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Yu H, Kim H, Cheong H. Extralobar Pulmonary Sequestration: A Case of Incidental Autopsy Diagnosis. Am J Forensic Med Pathol 2024:00000433-990000000-00150. [PMID: 38228310 DOI: 10.1097/paf.0000000000000894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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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Pham LH, Hamdaoui Y, Zeron G, El-Bershawi A, Alazzeh A. Separating Out Pulmonary Sequestration. Cureus 2024; 16:e53190. [PMID: 38425603 PMCID: PMC10901696 DOI: 10.7759/cureus.53190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2024] [Indexed: 03/02/2024] Open
Abstract
Pulmonary sequestration (PS) is a rare congenital anomaly that accounts for 1% to 6% of all pulmonary malformations at birth. It is characterized by a focal area of pulmonary tissue that does not have direct communication with the tracheobronchial tree and does not get blood supply from the pulmonary circulation. We present the case of a 28-year-old female with a history of recurrent pulmonary infections who was found to have intralobar sequestration and underwent curative surgical excision. Because pulmonary sequestration is commonly misdiagnosed, as it can mimic other conditions on chest X-rays, this case illustrates the importance of recognizing pulmonary sequestration as a separate entity and diagnosing/treating it appropriately. The patient presented to the hospital with a one-week history of upper chest pain. Chest radiograph showed mild hyperinflated right lung. Computed tomography angiogram (CTA) revealed an 8.9 x 8.3 cm area of hyper-lucency and decreased normal lung architecture in the right lower lobe with an aberrant arterial blood supply suggestive of intralobar pulmonary sequestration. The patient was referred to cardiothoracic surgery and underwent preoperative outpatient pulmonary function testing, which was unremarkable. The patient subsequently underwent successful robotic resection of the right lower lobe sequestration and the pathology report confirmed PS. A diagnosis of pulmonary sequestration is commonly missed, as it can mimic other conditions on chest X-rays. It can present as a solitary nodule or mass, cystic lesion, consolidation, or an air-fluid level. The period between symptom onset and diagnosis is typically more than five years. While digital subtraction angiography is considered the gold standard for imaging, CTA is now preferred because it allows for clear visualization of lung parenchyma and vascular assisting in surgical planning. For our patient, CTA demonstrated a prominent tubular vessel, which showed less enhancement than the opacified pulmonary artery and pulmonary veins, suggestive of an abnormal vascular supply for the right lower lobe sequestration. Management of intralobar sequestration is curative surgical excision. Both video-assisted thoracoscopic surgery (VATS) and posterolateral thoracotomy are viable options for resection. It should be noted that in symptomatic patients, it is recommended to proceed with surgical resection. However, in asymptomatic individuals with intralobar sequestration (ILS), surgical resection is not required but could be considered as prophylaxis to prevent recurrent infections. Asymptomatic individuals with extralobar sequestration (ELS), on the other hand, should undergo serial monitoring as non-operative management is appropriate. This case highlights the importance of including pulmonary sequestration, especially intralobar sequestration in the differential diagnosis of recurrent localized pulmonary infections, especially in a patient who is otherwise healthy. Although rare, it is important to consider this congenital anomaly when evaluating patients with recurrent localized pulmonary infections, chest pain, or hemoptysis.
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Affiliation(s)
- Linda H Pham
- Internal Medicine, HCA Riverside, Riverside, USA
| | - Yassine Hamdaoui
- Internal Medicine, University Sidi Mohamed Ben Abdallah Faculty of Medicine and Pharmacy of Fes, Fes, MAR
| | | | | | - Ahmad Alazzeh
- Pulmonary Critical Care, HCA Riverside, Riverside, USA
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3
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Asif A, Lilley D, Howard-Walker S, Ajab S, Qadri SS. The diagnosis and surgical management of pulmonary sequestration in adults: a case series from a single centre in the UK. Indian J Thorac Cardiovasc Surg 2024; 40:91-95. [PMID: 38125332 PMCID: PMC10728387 DOI: 10.1007/s12055-023-01589-2] [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: 09/20/2022] [Revised: 08/07/2023] [Accepted: 08/07/2023] [Indexed: 12/23/2023] Open
Abstract
Pulmonary sequestration (PS) is a rare congenital malformation where extrapulmonary lung tissue receives systemic blood supply from an anomalous branch directly from the thoracic or abdominal aorta. Whilst non-malignant, it can often present with similar symptoms as lung cancer. We present a retrospective review of 8 consecutive adult patients undergoing surgical management for PS within a single centre in the UK. Of our cohort, 62.5% had never smoked. PS in the right lung was seen in 62.5% of cases. Anomalous branches of the pulmonary artery, pulmonary vein or coeliac axis supplied 37.5% of the PS seen in our cohort, and 12.5% did not have a radiologically identifiable blood supply. Techniques varied from thoracotomy (n = 4), video-assisted thoracoscopic surgery (VATS) (n = 3) to robotic resection (n = 1) with no intra-operative or post-operative complications reported within hospital. The mean length of stay was 2 days. The post-operative mortality rate was 12.5%; one patient had died following the robotic resection of the mass of pneumonia in the local district hospital 26 days post-operatively after being discharged. No other complications nor recurrence was recorded over the follow-up period. Where pulmonary masses receive blood supply from anomalous branches of the pulmonary vein and coeliac axis, diagnoses of PS should be considered. The clinical feasibility of discharge in 2 days with no symptom recurrence should undergo further investigation with a larger sample size.
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Affiliation(s)
- Ashar Asif
- Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, Castle Rd, Cottingham, HU16 5JQ UK
- Hull York Medical School, University Rd, Heslington, York YO10 5DD UK
| | - Daniel Lilley
- Hull York Medical School, University Rd, Heslington, York YO10 5DD UK
| | - Sherene Howard-Walker
- Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, Castle Rd, Cottingham, HU16 5JQ UK
| | - Shereen Ajab
- Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, Castle Rd, Cottingham, HU16 5JQ UK
- Hull York Medical School, University Rd, Heslington, York YO10 5DD UK
| | - Syed Suhail Qadri
- Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, Castle Rd, Cottingham, HU16 5JQ UK
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4
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Bhavsar VD, Jaber JF, Rackauskas M, Ataya A. Intralobar pulmonary sequestration presenting as recurrent left lower lobe pneumonia. Proc AMIA Symp 2023; 36:767-769. [PMID: 37829237 PMCID: PMC10566425 DOI: 10.1080/08998280.2023.2258318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/06/2023] [Indexed: 10/14/2023] Open
Abstract
This case discusses the diagnosis and management of pulmonary sequestration. Typically discovered incidentally on imaging, it can be a cause of recurrent pulmonary infections causing severe morbidity to the patient. Surgical management is indicated when found to prevent the complications of recurrent infections, including pulmonary necrosis, abscess, or fistula formation.
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Affiliation(s)
| | - Johnny F. Jaber
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida Health, Gainesville, Florida, USA
| | - Mindaugas Rackauskas
- Division of Thoracic and Cardiovascular Surgery, University of Florida Health, Gainesville, Florida, USA
| | - Ali Ataya
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida Health, Gainesville, Florida, USA
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5
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Mughrabi A, Fennelly J, Fandreyer F, Fleisher J. Unravelling the mystery of a rare infection: a challenging case of pulmonary sequestration with Mycobacterium avium complex and the importance of a thorough microbiological investigation. BMJ Case Rep 2023; 16:e255346. [PMID: 37699740 PMCID: PMC10503325 DOI: 10.1136/bcr-2023-255346] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 09/14/2023] Open
Abstract
Pulmonary sequestration is a rare congenital condition. It is a dysplastic lung tissue with a separate systemic blood supply and without a bronchial tree connection. The emergence of a superimposed infection can lead to its diagnosis, such as Staphylococcus aureus, Pseudomonas aeruginosa, Nocardia asteroids and Aspergillus sp pneumonia. Mycobacterium avium complex (MAC) superimposed disease is exceedingly rare. We report a case of a man in his third decade without known medical disorders presenting with a persistent cough. After an extensive microbiological workup, an MAC infection was diagnosed. An elevated carbohydrate antigen 19-9 (CA 19-9) was also noted. He was treated with antimycobacterial therapy and lobectomy resulting in clinical improvement and CA19-9 normalisation. This case illustrates the value of comprehensive microbiological investigations in patients with chronic respiratory symptoms and imaging findings that are not typical of bacterial pneumonia. Clinical studies remain needed to investigate the utility of CA 19-9 in a scoring system to guide MAC therapy.
