences Centre, London, Ontario N6A 5W9, Canada
| | - Dalilah Fortin
- Division of Thoracic Surgery, Western University, Victoria Hospital, London Health Sciences Centre, London, Ontario N6A 5W9, Canada
| | - Richard A Malthaner
- Division of Thoracic Surgery, Western University, Victoria Hospital, London Health Sciences Centre, London, Ontario N6A 5W9, Canada
| | - Richard I Inculet
- Division of Thoracic Surgery, Western University, Victoria Hospital, London Health Sciences Centre, London, Ontario N6A 5W9, Canada
| | - Amol Mujoomdar
- Department of Medical Imaging, Western University, Victoria Hospital, London Health Sciences Centre, London, Ontario N6A 5W9, Canada
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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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40
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Pikwer A, Gyllstedt E, Lillo-Gil R, Jönsson P, Gudbjartsson T. Pulmonary Sequestration — A Review of 8 Cases Treated with Lobectomy. Scand J Surg 2016; 95:190-4. [PMID: 17066616 DOI: 10.1177/145749690609500312] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background and Aims: Pulmonary sequestration (PS) is a rare congenital malformation where non-functioning lung tissue is separated from the bronchial tree and vascularised with an aberrant artery from the systemic circulation. The aim of this report was to study all patients who were treated for PS at Lund University Hospital between 1994 and 2004, with emphasis on clinical presentation of the disease and evaluate the results of surgical treatment. Material and Methods: 8 cases were identified, 7 females and one male, with a mean age of 7.3 years (range 25 days — 17 years) at the time of diagnosis. Results: Out of 8 patients, seven presented with respiratory symptoms and two with congestive heart failure. Five patients had other congenitial malformations; including scimitar syndrome and congenital heart disease. All the patients underwent a successful lobectomy. There were no major postoperative complications. At a medium follow-up of 77 months all of the fully treated children were doing well. Conclusion: Respiratory and cardiovascular symptoms are the most common symptoms related to PS. The wide range of clinical symptoms may cause diagnostic problems, especially in children and young adults with concomitant congenital heart disease. Therefore PS should be considered as a differential diagnosis in children with unexplained respiratory symptoms or with signs of congestive heart failure. In patients with PS, lobectomy seems to be a good therapeutic option.
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Affiliation(s)
- A Pikwer
- The Department of Cardiothoracic Surgery, Faculty of Medicine, Lund University Hospital and Lund University, Lund, Sweden
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Tashtoush B, Memarpour R, Gonzalez J, Gleason JB, Hadeh A. Pulmonary Sequestration: A 29 Patient Case Series and Review. J Clin Diagn Res 2015; 9:AC05-8. [PMID: 26816878 DOI: 10.7860/jcdr/2015/16004.7006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 10/22/2015] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Pulmonary sequestration also known as bronchopulmonary sequestration is a rare disease, with very few case series reviewed in literature. In this study, we review the demographics, presentation, imaging and treatment of pulmonary sequestration in 29 patients from our institution, and provide comparison data from previously published series with an overview of the disease history. MATERIALS AND METHODS Records reviewed for all patients evaluated and treated in our institution with a pathological proven diagnosis of pulmonary sequestration from January 2004 through December 2013. Collected data included demographics, clinical presentation, diagnostic imaging, location of the lesion, type of sequestration, and subsequent treatment. RESULTS Of the 29 patients reviewed 8 (28%) were children 0-2 years, 1 adolescent age 17, and 20 (69%) adults 21-70 years with a mean age of 42 among adults. Systemic arterial supply to the sequestered segment was demonstrated with computed tomographic angiography (CTA) in 25 patients (86%). In 19 patients (66%), the sequestered segment was located in the left lower lobe, and 16 (55%) were intralobar. CONCLUSION Diagnostic delays of pulmonary sequestration were common among the adult population as the presenting symptoms often mimicked other common pulmonary diseases, such as pneumonia and asthma. These findings were consistent among previously published series. CTA was the preferred imaging modality for preoperative planning with high sensitivity and specificity in identifying the lesion.
