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Liu X, Wu R, Zhu S, Gu L, Tang Z. Imaging and pathological characteristics, treatment, and prognosis of pulmonary sequestration-A retrospective study of 13 cases. THE CLINICAL RESPIRATORY JOURNAL 2023; 17:865-873. [PMID: 37533295 PMCID: PMC10500327 DOI: 10.1111/crj.13672] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVE This study aimed to summarize and analyze the characteristics of pulmonary sequestration to improve our understanding of this disease. METHODS Between January 2019 and April 2023, the clinical data of 13 patients with pulmonary sequestration underwent surgical treatment at the First Affiliated Hospital of Gannan Medical University. RESULTS The male-to-female ratio was 4:9, the age was 0.5 to 60 years, and the average age was 38 ± 19 years. There were 10 and 3 cases of intralobar and extralobar pulmonary sequestration, respectively. Chest enhanced computed tomography (CT) and three-dimensional vascular reconstruction showed that the abnormal blood vessels were derived from the descending thoracic aorta in nine cases and from other blood vessels in four cases. Three patients underwent thoracoscopic lobectomy, two underwent thoracoscopic segmentectomy, and eight underwent thoracoscopic wedge resection. All the patients successfully completed the surgery and were discharged postoperatively. CONCLUSIONS Some patients with pulmonary sequestration exhibit no obvious symptoms. Patients with clinical symptoms are easily confused for pneumonia, bronchial cysts, lung abscesses, and lung tumors; therefore, patients with pulmonary sequestration are prone to missed diagnosis and misdiagnosis. Currently, enhanced chest CT combined with three-dimensional vascular reconstruction can accurately show the course, branches, and relationship with the mass of the feeding artery. Routine pathological examination is helpful to further clarify the diagnosis of pulmonary sequestration. Minimally invasive thoracoscopic surgery is the preferred treatment for patients with pulmonary sequestration. Surgical resection is safe and feasible, and satisfactory results are typically obtained.
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Affiliation(s)
- Xiangjin Liu
- First Clinical Medical CollegeThe Gannan Medical UniversityGanzhouChina
| | - Rongqian Wu
- First Clinical Medical CollegeThe Nanchang UniversityNanchangChina
| | - Shenyu Zhu
- Department of Thoracic SurgeryThe First Affiliated Hospital of Gannan Medical UniversityGanzhouChina
| | - Liang Gu
- Department of Thoracic SurgeryThe First Affiliated Hospital of Gannan Medical UniversityGanzhouChina
| | - Zhixian Tang
- Department of Thoracic SurgeryThe First Affiliated Hospital of Gannan Medical UniversityGanzhouChina
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Zheng W, Zhang M, Wu W, Zhang H, Zhang X. Three-dimensional CT angiography facilitates uniportal thoracoscopic anatomic lung resection for pulmonary sequestration: a retrospective cohort study. J Cardiothorac Surg 2022; 17:218. [PMID: 36042500 PMCID: PMC9429313 DOI: 10.1186/s13019-022-01975-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 08/26/2022] [Indexed: 12/01/2022] Open
Abstract
Background Pulmonary sequestration (PS) is a rare lesion with independent blood supply from an anomalous systemic artery. A timely resection is considered as the best treatment for PS. Three-dimensional computed tomography angiography (3D-CTA) has been widely utilized for precise thoracic surgery. This study aimed to investigate the role of preoperative 3D-CTA and resection simulation in uniportal video-assisted thoracoscopic surgery (VATS) anatomical lung surgery for PS. Methods The data of 20 consecutive PS patents undergoing anatomic lung resection between April 2011 and May 2021 in a single centre were retrospectively reviewed. These patients were divided into the 3D-CTA group (10 patients) and the control group (10 patients) according to the initial surgical planning with or without 3D-CTA. The perioperative parameters regarding safety and fluency such as the incidence of conversion to open thoracotomy, operation time, blood loss, complications and chest tube duration were analyzed. Results This cohort included 12 female and 8 male patients, with a mean age of 45 years old (range 24–60 years). Nine cases demonstrated recurrent febrile, cough, or hemoptysis; whereas the other 11 patients were asymptomatic on admission. Eighteen (90.0%) intralobar and 2 extralobar PS were confirmed, whereas 18 (90.0%) lesions were located in the left thorax. The feeding vessels originated from the thoracic aorta in 16 patients (80.0%), the abdominal aorta in 3 (15.0%), and the inferior phrenic artery in 1 patient (5.0%). There was no major bleeding or 30 days mortality. The initial surgical planning included 9 uniportal and 1 two-port VATS in the 3D-CTA group, as compared with 10 two-port VATS in the control group. Thirteen lobectomies, 5 segmentectomies and 2 mass excisions were performed. However, no conversion was needed in the 3D-CTA group; whereas 6 (60.0%) conversions (4 to multiple-port and 2 to thoracotomy) occurred in the control group, indicating a significant difference (P = 0.003). In addition, the operation time in the 3D-CTA group was significantly shorter than those in the control group [(108.5 ± 24.9) min vs. (154.5 ± 39.4) min, P = 0.006]. The other surgery-related outcomes were similar between the two groups. Conclusion Preoperative 3D-CTA facilitates the safe and fluent performance of uniportal VATS anatomical lung resection for PS with shortened operation time and lessened surgical conversions.