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Affiliation(s)
- Abdallah Mughrabi
- Department of Internal Medicine, St. Elizabeth's Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | | | | | - Jorge Fleisher
- Division of Infectious Diseases, Department of Medicine, St. Elizabeth's Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachussets, USA
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6
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Ram A, Warsha F, Vinisha F, Kumar D, Kumari M. Pulmonary Sequestration Mimicking Symptoms of Ischemic Heart Disease. Cureus 2023; 15:e40200. [PMID: 37435277 PMCID: PMC10330954 DOI: 10.7759/cureus.40200] [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: 06/09/2023] [Indexed: 07/13/2023] Open
Abstract
Pulmonary sequestration is a rare congenital abnormality characterized by the presence of a nonfunctional lobe of the lung being separated in both blood flow and function from the rest of the lung. The condition may go unrecognized on prenatal imaging and present during adolescence and young adulthood with cough, chest pain, shortness of breath, and recurrent pneumonia. However, some patients may remain asymptomatic until later adulthood and be diagnosed based on incidental imaging findings. Surgical resection is the recommended treatment for this condition, although controversy exists regarding its use in asymptomatic patients and adults. In this case report, we present a case of a 66-year-old man who presented with progressively worsening dyspnea on exertion and atypical chest pain and underwent an ischemic workup to rule out coronary artery disease. The extensive diagnostic evaluation led to the diagnosis of nonobstructive coronary artery disease and left-sided pulmonary sequestration. The patient subsequently underwent surgical resection of the left lower pulmonary lobe, resulting in a significant improvement in symptoms.
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Affiliation(s)
- Aatma Ram
- Hospice and Palliative Medicine, Lehigh Valley Health Network, Allentown, USA
- Internal Medicine, Rosalind Franklin Medical University, McHenry, USA
| | - Fnu Warsha
- Internal Medicine, Interfaith Medical Center, New York, USA
| | - Fnu Vinisha
- Internal Medicine, Liaquat National Hospital, Karachi, PAK
| | - Dilpat Kumar
- Cardiology, East Tennessee State University, Johnson City, USA
| | - Muskan Kumari
- General Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
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7
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Gupta A, Chetty G, Hopkinson D, Rao J, Chetty G. Right upper lobe pulmonary sequestration masquerading clinically and radiologically as malignancy: a case report. J Surg Case Rep 2023; 2023:rjad022. [PMID: 36741081 PMCID: PMC9890208 DOI: 10.1093/jscr/rjad022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/06/2022] [Indexed: 02/04/2023] Open
Abstract
Bronchopulmonary sequestration is a rare disease in which a non-functional region of pulmonary tissue receives an aberrant vascular supply and lacks normal communication with the tracheobronchial tree. We present the case of a 30-year-old female with a primary complaint of unexplained weight loss and no other additional signs or symptoms. In view of this, computed tomography imaging was ordered, showing a 33HU mass in the right upper lobe. A specialist radiologist reviewed the images and concluded that the most likely differentials were mediastinal lymphoma or thymic malignancy. Video-assisted thoracoscopic surgery was performed, when it was seen that no malignancy was present, but rather a bronchopulmonary sequestration. Histology confirmed the diagnosis; the patient fared well post-operatively. Bronchopulmonary sequestration is a rare pathology, with most cases occurring in the lower lung lobes. This case is highly atypical, due to the lack of clinical features and the lesion radiologically mimicking the appearance of malignancy.
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Affiliation(s)
- Ankit Gupta
- School of Medicine, Worsley Building, University of Leeds, Woodhouse, Leeds, LS2 9JT, UK
| | - Gavin Chetty
- Northern General Hospital, Herries Road, Sheffield S5 7AU, UK
| | - David Hopkinson
- Northern General Hospital, Herries Road, Sheffield S5 7AU, UK
| | - Jagan Rao
- Northern General Hospital, Herries Road, Sheffield S5 7AU, UK
| | - Govind Chetty
- Correspondence address. Northern General Hospital, Herries Road, Sheffield S5 7AU, UK. Tel: (+44)114 2714833; Fax: (+44)114 2610350; E-mail:
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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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Ren S, Yang L, Xiao Y, Tong Z, Wang L, Hu Y. Pulmonary sequestration in adult patients: a single-center retrospective study. Respir Res 2023; 24:13. [PMID: 36635696 PMCID: PMC9837954 DOI: 10.1186/s12931-023-02320-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 01/09/2023] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Pulmonary sequestration (PS) is a rare congenital lower airway malformation. This study presents the clinical and imaging features and surgical outcomes of PS in adults, and compare the safety and feasibility of minimally invasive surgery versus open thoracotomy for PS. METHODS Adult patients with PS treated at our center from July 2011 to September 2021 were included. Information regarding the patient demographics, clinical and CT features, arterial supply and venous drainage, and surgical outcomes were collected. RESULTS Ninety seven patients were included. The most common CT findings were mass lesions (50.5%) and cystic lesions (20.6%). The vast majority of the lesions (96 out of 97) were located close to the spine in the lower lobes (left vs. right: 3.6 vs. 1). Arterial supply was mainly provided by the thoracic aorta (87.4%) and abdominal aorta (10.5%). Intralobar and extralobar PS accounted for 90.7% and 9.3% of the patients, respectively. Three (4.5%) patients who underwent minimally invasive surgery were converted to open thoracotomy due to dense adhesions. Though no significant differences regarding operative time (P = 0.133), the minimally invasive surgery group was significantly better than the open thoracotomy group regarding intraoperative blood loss (P = 0.001), drainage volume (P = 0.004), postoperative hospital days (P = 0.017) and duration of chest drainage (P = 0.001). There were no cases of perioperative mortality. Only four (4.1%) patients developed postoperative complications, and no significant difference existed between the two groups. CONCLUSION Our study revealed PS can present with a variety of different clinical and radiologic manifestations. Clinicians should consider the possibility of PS when diagnosing a lesion in the lower lobes close to the spine. Moreover, minimally invasive surgery is a safe and effective treatment modality for the treatment of PS in an experienced center.
