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Li L, Wang Y, Sun L, Wang W. A seven-month-old baby presenting excessive crying for pulmonary sequestration with torsion: A case report and literature review. Respirol Case Rep 2024; 12:e70016. [PMID: 39224119 PMCID: PMC11368437 DOI: 10.1002/rcr2.70016] [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: 07/01/2024] [Accepted: 08/27/2024] [Indexed: 09/04/2024] Open
Abstract
Pulmonary sequestration with torsion is a rare condition. We describe a seven-month-old baby presenting excessive crying for pulmonary sequestration with torsion. Contrast-enhanced chest computed tomography demonstrated an oval-shaped mass in the posteromedial right lower chest, no systemic arterial supply was evident. The edge of the mass showed slight linear reinforcement, and its interior had no reinforcement. Thoracoscopic segmentectomy was carried out and histology confirmed pulmonary sequestration with torsion.
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Affiliation(s)
- Li Li
- Department of Respiratory DiseasesShenzhen Children's HospitalShenzhenChina
| | - Yuanxiang Wang
- Department of Thoracic SurgeryShenzhen Children's HospitalShenzhenChina
| | - Longwei Sun
- Department of RadiologyShenzhen Children's HospitalShenzhenChina
| | - Wenjian Wang
- Department of Respiratory DiseasesShenzhen Children's HospitalShenzhenChina
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El Moghazy H, Mahmoud T, Mamdoh A, Rashed EN, Eissa M. Mini-laparotomy in-situ pyeloplasty for repair of the ureteropelvic junction obstruction: Outcome of 150 cases. Urologia 2023; 90:702-708. [PMID: 37572011 DOI: 10.1177/03915603231175710] [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: 08/14/2023]
Abstract
OBJECTIVE To evaluate the functional and cosmetic outcomes of using the mini-laparotomy technique In Situ pyeloplasty to repair UPJ obstruction in young infants less than 6 months. MATERIALS AND METHODS Between January 2014 and March 2020, 150 young infants (less than 6 months) diagnosed with unilateral ureteropelvic junction obstruction (UPJO) and treated by mini-laparotomy In Situ pyeloplasty were included in this analysis. Once the UPJ has been identified, it was grasped by an Allis forceps for gentle traction. Two facing transverse incisions were made in the dilated pelvis facing the upper ureter. The transverse ureteric incision was then opened longitudinally. An anastomosis was done between the most dependent part of the lower lip of the pelvis and the apex of ureteric spatulation using 6/0 polyglactin (Vicryl®) sutures in the direction of "out-in-in-out." Follow-up was scheduled for 1 month and then every 3 months for a year with abdominal ultrasonography. DTPA was done for all patients 1 year after repair. RESULTS The mean age was 3 ± 0.5 months, and the mean follow-up was 1.5 ± 0.3 years. Our technique was done in all included patients with a functional success of 96% (all patients restored normal function, and no obstruction was reported). Parents were satisfied with the cosmetic appearance of the wound in 91% of cases. Major complications occurred in 4% of cases. CONCLUSION Successful repair of ureteropelvic junction obstruction in young infants can be achieved by using mini-laparotomy In Situ pyeloplasty technique with satisfactory functional and cosmetic outcomes.
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Affiliation(s)
| | - Tarek Mahmoud
- Department of Urology, Sohag University Hospital, Sohag, Egypt
| | - Ahmed Mamdoh
- Department of Urology, Sohag University Hospital, Sohag, Egypt
| | - El Nisr Rashed
- Department of Urology, Sohag University Hospital, Sohag, Egypt
| | - Mohamed Eissa
- Department of Urology, Cairo University Hospital, Cairo, Egypt
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Wu C, Fu J, Zhu X, Li H, Wu Y. Heart failure due to pulmonary sequestration in an infant. Pediatr Pulmonol 2023; 58:2947-2949. [PMID: 37431951 DOI: 10.1002/ppul.26596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/16/2023] [Accepted: 06/30/2023] [Indexed: 07/12/2023]
Affiliation(s)
- Chun Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jian Fu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xu Zhu
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
- Department of Ultrasonography, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Hongbo Li
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yuhao Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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Ti Y, Wang Y, Huang J, Zheng F, Zhang Q. Clinical analysis of extralobar pulmonary sequestration with torsion in children: report of 6 cases. J Cardiothorac Surg 2022; 17:168. [PMID: 35768850 PMCID: PMC9241176 DOI: 10.1186/s13019-022-01921-8] [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: 01/09/2022] [Accepted: 06/18/2022] [Indexed: 12/05/2022] Open
Abstract
Background Extralobar pulmonary sequestration is an uncommon congenital pulmonary malformation. Clinically, pedicle torsion of extralobar pulmonary sequestration is extremely rare. Due to inadequate awareness of its atypical presentation and imaging characteristics, clinical diagnosis is very difficult, and it is extremely easy to misdiagnose.
