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DiChiacchio L, Cappiello CD, Greenspon J. Extrapulmonary sequestration with a left internal thoracic arterial feeding vessel in an infant treated with video-assisted Thoracoscopic resection: a case report. J Cardiothorac Surg 2018; 13:88. [PMID: 30029655 PMCID: PMC6053796 DOI: 10.1186/s13019-018-0775-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/10/2018] [Indexed: 11/10/2022] Open
Abstract
Background Congenital lung malformations exist along a spectrum of pathogenesis and disease severity. Extrapulmonary sequestration (EPS), in which nonfunctional lung tissue develops without connection to the tracheobronchial tree, is one rare manifestation of this disease. Atypical vascular anatomy with a systemic feeding vessel characterizes these lesions. Case presentation A 3 day old, 37 week gestation infant underwent chest X-ray for confirmation of umbilical catheter placement and was found to have an elevated left hemidiaphragm consistent with eventration versus congenital diaphragmatic hernia. He remained asymptomatic and was evaluated as an outpatient at the age of 9 months, where CT angiogram demonstrated extrapulmonary versus intrapulmonary sequestration with a systemic feeding vessel from the left internal mammary artery. Conclusions It is exceedingly rare for the feeding artery to arise from the internal mammary; two such cases have been reported to date, both in adult patients. Here we present a third case of EPS with arterial supply from the internal mammary successfully treated with video-assisted thoracoscopic resection in a 9 month old infant.
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Affiliation(s)
- Laura DiChiacchio
- Department of Surgery, Univeristy of Maryland Medical Center, Baltimore, 21201, USA.
| | - Clint D Cappiello
- Department of Surgery, SSM Health Cardinal Glennon Children's Hospital, St. Louis, 63104, USA
| | - Jose Greenspon
- Department of Surgery, SSM Health Cardinal Glennon Children's Hospital, St. Louis, 63104, USA
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Takeuchi K, Ono A, Yamada A, Toyooka M, Takahashi T, Shigematsu Y, Ohta M, Sagoh T. Two adult cases of extralobar pulmonary sequestration: A non-complicated case and a necrotic case with torsion. Pol J Radiol 2014; 79:145-9. [PMID: 24944723 PMCID: PMC4061149 DOI: 10.12659/pjr.890662] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 03/31/2014] [Indexed: 11/09/2022] Open
Abstract
Background This case report describes two cases of extralobar pulmonary sequestration in adults with and without torsion/necrosis. Case Reports Non-complicated extralobar pulmonary sequestration was found incidentally in a 50-year-old asymptomatic woman (Case 1), diagnosed with the presence of a branching structure in a mass lesion and blood supply from the right inferior phrenic artery. Another case of a 38-year-old woman presented with a sudden onset of back pain caused by extralobar pulmonary sequestration with torsion/necrosis (Case 2). A 4-cm fusiform mass in the paravertebral region showed enhancement in the peripheral rim only, and no feeding artery. These were the same as it had been reported typical findings in extralobar pulmonary sequestration with necrosis. On magnetic resonance imaging, the masses in both cases showed inhomogeneous low signal and branching high signal on T2-weighted images. That was characteristic for a stroma without dilated alveoli as a solid part and dilated alveoli as fluid regions. Conclusions By comparing those two cases, we came to a conclusion that only T2-weighted imaging reflects the native structure, even after infarction. Although differentiation from a cystic tumor with hemorrhage or infection can be problematic, inhomogeneous low signal and branching high signal on T2-weighted images may help us distinguish extralobar pulmonary sequestration from other cystic lesions.