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Affiliation(s)
- Siying Ren
- grid.452708.c0000 0004 1803 0208Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, China ,grid.216417.70000 0001 0379 7164Research Unit of Respiratory Disease, Central South University, Changsha, China ,Hunan Diagnosis and Treatment Center of Respiratory Disease, Changsha, China
| | - Lulu Yang
- grid.452708.c0000 0004 1803 0208Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, China ,grid.216417.70000 0001 0379 7164Research Unit of Respiratory Disease, Central South University, Changsha, China ,Hunan Diagnosis and Treatment Center of Respiratory Disease, Changsha, China
| | - Ying Xiao
- grid.452708.c0000 0004 1803 0208Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, China ,grid.216417.70000 0001 0379 7164Research Unit of Respiratory Disease, Central South University, Changsha, China ,Hunan Diagnosis and Treatment Center of Respiratory Disease, Changsha, China
| | - Zhongyi Tong
- grid.452708.c0000 0004 1803 0208Department of Pathology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Li Wang
- grid.452708.c0000 0004 1803 0208Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, China ,grid.452708.c0000 0004 1803 0208Hunan Key Laboratory of Early Diagnosis and Precision Treatment of Lung Cancer, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yan Hu
- grid.452708.c0000 0004 1803 0208Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, China ,grid.452708.c0000 0004 1803 0208Hunan Key Laboratory of Early Diagnosis and Precision Treatment of Lung Cancer, The Second Xiangya Hospital of Central South University, Changsha, China
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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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11
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Jin HJ, Yu Y, He W, Han Y. Posterior mediastinal extralobar pulmonary sequestration misdiagnosed as a neurogenic tumor: A case report. World J Clin Cases 2022; 10:9340-9347. [PMID: 36159437 PMCID: PMC9477660 DOI: 10.12998/wjcc.v10.i26.9340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/22/2022] [Accepted: 08/05/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pulmonary sequestration-both intralobar and extralobar-is a rare congenital developmental malformation. Extralobar pulmonary sequestrations (EPS) have their own pleura but are separated from the bronchus and usually occur in the left lung. They are mainly found mainly between the lower lobe and the mediastinum. EPS is rarely found within the mediastinum itself, even rarer so in the posterior mediastinum.
CASE SUMMARY We report the case of a 27-year-old man who was misdiagnosed with a neurogenic tumor based on preoperative contrast-enhanced computed tomography (CT) and magnetic resonance imaging findings. Contrast-enhanced chest CT revealed a posterior mediastinal mass measuring 1.2 cm × 1.4 cm × 3.3 cm, which consisted of some cystic areas and showed slight enhancement. The mass was in the 11th paravertebral region and attached to the 11th thoracic vertebra behind the descending aorta in the posterior mediastinum. An arteriole originating from the intercostal artery and a vein originating directly from the hemiazygos vein were found in the pedicle of the mass. The mass was resected in a uniport video-assisted thoracoscopic surgery. During the operation, the pyramid-shaped mass appeared well-encapsulated. Postoperative histopathology established a diagnosis of EPS. One month later, a follow-up CT of the thorax showed good recovery.
CONCLUSION Although EPS rarely occurs in the posterior mediastinum, its diagnosis should be considered when posterior mediastinal tumors are suspected.
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Affiliation(s)
- Hong-Jie Jin
- Department of Thoracic Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Yue Yu
- Department of Thoracic Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Wei He
- Department of Thoracic Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Yun Han
- Department of Thoracic Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
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12
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Anwar M. Hemothorax From an Anomalous Bronchial Artery Bleed in an Infected Intralobar Pulmonary Sequestration. Cureus 2022; 14:e28656. [PMID: 36196329 PMCID: PMC9525033 DOI: 10.7759/cureus.28656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 11/06/2022] Open
Abstract
Pulmonary sequestration is a rare congenital malformation. It represents 0.15-6.4% of all congenital pulmonary malformations. It is characterized by non-functional, dysplastic mass of lung tissue that is not in communication with the normal tracheobronchial tree and is associated with a systemic arterial supply. We report a young gentleman in his mid-thirties who presented with community-acquired pneumonia from an infected intralobar pulmonary sequestration which subsequently developed a hemothorax from an anomalous bronchial artery bleed.
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13
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Kasuga I, Maezawa H, Gamo S, Yokoe Y, Yanagihara Y, Sugiyama T, Tokura M, Okayama M, Ohtsubo O. Evaluation of chest radiography and low-dose computed tomography as valuable screening tools for thoracic diseases. Medicine (Baltimore) 2022; 101:e29261. [PMID: 35866756 PMCID: PMC9302368 DOI: 10.1097/md.0000000000029261] [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: 01/04/2023] Open
Abstract
BACKGROUND Recent studies have shown that low-dose computed tomography (LDCT) is effective for the early detection of lung cancer. However, the utility of chest radiography (CR) and LDCT for other thoracic diseases has not been as well investigated as it has been for lung cancer. This study aimed to clarify the usefulness of the veridical method in the screening of various thoracic diseases. METHODS Among individuals who had received general health checkups over a 10-year period, those who had undergone both CR and LDCT were selected for analysis. The present study included 4317 individuals (3146 men and 1171 women). We investigated cases in which abnormal opacity was detected on CR and/or LDCT. RESULTS A total of 47 and 124 cases had abnormal opacity on CR and LDCT, respectively. Among these, 41 cases in which the abnormal opacity was identified by both methods contained 20 treated cases. Six cases had abnormalities only on CR, and none of the cases required further treatment. Eighty-three cases were identified using LDCT alone. Of these, many cases, especially those over the age of 50 years, were diagnosed with thoracic tumors and chronic obstructive pulmonary disease, which required early treatment. In contrast, many cases of pulmonary infections have improved spontaneously, without any treatment. CONCLUSION These results revealed that LDCT allowed early detection of thoracic tumors and chronic obstructive pulmonary disease, especially in individuals over the age of 50 years. CR is still a useful imaging modality for other thoracic diseases, especially in individuals under the age of 49 years.
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Affiliation(s)
- Ikuma Kasuga
- Health Care Center, Shinjuku Oiwake Clinic and Ladies Branch, Tokyo, Japan
- Department of Internal Medicine, Tokyo Medical University, Tokyo, Japan
- *Correspondence: Ikuma Kasuga, Health Care Center, Shinjuku Oiwake Clinic, 7th floor 3-1-13, Shinjuku, Shinjuku-ku, Tokyo 160-0022, Japan (e-mail: )
| | - Hiromi Maezawa
- Health Care Center, Shinjuku Oiwake Clinic and Ladies Branch, Tokyo, Japan
| | - Sanae Gamo
- Health Care Center, Shinjuku Oiwake Clinic and Ladies Branch, Tokyo, Japan
| | - Yoshimi Yokoe
- Health Care Center, Shinjuku Oiwake Clinic and Ladies Branch, Tokyo, Japan
| | - Yuri Yanagihara
- Health Care Center, Shinjuku Oiwake Clinic and Ladies Branch, Tokyo, Japan
| | - Tomoko Sugiyama
- Health Care Center, Shinjuku Oiwake Clinic and Ladies Branch, Tokyo, Japan
| | - Michiyo Tokura
- Health Care Center, Shinjuku Oiwake Clinic and Ladies Branch, Tokyo, Japan
| | - Mayumi Okayama
- Health Care Center, Shinjuku Oiwake Clinic and Ladies Branch, Tokyo, Japan
| | - Osamu Ohtsubo
- Health Care Center, Shinjuku Oiwake Clinic and Ladies Branch, Tokyo, Japan
- Department of Nursing, Faculty of Human Care, Tohto University, Saitama, Japan
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14
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Wu Y, Ye Z, He Z, He X, Hong X, Chen F, Xin S. Video-assisted thoracoscopic surgery lobectomy for giant intralobar pulmonary sequestration: A case report. Medicine (Baltimore) 2022; 101:e29284. [PMID: 35866794 PMCID: PMC9302343 DOI: 10.1097/md.0000000000029284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Pulmonary sequestration, which can be divided into 2 main types: intralobar pulmonary sequestration (IPS) and extralobar pulmonary sequestration, is an uncommon congenital condition for which surgical resection is usually indicated. Video-assisted thoracoscopic surgery, as compared with open thoracotomy, has increasingly become the preferred operative procedure in the treatment of PS, owing to less postoperative pain and faster recovery. This report describes a rare and challenging case with a giant IPS undergoing video-assisted thoracic lobectomy. PATIENT CONCERNS A 39-year old woman suffered from recurrent pneumonia for nearly 3 years. An enhanced computed tomography scan performed in our hospital revealed a 12.0 cm × 10.0 cm-sized IPS in the left lower lobe, supplied by an 8-mm aberrant artery originating from the descending thoracic aorta. DIAGNOSIS Histology of the resected lobe confirmed the diagnosis of giant intralobar pulmonary sequestration associated with infection. INTERVENTIONS Thoracoscopic left lower lobectomy was performed. OUTCOMES The patient has been discharged from the hospital on the ninth day after surgery with an uneventful recovery, she was in good health after a 1-year follow-up. LESSONS Although full of challenges, thoracoscopic lobectomy for giant IPS is a safe and feasible surgical procedure associated with reduced surgical trauma and postoperative pain as well as improved cosmetic results compared with traditional thoracotomy.