Case presentation There were 6 children (3 males and 3 females), aged 3–12 years old. The main clinical symptoms of the children were abdominal and chest pain (3 cases), abdominal pain (1 case), chest pain (1 case), and vomiting and abdominal distension (1 case). Two cases were accompanied by fever. Preoperative ultrasound revealed a well-bordered mass with soft-tissue density, accompanied by pleural effusion. On contrast-enhanced computed tomography scans, the mass showed no obvious enhancement. A blood supply was only present in 1 case, and there was no feeding artery shown in the other 5 cases. Extralobar pulmonary sequestration with haemorrhagic infarction was pathologically confirmed. On postoperative days 2–6, the children were discharged uneventfully. There were no complications during the median follow-up of 4 months. Conclusions Torsed extralobar pulmonary sequestration usually occurs in childhood or adolescence, with abdominal and/or chest pain as the primary symptoms. Imaging examination shows a well-defined soft-tissue mass without enhancement. The feeding vessel is not clearly displayed in the mass, and extralobar pulmonary sequestration is accompanied by varying amounts of pleural effusion. Video-assisted thoracoscopic surgical resection is associated with excellent prognosis.
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Affiliation(s)
- Yunxing Ti
- Department of Cardiothoracic Surgery, Shenzhen Children's Hospital, No.7019, Yitian Road, Shenzhen, 518038, Guangdong, China
| | - Yuanxiang Wang
- Department of Cardiothoracic Surgery, Shenzhen Children's Hospital, No.7019, Yitian Road, Shenzhen, 518038, Guangdong, China.
| | - Junrong Huang
- Department of Cardiothoracic Surgery, Shenzhen Children's Hospital, No.7019, Yitian Road, Shenzhen, 518038, Guangdong, China
| | - Fengnan Zheng
- Department of Cardiothoracic Surgery, Shenzhen Children's Hospital, No.7019, Yitian Road, Shenzhen, 518038, Guangdong, China
| | - Qing Zhang
- Department of Cardiothoracic Surgery, Shenzhen Children's Hospital, No.7019, Yitian Road, Shenzhen, 518038, Guangdong, China
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Walcutt J, Abdessalam S, Timmons Z, Winningham P, Beavers A. A rare case of torsion and infarction of an extralobar pulmonary sequestration with MR, CT, and surgical correlation. Radiol Case Rep 2021; 16:3931-3936. [PMID: 34712371 PMCID: PMC8529221 DOI: 10.1016/j.radcr.2021.09.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 01/06/2023] Open
Abstract
Extralobar pulmonary sequestration is a rare congenital pulmonary malformation that may present early in life or remain asymptomatic. Here we present a case of torsion of an extralobar pulmonary sequestration on its vascular pedicle. Although the patient's initial symptomatology suggested intraabdominal pathology, the correct preoperative diagnosis was determined in large part by the lesion's MRI characteristics, which strongly suggested tissue infarction.
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Affiliation(s)
- Julie Walcutt
- Department of Radiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Shahab Abdessalam
- Department of Pediatric Surgery, Boystown National Research Hospital, Nebraska, USA
| | - Zebulon Timmons
- Department of Pediatric Emergency Medicine, Children's Hospital and Medical Center, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Peter Winningham
- Department of Pediatric Radiology, Children's Hospital and Medical Center, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Angela Beavers
- Department of Pediatric Radiology, Children's Hospital and Medical Center, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Abstract
RATIONALE Pulmonary sequestration is a congenital abnormality of the lower airway. It is characterized by a nonfunctioning mass of lung tissue that lacks normal communication with the tracheobronchial tree or pulmonary arteries and always receives its arterial blood supply from the systemic circulation. Most cases of extralobar pulmonary sequestrations (ELSs) are asymptomatic and found incidentally or in prenatal ultrasound screening. PATIENT CONCERNS A 10-year-old boy had severe chest pain and vomiting for 2 days. DIAGNOSES ELS was diagnosed, and torsion of the ELS had developed as a complication. INTERVENTIONS In video-assisted thoracoscopic surgery, the ELS was resected. OUTCOMES The clinical symptoms were relieved the 2nd day after surgery and did not recur over a follow-up period of 3 months. LESSONS In young patients with sudden abdominal pain or chest pain, in whom computed tomography shows a well-defined mass of homogeneous soft-tissue density in the thorax, ELS with torsion should be suspected. The presence of a feeding artery greatly supports the diagnosis of ELS, and the absence of this classic finding may indicate torsion of the pulmonary sequestration.
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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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Son SA, Do YW, Kim YE, Lee SM, Lee DH. Infarction of torsed extralobar pulmonary sequestration in adolescence. Gen Thorac Cardiovasc Surg 2019; 68:77-80. [PMID: 30875002 DOI: 10.1007/s11748-019-01105-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 03/07/2019] [Indexed: 10/27/2022]
Abstract
Torsion of pulmonary extralobar sequestration is extremely rare in childhood and adolescence, and as it presents with a variety of symptoms ranging from intermittent pain to fever from infarction, differential diagnosis is necessary. Herein, we report a rare case of 13-year-old girl who presented with abdominal pain and fever was diagnosed as infarction of torsed extralobar pulmonary sequestration. Torsed extralobar pulmonary sequestration was removed by thoracoscopic surgery, and the patient remained in good clinical condition.