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Affiliation(s)
- Basheer Tashtoush
- Fellow, Department of Pulmonary and Critical Care Medicine, Cleveland Clinic , Florida, 2950 Cleveland Clinic Blvd. 33331, Weston, Florida, USA
| | - Roya Memarpour
- Research Fellow, Department of Pulmonary and Critical Care Medicine, Cleveland Clinic , Florida, 2950 Cleveland Clinic Blvd. 33331, Weston, Florida, USA
| | - Jose Gonzalez
- Fellow, Department of Pulmonary and Critical Care Medicine, Cleveland Clinic , Florida, 2950 Cleveland Clinic Blvd. 33331, Weston, Florida, USA
| | - James Benjamin Gleason
- Fellow, Department of Pulmonary and Critical Care Medicine, Cleveland Clinic , Florida, 2950 Cleveland Clinic Blvd. 33331, Weston, Florida, USA
| | - Anas Hadeh
- Attending Physician, Department of Pulmonary and Critical Care Medicine, Cleveland Clinic , Florida, 2950 Cleveland Clinic Blvd. 33331, Weston, Florida, USA
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Sotto Mayor J, Rocha D, Esperança S, Oliveira e Silva A. Intralobar pulmonary sequestration: diagnostic expertise. BMJ Case Rep 2015; 2015:bcr-2015-212384. [PMID: 26584907 DOI: 10.1136/bcr-2015-212384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
An obese 22-year-old man with a history of recurrent respiratory infections presented to the emergency room with left pleuritic chest pain, productive cough with mucupurulent sputum and an axillary temperature of 37.7°C. Blood work showed elevated inflammatory parameters and chest X-ray was relevant for heterogeneous infiltration in the left base and opacity of the left costophrenic angle. An angio-CT scan revealed areas of bilateral consolidation with presence of an arterial branch originating from the aorta to the collected area of the left lower lobe, consistent with a respiratory infection grafted on a intralobar pulmonary sequestration of the left lung base. The infectious process was treated and the patient was planned for a lower left lobectomy.
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Affiliation(s)
| | - Diogo Rocha
- Department of Radiology, Hospital de Braga, Braga, Portugal
| | - Sofia Esperança
- Department of Internal Medicine, Hospital de Braga, Braga, Portugal
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Tsubouchi H, Matsumoto N, Yanagi S, Ashitani JI, Nakazato M. Successful treatment of chronic lower respiratory tract infection by macrolide administration in a patient with intralobar pulmonary sequestration and primary ciliary dyskinesia. Respir Med Case Rep 2015; 15:62-5. [PMID: 26236606 PMCID: PMC4501538 DOI: 10.1016/j.rmcr.2015.05.008] [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] [Received: 02/27/2015] [Revised: 04/19/2015] [Accepted: 05/12/2015] [Indexed: 12/21/2022] Open
Abstract
Primary ciliary dyskinesia (PCD) is a genetic disease associated with abnormalities in ciliary structure and function. Although recurrent respiratory infection associated with ciliary dysfunction is a common clinical feature, there is no standardized treatment or management of respiratory infection in PCD patients. Here, we report that respiratory infection with PCD and intralobar sequestration (ILS) were treated successfully with clarithromycin before the surgical resection of ILS. A 15-year-old non-smoking Japanese woman was admitted for productive cough and dyspnea on exertion. Chest CT scan on admission showed complex cystic LESIONS with air-fluid level in the right lower lobe, and diffuse nodular shadows in the whole lobe of the lung. On flexible bronchoscopy examination, sputum and bronchiolar fluid cultures revealed Staphylococcus aureus (S. aureus). An electron microscopic examination of the cilia showed inner dynein arm deficiency. Administration of clarithromycin improved the lower respiratory tract infection associated with S. aureus. CT angiography after clarithromycin treatment demonstrated an aberrant systemic artery arising from the celiac trunk and supplying the cystic mass lesions that were incorporated into the normal pulmonary parenchyma without their own pleural covering. Based on these results, the patient was diagnosed with PCD and ILS. Because of the clarithromycin treatment, resection of the ILS was performed safely without any complications. Although further observation of clarithromycin treatment is needed, we believe that clarithromycin may be considered one of the agents for treating PCD.
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Affiliation(s)
- Hironobu Tsubouchi
- Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 889-1692, Japan
| | - Nobuhiro Matsumoto
- Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 889-1692, Japan
| | - Shigehisa Yanagi
- Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 889-1692, Japan
| | - Jun-Ichi Ashitani
- Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 889-1692, Japan
| | - Masamitsu Nakazato
- Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 889-1692, Japan
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Abstract
Antenatal diagnosis of lung lesion has become more accurate resulting in dilemma and controversies of its antenatal and postnatal management. Majority of antenatally diagnosed congenital lung lesions are asymptomatic in the neonatal age group. Large lung lesions cause respiratory compromise and inevitably require urgent investigations and surgery. The congenital lung lesion presenting with hydrops requires careful postnatal management of lung hypoplasia and persistent pulmonary hypertension. Preoperative stabilization with gentle ventilation with permissive hypercapnia and delayed surgery similar to congenital diaphragmatic hernia management has been shown to result in good outcome. The diagnostic investigations and surgical management of the asymptomatic lung lesions remain controversial. Postnatal management and outcome of congenital cystic lung lesions are discussed.