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Affiliation(s)
- Yongyong Wu
- Department of Cardiothoracic Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Zhongrui Ye
- Department of Cardiothoracic Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Zhongliang He
- Department of Cardiothoracic Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Xueming He
- Department of Cardiothoracic Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Xia Hong
- Department of Cardiothoracic Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Fei Chen
- Department of Cardiothoracic Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Shunxin Xin
- Department of Cardiothoracic Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, China
- *Correspondence: Shunxin Xin, Department of Cardiothoracic Surgery, Tongde Hospital of Zhejiang Province, No. 234 Gucui Road, Xihu District, Hangzhou 310004, Zhejiang Province, China (e-mail: )
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15
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Pauels L, De Waele M, Medart L, Debruche M. Two unusual variants of pulmonary intra-lobar sequestration. Interact Cardiovasc Thorac Surg 2022; 35:6647849. [PMID: 35861412 PMCID: PMC9318888 DOI: 10.1093/icvts/ivac189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/20/2022] [Accepted: 07/20/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
A pulmonary sequestration is a congenital malformation characterized by non-functional lung tissue with abnormal arterial systemic supply and abnormal connection to the bronchial tree. This may lead to recurrent infections rendering a surgical intervention more demanding. Because of multiple anatomic variations, it is important to obtain high-quality preoperative radiological clarification to determine the most suitable surgical approach. Although a non-surgical technique, consisting of embolization of the aberrant artery has been described, a surgical technique remains the treatment of choice in operable patients. Preoperative embolization of the aberrant artery may reduce the risk of haemorrhage but could cause technical challenges in a hybrid approach and therefore unforeseen peroperative stress to the surgical team. We report 2 adult patients with unusual intra-lobar sequestration with aberrant vascular rare anatomy. Both were treated by surgery. In the latter patient, we performed a hybrid approach. This was complicated by peroperative coils exposure making it a technical challenge to proceed.
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Affiliation(s)
- Laura Pauels
- Departement of Cardiothoracic and Vascular Surgery, Hôpital de la Citadelle , Liège, Belgium
| | - Michèle De Waele
- Departement of Cardiothoracic and Vascular Surgery, Hôpital de la Citadelle , Liège, Belgium
| | - Laurent Medart
- Departement of Radiology, Hôpital de la Citadelle , Liège, Belgium
| | - Mathieu Debruche
- Departement of Respiratory Medicine, Hôpital de la Citadelle , Liège, Belgium
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16
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Ohm B, Jungraithmayr W. Angeborene Fehlbildungen der Lunge – eine Übersicht. Zentralbl Chir 2022; 147:90-97. [DOI: 10.1055/a-1669-9574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
ZusammenfassungKongenitale pulmonale Malformationen stellen eine heterogene Gruppe seltener
Erkrankungen dar, die auf Fehlentwicklungen während der embryonalen und fetalen
Wachstumsphase basieren. Zu ihnen gehören der Trachealbronchus, die bronchiale
Atresie, die bronchogene Zyste, die Lungensequestration, das kongenitale lobäre
Emphysem sowie die sogenannte Congenital pulmonary Airway Malformation. Eines
der Leitsymptome dieser Malformationen ist die durch ihren verdrängenden Effekt
bedingte postnatale respiratorische Insuffizienz, welche eine rasche operative
Versorgung erfordert. Auch bei asymptomatischen Malformationen wird aufgrund des
erhöhten Infektrisikos die Resektion empfohlen.In der folgenden Übersicht wird auf die Ursachen, das klinische Bild und die
therapeutischen Optionen dieser angeborenen Fehlbildungen der Lunge und des
Bronchialsystems eingegangen.
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Affiliation(s)
- Birte Ohm
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Medizinische
Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg,
Deutschland
| | - Wolfgang Jungraithmayr
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Medizinische
Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg,
Deutschland
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17
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Hai VA, Giang NT, Anh LV, Pho DC, Van Nam N. Aberrant artery embolization prior to pulmonary sequestration surgery: A case series report. Int J Surg Case Rep 2022; 91:106747. [PMID: 35007987 PMCID: PMC8749283 DOI: 10.1016/j.ijscr.2021.106747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/28/2021] [Accepted: 12/31/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives Pulmonary sequestration is a rare congenital malformation, and part of its treatment requires the removal of the aberrant artery by surgical means. Materials and methods Five patients treated at Military Hospital 103 - Department of Thoracic Disease were diagnosed with PS via CT scan, MS-CT, and DSA, and histopathological data were evaluated retrospectively between January and December 2019. Results In all patients, surgery is the preferred option, with two cases of video-assisted thoracoscopic surgery (one lobectomy and one wedge resection), and three cases of hybrid video-assisted thoracoscopic surgery (adhesive inflammation was observed, the bronchus is challenging to reveal, to resect, and tend to bleed when resecting). The average length of stay following surgery is 11.6 ± 8.1 days. The mean duration of postoperative follow-up is 13.8 ± 3.3 months, all patients had a good quality of life, and no respiratory problems such as hemoptysis or pneumonia were detected. Conclusion The excellent outcomes obtained in all patients in our study during the follow-up period (13.8 ± 3.3 months) established the appropriate indication and treatment. However, these are preliminary findings; a longer study period with a larger sample size is required to draw more valid conclusions. Pulmonary sequestration is a rare congenital malformation. Aberrant artery embolization prior to pulmonary sequestration surgery is potential for excellent outcomes. The excellent outcomes obtained in all patients established the appropriate indication and treatment
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Affiliation(s)
- Vu Anh Hai
- Department of Thoracic Surgery, Military Hospital 103, Vietnam Military Medical University, Viet Nam
| | - Nguyen Truong Giang
- Department of Cardiothoracic Surgery, Military Hospital 103, Vietnam Military Medical University, Viet Nam
| | - Le Viet Anh
- Department of Thoracic Surgery, Military Hospital 103, Vietnam Military Medical University, Viet Nam
| | - Dinh Cong Pho
- Department of Military Science, Vietnam Military Medical University, Viet Nam
| | - Nguyen Van Nam
- Department of Thoracic Surgery, Military Hospital 103, Vietnam Military Medical University, Viet Nam.
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18
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Ogunleye E, Olusoji O, Fajolu I, Iwuchukwu P. Ten years experience in surgical management of congenital lung malformations: A prospective, cross sectional study. JOURNAL OF CLINICAL SCIENCES 2022. [DOI: 10.4103/jcls.jcls_53_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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19
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Ceylan KC, Batihan G, Üçvet A, Gürsoy S. Surgery in congenital lung malformations: the evolution from thoracotomy to VATS, 10-year experience in a single center. J Cardiothorac Surg 2021; 16:131. [PMID: 34001173 PMCID: PMC8130166 DOI: 10.1186/s13019-021-01511-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 05/05/2021] [Indexed: 11/25/2022] Open
Abstract
Background Congenital lung malformation is an umbrella term and consist of various kind of parenchymal and mediastinal pathologies. Surgical resection is often required for diagnosis and curative treatment. We aimed to review our experience in surgical treatment for congenital lung disease and present the role of minimally invasive surgery. Methods Surgical resections performed for benign lesions of the lung and mediastinum between January 2009 and May 2019 were retrospectively analyzed. Patients who were found to have congenital lung malformation as a result of pathological examination were included in our study. Distribution characteristics of the patients according to congenital lung malformation subtypes, differences in surgical approach and postoperative results were investigated. Results A total of 94 patients who underwent surgical resection and were diagnosed with the bronchogenic cyst, sequestration, bronchial atresia, congenital cystic adenomatoid malformation (CCAM), or enteric cyst as a result of pathological examination were included the study. There were no significant differences between pathological subtypes in the postoperative length of hospital stay and drainage duration however, perioperative complication rate was higher in the sequestration group. In addition, in the first three days postoperatively, the mean pain score was found to be lower in the VATS group compared to thoracotomy. Conclusions Congenital lung malformations consist of a heterogeneous group of diseases and the surgical treatment in these patients can range from a simple cyst excision to pneumonectomy. Video-assisted thoracoscopic surgery should be considered as the first choice in the surgical treatment of these patients in experienced centers.