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Affiliation(s)
- Shin-Ah Son
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, South Korea
| | - Young Woo Do
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, South Korea
| | - Young Eun Kim
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, South Korea
| | - So Mi Lee
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Deok Heon Lee
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, South Korea.
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Choe J, Goo HW. Extralobar pulmonary sequestration with hemorrhagic infarction in a child: preoperative imaging diagnosis and pathological correlation. Korean J Radiol 2015; 16:662-7. [PMID: 25995698 PMCID: PMC4435998 DOI: 10.3348/kjr.2015.16.3.662] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 01/17/2015] [Indexed: 11/15/2022] Open
Abstract
We describe a rare case of extralobar pulmonary sequestration with hemorrhagic infarction in a 10-year-old boy who presented with acute abdominal pain and fever. In our case, internal branching linear architecture, lack of enhancement in the peripheral portion of the lesion with internal hemorrhage, and vascular pedicle were well visualized on preoperative magnetic resonance imaging that led to successful preoperative diagnosis of extralobar pulmonary sequestration with hemorrhagic infarction probably due to torsion.
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Affiliation(s)
- Jooae Choe
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
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Bernard Stover L, Marchese SM, Saenz NC, Shayan K. Torsion of an extralobar pulmonary sequestration: A rare cause of acute chest & flank pain in an adolescent. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2014. [DOI: 10.1016/j.epsc.2014.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Kirkendall ES, Guiot AB. Torsed pulmonary sequestration presenting with gastrointestinal manifestations. Clin Pediatr (Phila) 2013; 52:981-4. [PMID: 22890328 DOI: 10.1177/0009922812453197] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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12
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Paediatric torsed extralobar sequestration containing calcification: Imaging findings with pathological correlation. Clin Radiol 2012; 68:94-7. [PMID: 22749813 DOI: 10.1016/j.crad.2012.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Revised: 05/01/2012] [Accepted: 05/03/2012] [Indexed: 11/23/2022]
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Kheirandish R, Azizi S, Alidadi S. A case report of extralobar pulmonary sequestration in a dog. Asian Pac J Trop Biomed 2012; 2:333-5. [PMID: 23569925 PMCID: PMC3609297 DOI: 10.1016/s2221-1691(12)60034-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 11/20/2011] [Accepted: 12/04/2011] [Indexed: 01/28/2023] Open
Abstract
Pulmonary sequestration is a rare congenital anomaly in the veterinary literature. This malformation is characterized by a cystic mass of non-functioning primitive lung tissue that does not communicate with the tracheobronchial tree or with the pulmonary arteries. This article describes gross and histopathological characteristics of extralobar pulmonary sequestration in a dog. Grossly, a mass was observed in the left side of the thoracic cavity, closed to the caudal lobes of the lung, without communication with the tracheobronchial tree and the pulmonary arteries that was separated by pleural covering. Histopathologic examination showed emphysematous alveoli and bronchi, hypertrophy of smooth muscles and presence of the undifferentiated mesenchymal tissue. Therefore, based on microscopic findings, extralobar pulmonary sequestration was diagnosed. To the best of our knowledge, this is the first report of extralobar pulmonary sequestration in dog.
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Affiliation(s)
- Reza Kheirandish
- Department of Pathobiology, School of Veterinary Medicine, Shahid-Bahonar University of Kerman, Kerman, Iran
| | - Shahrzad Azizi
- Department of Pathology, School of Veterinary Medicine, Islamic Azad University, Shahrekord Branch, Shahrekord, Iran
| | - Soodeh Alidadi
- School of Veterinary Medicine, Shahid-Bahonar University of Kerman, Kerman, Iran
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Chen W, Wagner L, Boyd T, Nagarajan R, Dasgupta R. Extralobar pulmonary sequestration presenting with torsion: a case report and review of literature. J Pediatr Surg 2011; 46:2025-8. [PMID: 22008345 DOI: 10.1016/j.jpedsurg.2011.07.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2011] [Revised: 07/13/2011] [Accepted: 07/13/2011] [Indexed: 11/29/2022]
Abstract
Posterior mediastinal masses have widely variant presentations and a broad differential diagnosis. We describe an adolescent boy presenting with a posterior mediastinal mass, associated with abdominal pain and pleural effusion. Radiologic, operative, and pathologic findings are reviewed. This patient was found to have torsion of an extralobar pulmonary sequestration, of which only 2 other cases have been reported in the literature. Although radiologic findings of a systemic arterial supply to the mass may be absent, with patients presenting with this constellation of symptoms, a high index of suspicion of a sequestration should be maintained.
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Affiliation(s)
- Wendy Chen
- Department of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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