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Affiliation(s)
- Dakshesh H Parikh
- Department of Paediatric Surgery, Birmingham Children׳s Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham B4 6NH, UK.
| | - Shree Vishna Rasiah
- Southern West Midlands Newborn Network and Birmingham Women's Health Care NHS Trust, Mindelsohn Way, Edgbaston Birmingham, B15 2TG UK
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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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Liang C, Xu S, Zhao B, Ma G, Du Y. Primary Pulmonary Sequestration With Secondary Hamartomatosis Change. IRANIAN JOURNAL OF RADIOLOGY 2015; 12:e11591. [PMID: 26528382 PMCID: PMC4623778 DOI: 10.5812/iranjradiol.11591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 02/27/2014] [Accepted: 05/17/2014] [Indexed: 11/21/2022]
Abstract
The radiologic features of intralobar pulmonary sequestration (ILPS) have been describe and include the identification of a feeding systemic artery with venous drainage through pulmonary veins. Primary sequestration associated with typical hamartoma signs is really rare and has been described only once. We describe a patient with ILPS whose radiographic findings were unusual for two reasons. First, computed tomography (CT) demonstrated a bulky mass in the pulmonary sequestration. The size of lesion and histopathology made it an unusual presentation. Final histology study demonstrated pulmonary hamartoma with predominantly adipose and cartilage differentiation, which is an unusual complication originated from ILPS. Another sign also explains the second unusual feature, intracranial cholesteatoma, occurring concurrently with ILPS.
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Affiliation(s)
- Changhu Liang
- Shandong Medical Imaging Research Institute, Affiliated to Shandong University, Jinan, P. R. China
| | - Shifeng Xu
- Department of Surgery, Provincial Hospital, Affiliated to Shandong University, Jinan, P. R. China
- Corresponding author: Shifeng Xu, Department of Surgery, Provincial Hospital, Affiliated to Shandong University, Jinan, P. R. China. Tel: +86-53168776931, Fax: +86-53187938911, E-mail:
| | - Bin Zhao
- Shandong Medical Imaging Research Institute, Affiliated to Shandong University, Jinan, P. R. China
| | - Guoyuan Ma
- Department of Thoracic Surgery, Provincial Hospital, Affiliated to Shandong University, Jinan, P. R. China
| | - Yinglin Du
- Shandong Provincial Center for Disease Control and Prevention, Public Health Institute 72, Jinan, P. R. China
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Pinto RM, Araujo Júnior E, Augusto LC, Costa JIF, Dias DA, Aguiar LB, Carvalho FH. Spontaneous regression of intralobar pulmonary sequestration during the pregnancy: report of two cases through relationships between mass and fetal biometry and review of the literature. J Matern Fetal Neonatal Med 2015; 29:1720-4. [DOI: 10.3109/14767058.2015.1063608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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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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Yagasaki H, Makino K, Goto Y, Suzuki T, Oyachi N, Obana K, Ko J, Komai T. Thyroglossal duct cyst accompanied by laryngomalacia and pulmonary sequestration. Pediatr Int 2014; 56:e7-10. [PMID: 24894942 DOI: 10.1111/ped.12309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 01/10/2014] [Accepted: 01/27/2014] [Indexed: 11/30/2022]
Abstract
A 2-month-old full-term female infant developed nasal stridor, which progressed to respiratory distress and poor sucking ability. Direct pharyngoscopy showed laryngomalacia and a midline cystic mass in the lingual region. The mass pressed on the epiglottis, causing dyspnea. Computed tomography incidentally revealed extralobar pulmonary sequestration. Direct deroofing of the lingual cyst and plication of the epiglottis were performed at 3 months of age, and the patient recovered from the respiratory distress. Histopathology of the cystic mass showed a thyroglossal duct cyst. Thoracoscopic resection of the pulmonary sequestration was then done at 17 months of age. Thyroglossal duct cysts in the lingual region may cause destabilization of the epiglottis and laryngomalacia, resulting in acquired respiratory obstruction. The combination of thyroglossal duct cyst, laryngomalacia, and pulmonary sequestration is rare; therefore, reports must be accumulated in order to explore the embryological origins of such cases.
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Affiliation(s)
- Hideaki Yagasaki
- Department of Pediatrics, Yamanashi Prefectural Central Hospital, Yamanishi, Japan; Department of Pediatrics, Faculty of Medicine, University of Yamanashi, Yamanishi, Japan
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