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Affiliation(s)
- Kenan C Ceylan
- Department of Thoracic Surgery, University of Health Sciences Dr Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital Izmir, 35110, Yenişehir, Gaziler Street, 331, Izmir, Turkey
| | - Güntuğ Batihan
- Department of Thoracic Surgery, University of Health Sciences Dr Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital Izmir, 35110, Yenişehir, Gaziler Street, 331, Izmir, Turkey.
| | - Ahmet Üçvet
- Department of Thoracic Surgery, University of Health Sciences Dr Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital Izmir, 35110, Yenişehir, Gaziler Street, 331, Izmir, Turkey
| | - Soner Gürsoy
- Department of Thoracic Surgery, University of Health Sciences Dr Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital Izmir, 35110, Yenişehir, Gaziler Street, 331, Izmir, Turkey
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20
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Kanwar SS, Downey SA, Tandon YK. An Unusual Case of Lung Consolidation: Thinking Beyond Pneumonia. Am J Med 2021; 134:477-481. [PMID: 32997979 DOI: 10.1016/j.amjmed.2020.08.029] [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] [Received: 08/16/2020] [Revised: 08/25/2020] [Accepted: 08/25/2020] [Indexed: 11/19/2022]
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21
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Hakiri S, Fukui T, Chen-Yoshikawa TF. Combined surgical therapy for pulmonary sequestration and aberrant artery from the abdominal aorta. Gen Thorac Cardiovasc Surg 2021; 69:1031-1034. [PMID: 33743137 DOI: 10.1007/s11748-021-01612-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 02/26/2021] [Indexed: 10/21/2022]
Abstract
Pulmonary sequestration with feeding vessels from the abdominal aorta is relatively rare. A 56-year-old woman with chronic left thoracic pain was referred to our hospital. Computed tomography showed multiple pulmonary cysts in the left lung and an aberrant artery from the abdominal aorta. She was diagnosed with pulmonary sequestration. She underwent embolization of the aberrant artery and wedge resection of the sequestrated lung under indocyanine green guidance. The surgical treatment combining preoperative embolization of the artery and intraoperative indocyanine green-guided lung resection might be safe and minimally invasive for patients with lung sequestrations accompanied by feeding vessels from the abdominal aorta.
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Affiliation(s)
- Shuhei Hakiri
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Takayuki Fukui
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Toyofumi F Chen-Yoshikawa
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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22
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Gabelloni M, Faggioni L, Accogli S, Aringhieri G, Neri E. Pulmonary sequestration: What the radiologist should know. Clin Imaging 2020; 73:61-72. [PMID: 33310586 DOI: 10.1016/j.clinimag.2020.11.040] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/13/2020] [Accepted: 11/24/2020] [Indexed: 12/11/2022]
Abstract
Pulmonary sequestration consists of a nonfunctioning mass of lung tissue, either sharing the pleural envelope of the normal lung (intralobar) or with its own pleura (extralobar), lacking normal communication with the tracheobronchial tree and receiving its arterial supply by one or more systemic vessels. It is the second most common congenital lung anomaly according to pediatric case series, but its real prevalence is likely to be underestimated, and imaging plays a key role in the diagnosis and treatment management of the condition and its potential complications. We will give a brief overview of the pathophysiology, clinical presentation and imaging findings of intra- and extralobar pulmonary sequestration, with particular reference to multidetector computed tomography as part of a powerful and streamlined diagnostic approach.
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Affiliation(s)
- Michela Gabelloni
- Diagnostic and Interventional Radiology, Department of Translational Research, University of Pisa, Via Roma, 67, 56126 Pisa, Italy
| | - Lorenzo Faggioni
- Diagnostic and Interventional Radiology, Department of Translational Research, University of Pisa, Via Roma, 67, 56126 Pisa, Italy.
| | - Sandra Accogli
- Diagnostic and Interventional Radiology, Department of Translational Research, University of Pisa, Via Roma, 67, 56126 Pisa, Italy
| | - Giacomo Aringhieri
- Diagnostic and Interventional Radiology, Department of Translational Research, University of Pisa, Via Roma, 67, 56126 Pisa, Italy
| | - Emanuele Neri
- Diagnostic and Interventional Radiology, Department of Translational Research, University of Pisa, Via Roma, 67, 56126 Pisa, Italy
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23
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Teng G, Nie X, Wang D. Association of pulmonary sequestration with elevated serum cancer antigen 125 levels: a case report. J Int Med Res 2020; 48:300060520903871. [PMID: 32043395 PMCID: PMC7110917 DOI: 10.1177/0300060520903871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Pulmonary sequestration is a rare congenital lung anomaly that is characterized by a nonfunctioning pulmonary parenchyma, which typically lacks connection to the tracheobronchial airways, and thus has an anomalous systemic blood supply. Here we report the case of a 37-year-old man who was diagnosed with pulmonary sequestration and also presented with high levels of the serum tumor marker cancer antigen 125 (CA125). Computed tomography of the chest indicated the presence of a heterogeneous mass with low attenuation in the right S10 region that had a single aberrant artery supplying blood from the descending aorta. The patient eventually underwent thoracoscopic surgery with resection of the right sequestrated lung. Immunohistochemistry showed positive staining for CA125 in bronchial epithelial and epithelioid cells. After surgery, CA125 levels returned to the normal range. In summary, this report describes a case of pulmonary sequestration associated with elevated serum CA125 levels, and further provides relevant literature for this presentation.
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Affiliation(s)
- Guojie Teng
- Department of Pulmonary and Critical Care Medicine, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Xiuhong Nie
- Department of Pulmonary and Critical Care Medicine, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Dandan Wang
- Departments of Pathology, Xuanwu Hospital Capital Medical University, Beijing, China
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24
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Pulmonary Sequestration Associated with Actinomycosis: A Case Report. Antibiotics (Basel) 2020; 9:antibiotics9100687. [PMID: 33050328 PMCID: PMC7599791 DOI: 10.3390/antibiotics9100687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/07/2020] [Accepted: 10/07/2020] [Indexed: 01/14/2023] Open
Abstract
Background: Bronchopulmonary sequestration is a rare congenital malformation of the lower respiratory tract; it consists of a nonfunctioning mass of lung tissue that is irrigated by an anomalous systemic artery. The association with Actinomyces superinfection has not been well established. Methods: We present the case of a 35-year-old woman with a history of recurrent episodes of pneumonia. Based on radiological and histopathological examination, she was diagnosed with intralobar bronchopulmonary sequestration associated with Actinomyces infection. Promoting clinical suspicion is essential to diagnose pulmonary actinomycosis in patients with recurrent pneumonia, to improve early recognition and timely management.