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Affiliation(s)
- Wenlong Zheng
- Department of General Surgery, Xuzhou Central Hospital, Affiliated Xuzhou Clinical College of Xuzhou Medical University, 199 Jiefang South Road, Xuzhou, 221009, China
| | - Miao Zhang
- Department of Thoracic Surgery, Xuzhou Central Hospital, Affiliated Xuzhou Clinical College of Xuzhou Medical University, 199 Jiefang South Road, Xuzhou, 221009, China
| | - Wenbin Wu
- Department of Thoracic Surgery, Xuzhou Central Hospital, Affiliated Xuzhou Clinical College of Xuzhou Medical University, 199 Jiefang South Road, Xuzhou, 221009, China
| | - Hui Zhang
- Department of Thoracic Surgery, Xuzhou Central Hospital, Affiliated Xuzhou Clinical College of Xuzhou Medical University, 199 Jiefang South Road, Xuzhou, 221009, China
| | - Xinhui Zhang
- Department of General Surgery, Xuzhou Central Hospital, Affiliated Xuzhou Clinical College of Xuzhou Medical University, 199 Jiefang South Road, Xuzhou, 221009, China.
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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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Vasireddy A, Venkatesan A, Gonuguntla A, Maramreddy R, Rai GD, Kamath GS, Bishnoi AK. Mycobacterium tuberculosis infection of an intralobar pulmonary sequestration. Proc AMIA Symp 2022; 35:552-554. [DOI: 10.1080/08998280.2022.2062980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Anila Vasireddy
- Department of Cardiovascular and Thoracic Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Aadithiyavikram Venkatesan
- Department of Cardiovascular and Thoracic Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Akhilesh Gonuguntla
- Department of Cardiovascular and Thoracic Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Revanth Maramreddy
- Department of Cardiovascular and Thoracic Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Guruprasad D. Rai
- Department of Cardiovascular and Thoracic Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ganesh S. Kamath
- Department of Cardiovascular and Thoracic Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Arvind K. Bishnoi
- Department of Cardiovascular and Thoracic Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Nakanishi K, Goto M, Nakamura S, Chen-Yoshikawa TF. Lessons learned from hybrid surgery with preoperative coil embolization for an aberrant artery in pulmonary sequestration. Surg Case Rep 2021; 7:192. [PMID: 34427799 PMCID: PMC8385083 DOI: 10.1186/s40792-021-01277-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background The optimal management of an aberrant artery in pulmonary sequestration (PS) is controversial. Several studies have shown that hybrid surgery with preoperative coil embolization for an aberrant artery and surgical resection of the sequestrated lung is effective. However, there are no clear indications for the procedure. Case presentation A 68-year-old woman without any complaints was diagnosed with right intralobar PS, which was supplied by an aberrant artery from the thoracic aorta, via computed tomography performed during a medical examination. In addition, lung adenocarcinoma was detected over the border between the right upper and middle lobes. Preoperative coil embolization was performed by an interventional radiologist the day before surgery to decrease the risk of severe intraoperative hemorrhage. On the following day, bi-lobectomy of the right upper and middle lobes for lung adenocarcinoma with systemic lymph node dissection and segmentectomy of the sequestrated lung with thoracotomy was performed. Although no active hemorrhage was observed during surgery, the aberrant artery was challenging to dissect using an energy device due to the presence of an intravascular coil. Eventually, the coil stump was exposed, and it was cut with scissors. The postoperative course was uneventful. Conclusions We reported the pitfall of the hybrid surgery for intralobar PS. Preoperative coil embolization can prevent fatal intraoperative hemorrhage. If embolization is performed using a coil for an aberrant artery supplied from the thoracic aorta, where and how to dissect the aberrant artery should be cautiously determined based on preoperative images, with consideration of the presence of an intravascular coil.
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Affiliation(s)
- Keita Nakanishi
- Department of Thoracic Surgery, University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Masaki Goto
- Department of Thoracic Surgery, University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Shota Nakamura
- Department of Thoracic Surgery, University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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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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Phelps MC, Sanchirico PJ, Pfeiffer DC. Intralobar pulmonary sequestration: incidental finding in an asymptomatic patient. Radiol Case Rep 2020; 15:1891-1894. [PMID: 32874379 PMCID: PMC7452027 DOI: 10.1016/j.radcr.2020.07.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/19/2020] [Accepted: 07/20/2020] [Indexed: 11/21/2022] Open
Abstract
We describe a case of a 58-year-old male who presented to the emergency room with symptoms related to an appendicitis. A computed tomography scan with contrast confirmed the diagnosis of acute appendicitis but also revealed a mass medially in the base of the inferior lobe of the right lung. The mass measured 6.7 cm AP × 3.7 cm transverse. It had multiple lobulations and the anterior aspect was of very low density, possibly representing accumulated mucoid material. The mass had an arterial connection from the descending thoracic aorta and a venous drainage into the right pulmonary vein, classical features of intralobar pulmonary sequestration. The physical exam was unremarkable, and the patient had no history of pulmonary symptoms. This case helps increase awareness of intralobar pulmonary sequestration, a rare condition that may be asymptomatic.
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Affiliation(s)
- Megan C. Phelps
- WWAMI Medical Education Program (MD), University of Washington School of Medicine, Seattle, WA, USA
| | | | - David C. Pfeiffer
- WWAMI Medical Education Program and Department of Biological Sciences, University of Idaho, 875 Perimeter Drive, Moscow, ID 83844-3051, USA
- Corresponding author.
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