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25
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Liu Y, Yu Z, Yu P, Ito A, Gonzalez M, Hirai K, Polaczek M, Liu H. How to optimize the treatment strategy for patients of pulmonary sequestration with an elevated risk of fatal hemorrhage during operation: case discussion. J Thorac Dis 2020; 12:4450-4458. [PMID: 32944358 PMCID: PMC7475538 DOI: 10.21037/jtd-20-2059] [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] [Indexed: 11/26/2022]
Abstract
Video-assisted thoracoscopic surgery (VATS) lobectomy, especially uniportal VATS, is increasingly used for pulmonary sequestration (PS). However, there are few descriptions of safe handling of the aberrant artery with atherosclerosis, especially the diameter of arteries exceeds than 2.0 cm, under uniportal VATS approach. Here we report a 56-year-old man who was diagnosed with pulmonary sequestration following trauma. The patient had a long history of cough with purulent sputum. One month before the trauma, he had copious expectoration with foul smell again. A contrast CT scan revealed a 7.5 cm mass in his right lower lobe. The mass was supplied by a thick aberrant atherosclerotic artery (over than 2 cm in diameter), which stemmed from the thoracic aorta with multiple calcifications on both. After adequate preoperative evaluation, we performed a right lower lobectomy under uniportal VATS approach. No surgical-associated complications occurred, and the patient was discharged on the 5th days after the operation. We organized an iMDT (international multidisciplinary team) to discuss the reasonability and optimal treatment pattern for this patient. We found that fully assess the quality of the aberrant arteries of PS following blocking and cutting off in an appropriate way are crucial to avoid the happening of fatal bleeding during the operation.
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Affiliation(s)
- Yu Liu
- Department of Thoracic Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Zhanwu Yu
- Department of Thoracic Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Pingwen Yu
- Department of Thoracic Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Atsushi Ito
- Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Mie, Japan
| | - Michel Gonzalez
- Service of Thoracic Surgery, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Kyoji Hirai
- Department of Thoracic Surgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba, Japan
| | - Mateusz Polaczek
- Third Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, Warszawa, Poland
| | - Hongxu Liu
- Department of Thoracic Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital and Institute, Shenyang, China
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26
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Hoan L, Cuong NN, Thang ND, Hong DTT, Hang LM, Linh LT, Minh TN, Pons F, Natali D. A 24-Year-Old Man With Recurrent Hemoptysis. Chest 2020; 157:e31-e35. [PMID: 32033658 DOI: 10.1016/j.chest.2019.08.2184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/01/2019] [Accepted: 08/24/2019] [Indexed: 11/17/2022] Open
Abstract
CASE PRESENTATION A 24-year-old man was admitted for a new episode of hemoptysis. He reported 3 episodes of hemoptysis in the past 2 years. He had no other medical history and was a nonsmoker. As a Vietnamese person born and living in Vietnam, he was at risk for TB, but had not had contact with those having TB in his family or workplace, was never imprisoned nor homeless, and never traveled abroad. He never experienced pneumonia. He coughed up a small amount of fresh with air red blood (around 5 mL each time) several time for 3 days. He had no dyspnea, no chest pain, no fever, no asthenia, and no anorexia.
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Affiliation(s)
- Le Hoan
- Respiratory Medicine Department, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Nguyen Ngoc Cuong
- Radiology Department, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Nguyen Duy Thang
- Surgery Department, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Dinh Thi Thanh Hong
- Respiratory Medicine Department, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Le Minh Hang
- Respiratory Medicine Department, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Le Tuan Linh
- Radiology Department, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Tran Ngoc Minh
- Pathology Department, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - François Pons
- Visceral Surgery Department, Hanoi French Hospital, Hanoi, Vietnam
| | - Delphine Natali
- Respiratory Medicine Department, Hanoi French Hospital, Hanoi, Vietnam.
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Schooler GR, Restrepo R, Mas RP, Lee EY. Congenital Incidental Findings in Children that Can Be Mistaken as True Pathologies in Adults. Radiol Clin North Am 2020; 58:639-652. [DOI: 10.1016/j.rcl.2020.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Velasco-Álvarez D, Gorospe-Sarasúa L, Fra Fernandez S, Rodríguez Calle C. Secuestro pulmonar intralobar: una causa excepcional de hemoptisis en un paciente septuagenario. Arch Bronconeumol 2019; 55:499-500. [DOI: 10.1016/j.arbres.2019.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 02/10/2019] [Accepted: 02/13/2019] [Indexed: 11/16/2022]
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Chen Y, Liu B, Shao J, Liu D, Zheng Y. Endovascular treatment of pulmonary sequestration with thoracic endograft: Two case reports. Medicine (Baltimore) 2019; 98:e16666. [PMID: 31374041 PMCID: PMC6708911 DOI: 10.1097/md.0000000000016666] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Pulmonary sequestration (PS) is a rare congenital lung malformation. The classical treatment of the disease has been conventional surgery with resection of abnormal parenchyma. Recently, the endovascular embolization has been proposed for the treatment of this disease. Here we present 2 cases of PS successfully treated with thoracic endograft. PATIENT CONCERNS Two patients with abnormal consolidation in the left lower lobe were admitted in our hospital. DIAGNOSIS Chest computed tomography angiography (CTA) showed abnormal consolidation in the left lower lobe, which received systemic blood supply from the descending aorta in both patients. So the diagnosis of PS was confirmed. INTERVENTIONS Endovascular treatment with thoracic endograft was successfully performed. OUTCOMES The patients recovered well and were completely free of symptoms. And the CTA follow-up showed the abnormal pulmonary parenchyma shrunk significantly. CONCLUSIONS Endovascular treatment with thoracic endograft is a promising treatment option for PS.
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Tian Z, Zhou Y, Liu H. Extralobar pulmonary sequestration with absence of pericardium and atrial septal defect in a woman. J Cardiothorac Surg 2019; 14:113. [PMID: 31221172 PMCID: PMC6585077 DOI: 10.1186/s13019-019-0932-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 06/03/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Extralobar sequestration is a rare congenital malformation of lung tissue, which can be combined with other foregut and cardiac abnormalities. Our case is the first to report extralobar sequestration, absence of pericardium and atrial septal defect in the same patient. CASE PRESENTATION A 22-year-old female with atrial septal defect came for her recent atypical symptom of intermittent palpitation and shortness of breath. Her computed tomography showed a cystic mass located in left superior anterior mediastinum near the pulmonary trunk. With specious of cystic teratoma prior to video-assisted thoracoscopic surgery, she finally was diagnosed as extralobar sequestration, while incidentally found with congenital absence of pericardium during surgery. CONCLUSIONS Extralobar sequestration, absence of pericardium and atrial septal defect can occur in the same patient. The preoperative diagnostic rate of extralobar sequestration and asymptomatic absence of pericardium remains low attributed to atypical imaging features. A cardiac magnetic resonance imaging is highly recommended if necessary. Regular follow-up is essential to asymptomatic absence of pericardium and atrial septal defect patients. To patients with extralobar sequestration, an operation could be performed.
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Affiliation(s)
- Zhenhuan Tian
- Department of Thoracic surgery, Peking Union Medical College Hospital, Peking Union Medical College, Dongcheng District, Beijing, 100730, China
| | - Yuncan Zhou
- Peking Union Medical College, Beijing, China
| | - Hongsheng Liu
- Department of Thoracic surgery, Peking Union Medical College Hospital, Peking Union Medical College, Dongcheng District, Beijing, 100730, 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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Embolization of symptomatic intralobar pulmonary sequestration - A minimally invasive treatment option. Radiol Case Rep 2019; 14:759-762. [PMID: 31011373 PMCID: PMC6460251 DOI: 10.1016/j.radcr.2019.03.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 03/26/2019] [Accepted: 03/27/2019] [Indexed: 11/20/2022] Open
Abstract
The growing field of interventional radiology provides a number of treatment options alternative to previous relied upon invasive surgeries. Pulmonary sequestration is a condition where the option of interventional radiology is particularly promising. Described is a 41-year-old male who elected alternative treatment for his symptomatic intralobar sequestration in order to avoid associated complications of extensive surgery. Specifically, this case reports a successful cure utilizing minimally invasive embolization with polyvinyl alcohol particles and coil placement.
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A Rare Cause of Upper Gastrointestinal Bleeding: Adult Pulmonary Sequestration. J Gastrointest Surg 2018; 22:1801-1803. [PMID: 29476415 DOI: 10.1007/s11605-018-3713-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 02/07/2018] [Indexed: 02/05/2023]
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34
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Wu S, Zhang Y, Ma L, Ni Y. Surgical management of aorta-pulmonary vein fistulas. J Card Surg 2018; 33:673-675. [PMID: 30157543 DOI: 10.1111/jocs.13804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Shengjun Wu
- Department of Cardiothoracic Surgery; the First Affiliated Hospital, School of Medicine, Zhejiang University; Hangzhou China
| | - Yiran Zhang
- Department of Cardiothoracic Surgery; the First Affiliated Hospital, School of Medicine, Zhejiang University; Hangzhou China
| | - Liang Ma
- Department of Cardiothoracic Surgery; the First Affiliated Hospital, School of Medicine, Zhejiang University; Hangzhou China
| | - Yiming Ni
- Department of Cardiothoracic Surgery; the First Affiliated Hospital, School of Medicine, Zhejiang University; Hangzhou China
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Li X, He W, Li J, Ouyang R, Chen P, Peng H, Zong D. Pulmonary sequestration associated with increased serum tumor markers and elevated standard uptake value level in PET/CT: A case report and literature review. Medicine (Baltimore) 2018; 97:e11714. [PMID: 30075576 PMCID: PMC6081182 DOI: 10.1097/md.0000000000011714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Pulmonary sequestration (PS) is a congenital pulmonary malformation wherein a piece of tissue that ultimately develops into lung tissue is not attached to the pulmonary arterial blood supply, sometimes it is difficult to diagnosis with no specific laboratory tests, discover an abnormal blood supply from aorta by imaging tests is a key step in diagnose. PATIENT CONCERNS A 54-year-old male smoker presented with cough, expectoration and blood in the sputum. DIAGNOSES Computed tomography (CT) shows lesion in right lung, moderate standard uptake value (SUV) elevation of position-emission tomography/computed tomography (PET/CT) in a part of the lesion, and an increased (1,3)-β-D-glucan assay (G test), Galactomannan enzyme immune-assay (GM test) and tumor marker level, biopsy of lung in different times produced inconclusive results, then finally diagnose of pulmonary sequestration is made by observing an abnormal blood supply from the thoracic aorta and volume change of mass. INTERVENTIONS The patient refused lower lobectomy which is the main treatment of PS. He was discharged with oral hemostatic and was advised to undergo regular medical checkups. OUTCOMES The patient has been followed for a year under an outpatient regimen. Symptoms of the cough and expectoration were relieved, however, blood in the sputum remains unchanged. LESSONS It suggests the need for criteria for a thorough diagnostic work-up. It put emphasis on the importance of considering PS as part of the diagnosis of a lesion in the lung disease and underscore the blood supply of mass. Bronchoscopy or pulmonary lobectomy and follow up of the patient are important for patients diagnosed with pulmonary sequestration.
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Affiliation(s)
| | - Wenlong He
- Department of Respiratory Medicine, the Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Jinhua Li
- Department of Respiratory Medicine, the Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Ruoyun Ouyang
- Department of Respiratory Medicine, the Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Ping Chen
- Department of Respiratory Medicine, the Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Hong Peng
- Department of Respiratory Medicine, the Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Dandan Zong
- Department of Respiratory Medicine, the Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
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Khen-Dunlop N, Farmakis K, Berteloot L, Gobbo F, Stirnemann J, De Blic J, Brunelle F, Delacourt C, Revillon Y. Bronchopulmonary sequestrations in a paediatric centre: ongoing practices and debated management. Eur J Cardiothorac Surg 2018; 54:246-251. [DOI: 10.1093/ejcts/ezy049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 01/14/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Naziha Khen-Dunlop
- Deparmtent of Pediatric Surgery, AP-HP, Hopital Necker-Enfants malades, Paris, France
- Université Paris Descartes, Sorbonne Paris Cite, Paris, France
- EA FETUS, Paris, France
| | - Konstantinos Farmakis
- Deparmtent of Pediatric Surgery, AP-HP, Hopital Necker-Enfants malades, Paris, France
| | - Laureline Berteloot
- Deparmtent of Pediatric Radilogy, AP-HP, Hopital Necker-Enfants malades, Paris, France
| | - Francesca Gobbo
- Deparmtent of Pediatric Surgery, AP-HP, Hopital Necker-Enfants malades, Paris, France
| | - Julien Stirnemann
- Université Paris Descartes, Sorbonne Paris Cite, Paris, France
- EA FETUS, Paris, France
- Department of Obstetrics, AP-HP, Hopital Necker-Enfants malades, Paris, France
| | - Jacques De Blic
- Université Paris Descartes, Sorbonne Paris Cite, Paris, France
- Department of Pediatric Pulmunology, AP-HP, Hopital Necker-Enfants malades, Paris, France
| | - Francis Brunelle
- Université Paris Descartes, Sorbonne Paris Cite, Paris, France
- Deparmtent of Pediatric Radilogy, AP-HP, Hopital Necker-Enfants malades, Paris, France
| | - Christophe Delacourt
- Université Paris Descartes, Sorbonne Paris Cite, Paris, France
- Department of Pediatric Pulmunology, AP-HP, Hopital Necker-Enfants malades, Paris, France
| | - Yann Revillon
- Deparmtent of Pediatric Surgery, AP-HP, Hopital Necker-Enfants malades, Paris, France
- Université Paris Descartes, Sorbonne Paris Cite, Paris, France
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Majumdar G, Agarwal SK, Pande S, Rao RN, Lal H. Unusual presentation of an intralobar pulmonary sequestration with recurrent haemoptysis, associated with aspergillosis. Indian J Thorac Cardiovasc Surg 2017. [DOI: 10.1007/s12055-017-0513-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Zhang SX, Wang HD, Yang K, Cheng W, Wu W. Retrospective review of the diagnosis and treatment of pulmonary sequestration in 28 patients: surgery or endovascular techniques? J Thorac Dis 2017; 9:5153-5160. [PMID: 29312721 DOI: 10.21037/jtd.2017.10.145] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background Pulmonary sequestration (PS) is a rare congenital pulmonary malformation. In this study, we aimed to retrospect and evaluate the diagnosis, treatment, and outcomes of PS in 28 patients at our institute. Methods The files of 28 patients with PS who were treated with surgery (21 cases) or endovascular intervention (7 cases) between May 2005 and June 2016 from a single institute were retrospectively reviewed. The following data of all patients were analyzed: age, sex, clinical symptoms, diagnostic methods, operative techniques, and treatment outcomes. Results Twenty-eight patients, 15 male and 13 female, with a median age of 42.5 underwent operative intervention for PS. Twenty-one patients showed preoperative symptoms including cough, expectoration, hemoptysis, chest and/or back pain, and fever. General chest computed tomography (CT) scanning; percutaneous needle biopsy, bronchoscopy, enhanced CT scanning, and CT angiography (CTA) were used as diagnostic methods. Twenty-one patients were diagnosed preoperatively by enhanced CT scanning and CTA; seven patients were confirmed by surgery. Twenty-one patients underwent surgery (15 cases via thoracotomy and 6 cases via video-assisted thoracic surgery), seven patients underwent interventional therapy (three cases via endovascular embolization and four cases via thoracic aortic endovascular stent-graft exclusion). Three patients had a complication in surgery group (intraoperative hemorrhage in two patients and postoperative hydropneumothorax in one patient) and two patients had post-embolization syndrome in interventional group (fever and pain at embolism site). During the follow-up period ranging from 6 to 84 months, no recurrences or further complications were observed in two groups. Conclusions Enhanced CT or CTA may be a potential approach for the diagnosis of PS. Surgical resection for PS is the major treatment approach. Endovascular embolization of PS could be considered when pulmonary lesion is small-sized. Endovascular exclusion could be used to treat combined arterial aneurysm and dissection of PS.
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Affiliation(s)
- Shi-Xin Zhang
- Cardiothoracic Surgery Department, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Hai-Dong Wang
- Cardiothoracic Surgery Department, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Kang Yang
- Cardiothoracic Surgery Department, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Wei Cheng
- Cardiothoracic Surgery Department, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Wei Wu
- Cardiothoracic Surgery Department, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
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Abstract
Bronchopulmonary sequestration (BPS) is a lung mass that does not communicate with the tracheobronchial tree or the pulmonary arterial vasculature, and thus does not play a role in oxygenation. This article discusses the etiology of BPS, as well as its pathophysiology, signs and symptoms, imaging studies used to diagnose, and treatment options in both pediatric and adult patients.
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40
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Polaczek M, Baranska I, Szolkowska M, Zych J, Rudzinski P, Szopinski J, Orlowski T, Roszkowski-Sliz K. Clinical presentation and characteristics of 25 adult cases of pulmonary sequestration. J Thorac Dis 2017; 9:762-767. [PMID: 28449484 DOI: 10.21037/jtd.2017.03.107] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pulmonary sequestration (PS) is a rare congenital abnormality of lung tissue. Only few series of adult cases are reported. The aim was to describe clinical characteristics in adult cases of PS and to compare outcomes in different clinical situations. METHODS Using MSD engine we searched for cases of PS that have been diagnosed between Jan 1st, 2005 and Dec 31st, 2015. Clinical data was retrospectively gathered. Statistica v.12 (StatSoft, Inc.) was used for statistical analyses. RESULTS We found 25 cases (18 females, 7 males), which underwent surgery and were histologically proven. There were 22 cases of intralobar PS. 7 cases were asymptomatic, 12 had infectious history (including 3 cases of lung abscess and pleural empyema), 4 presented with hemoptysis, 2 with chest pain. The average age to undergo surgery was 38.24, in the asymptomatic group 34, in symptomatic 39.89. In the latter the symptoms preceded the surgery for 2.45-year. Great majority of sequestrations was located in lower lobes (96%), 52% on the left. Symptomatic cases were at higher than expected risk of surgical complications, comparing to asymptomatic (chi2, P=0.04). In most cases there were surgical and histological signs of infection, only in 9 cases etiological factor was determined: in 5 cases it was A. fumigatus. A 0.53-day longer post-surgical hospital stay was observed in the symptomatic group, no statistical significance was found (U-test, P=0.45). CONCLUSIONS Surgical treatment of symptomatic cases of PS is characterized by slightly longer post-surgical hospital stay and higher risk of surgical complications. Fungal infections are the most likely to occur in PS.
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Affiliation(s)
- Mateusz Polaczek
- Third Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland.,Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Warsaw, Poland
| | - Inga Baranska
- Radiology Department, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Malgorzata Szolkowska
- Pathology Department, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Jacek Zych
- Third Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Piotr Rudzinski
- Surgery Department, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Janusz Szopinski
- Third Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Tadeusz Orlowski
- Surgery Department, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Kazimierz Roszkowski-Sliz
- Third Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
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Abstract
OBJECTIVES: This study described the characteristics of the systemic arterial supply of pulmonary sequestration (PS) in an attempt to better distinguish PS from other acquired lesions. METHODS: We identified 25 patients hospitalized at the Peking Union Medical College Hospital during January 2013 to December 2015 with the assistance of medical catalogers. Twenty-three patients with a definite diagnosis of “pulmonary sequestration” clinically or pathologically were included in the study. The medical records, imaging information, and pathological data were reviewed retrospectively. The general characteristics of the patients and the features of the anomalous arteries were summarized. RESULTS: Aberrant arterial supply of PS was found in all 23 (100%) cases. Among them, twenty patients received surgery, including 14 (70%) with aberrant arterial supply found before surgery, and the other 6 (30%) found during surgery. Nineteen (82.6%) patients had a single systematic arterial supply, with a median diameter of 8 mm. More than one arterial supplies were found in four (17.4%) cases. In 21 (91.3%) cases, the anomalous systemic artery originated from the descending thoracic aorta just adjacent to the sequestrated lung which it supplied, without the presence of accompanying bronchi. In twenty (87.0%) patients who received the surgical intervention, samples of 12 (85.7%) were proved to have elastic vessel walls, out of the 14 samples in which the anomalous systemic arteries were available for analysis. CONCLUSIONS: There are no certain pathology diagnostic criteria for the diagnosis of PS. The detecting of the aberrant systematic artery and distinguishing it from the bronchial arteries corresponded to certain lung abnormalities are the keys to the accurate diagnosis of pulmonary sequestration in adult patients. We propose that the characteristic features of the anomalous arteries include: Originating from aorta and its main branches, adjacent to the sequestrated area, directly running into the sequestrated mass without accompanying bronchus branch, being large in diameter, and having elastic vessel wall.
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Affiliation(s)
- Xiaomeng Hou
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Ji Li
- Department of Pathology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Jing Li
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Baiqiang Cai
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
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Rao DS, Barik R. Rare presentation of intralobar pulmonary sequestration associated with repeated episodes of ventricular tachycardia. World J Cardiol 2016; 8:432-435. [PMID: 27468336 PMCID: PMC4958694 DOI: 10.4330/wjc.v8.i7.432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 05/02/2016] [Accepted: 06/02/2016] [Indexed: 02/06/2023] Open
Abstract
Arterial supply of an intralobar pulmonary sequestration (IPS) from the coronary circulation is extremely rare. A significant coronary steal does not occur because of dual or triple sources of blood supply to sequestrated lung tissue. We present a 60-year-old woman who presented to us with repeated episodes of monomorphic ventricular tachycardia (VT) in last 3 mo. Radio frequency ablation was ineffective. On evaluation, she had right lower lobe IPS with dual arterial blood supply, i.e., right pulmonary artery and the systemic arterial supply from the right coronary artery (RCA). Stress myocardial perfusion scan revealed significant inducible ischemia in the RCA territory. Coronary angiogram revealed critical stenosis of proximal RCA just after the origin of the systemic artery supplying IPS. The critical stenosis in the RCA was stented. At 12 mo follow-up, she had no further episodes of VT or angina.
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43
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Fumimoto S, Ochi K, Ichihashi Y, Sato K, Morita T, Hanaoka N, Katsumata T. Right intra lobar pulmonary sequestration with feeding artery arising from abdominal aorta: a case report. J Cardiothorac Surg 2015; 10:86. [PMID: 26109198 PMCID: PMC4479071 DOI: 10.1186/s13019-015-0290-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 05/29/2015] [Indexed: 11/11/2022] Open
Abstract
Pulmonary sequestration (PS) is a rare congenital malformation. Right intra lobar PS with a feeding artery arising from the abdominal aorta is extremely rare. This case report describes a 30-year-old man with a history of mental deficiency and repeated pneumonia who was referred to our hospital for further work-up of PS. Three-dimensional enhanced computed tomography of the chest and aorta revealed right intra lobar PS with an aberrant systemic artery from the abdominal aorta. We resected the PS using lower lobectomy by video-assisted thoracic surgery (VATS). The patient was discharged 10 days later without complications.
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Affiliation(s)
- Satoshi Fumimoto
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Osaka, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan.
| | - Kaoru Ochi
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Osaka, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan.
| | - Yoshio Ichihashi
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Osaka, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan.
| | - Kiyoshi Sato
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Osaka, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan.
| | - Takuya Morita
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Osaka, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan.
| | - Nobuharu Hanaoka
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Osaka, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan.
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Osaka, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan.
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