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Affiliation(s)
- Kayo Takeuchi
- Department of Radiology, Fukui Red Cross Hospital, Fukui, Japan
| | - Ayako Ono
- Department of Radiology, Fukui Red Cross Hospital, Fukui, Japan
| | - Atsushi Yamada
- Department of Radiology, Fukui Red Cross Hospital, Fukui, Japan
| | - Mariko Toyooka
- Department of Radiology, Fukui Red Cross Hospital, Fukui, Japan
| | | | | | - Makoto Ohta
- Department of Pathology, Fukui Red Cross Hospital, Fukui, Japan
| | - Tadashi Sagoh
- Department of Radiology, Fukui Red Cross Hospital, Fukui, Japan
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Thacker PG, Rao AG, Hill JG, Lee EY. Congenital Lung Anomalies in Children and Adults. Radiol Clin North Am 2014; 52:155-81. [DOI: 10.1016/j.rcl.2013.09.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Massive hemoptysis in a case of intralobar pulmonary sequestration associated with pulmonary hypoplasia and meandering right pulmonary vein: diagnosis and management. Case Rep Pulmonol 2012; 2012:960948. [PMID: 23133781 PMCID: PMC3485908 DOI: 10.1155/2012/960948] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 09/27/2012] [Indexed: 11/17/2022] Open
Abstract
Pulmonary sequestration is a congenital malformation characterized by focal area of dysplastic lung tissue that lacks normal communication with tracheobronchial tree and receives blood supply from systemic arteries. Surgical resection has been the conventional method of treatment of pulmonary sequestration. In recent years transarterial embolization of the anomalous systemic arteries has emerged as a suitable alternative to surgery. In this paper, we describe transarterial coil embolization for control of massive life-threatening hemoptysis in a rare case of intralobar sequestration in right lung associated with ipsilateral pulmonary hypoplasia and meandering right inferior pulmonary vein. A 3-year follow-up computed tomographic (CT) angiography revealed complete regression of the sequestration along with altered pulmonary arterial contour. To the best of our knowledge, transarterial coil embolization for control of massive life-threatening hemoptysis in such a complex pulmonary anomaly has not yet been reported.
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Berteloot L, Bobbio A, Millischer-Bellaïche AE, Lambot K, Breton S, Brunelle F. [Congenital malformations of the lung, the radiologist's point of view]. Rev Mal Respir 2012; 29:820-35. [PMID: 22742469 DOI: 10.1016/j.rmr.2011.10.976] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2011] [Accepted: 10/03/2011] [Indexed: 10/28/2022]
Abstract
Congenital lung malformations include a complex range of developmental abnormalities. Currently, most are diagnosed prenatally or during early childhood. They may, however, be discovered later, incidentally or in connection with non-specific symptoms, sometimes severe. Knowledge of their radiological appearances is necessary for their detection. Proper technique and analysis of cross-sectional imaging, computed tomography and magnetic resonance imaging, allow a definitive diagnosis in most patients and pre-treatment evaluation of surgical cases. This review will describe the radiological aspects of congenital pulmonary malformations, especially those which may occur in late childhood or adult life. When present, alternative diagnoses will be discussed. A distinction will be made between anomalies originating from bronchopulmonary structures, such as bronchial atresia, bronchogenic cyst, congenital lobar overinflation, cystic adenomatoid malformation, and forms related to vascular anomalies (vascular rings, anomalous left pulmonary artery, pulmonary underdevelopment, proximal interruption of the pulmonary artery, pulmonary sequestration, scimitar syndrome).
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Affiliation(s)
- L Berteloot
- Service de radiologie pédiatrique, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France.
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Congenital Pulmonary Malformations in Pediatric Patients: Review and Update on Etiology, Classification, and Imaging Findings. Radiol Clin North Am 2011; 49:921-48. [DOI: 10.1016/j.rcl.2011.06.009] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Pandey J, Pandey A, Gujral RB, Kureel SN. Unilateral total lung sequestration: a rare condition. J Paediatr Child Health 2011; 47:398-400. [PMID: 21649756 DOI: 10.1111/j.1440-1754.2011.02114.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Lee EY, Tracy DA, Mahmood SA, Weldon CB, Zurakowski D, Boiselle PM. Preoperative MDCT Evaluation of Congenital Lung Anomalies in Children: Comparison of Axial, Multiplanar, and 3D Images. AJR Am J Roentgenol 2011; 196:1040-1046. [DOI: 10.2214/ajr.10.5357] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Edward Y. Lee
- Department of Radiology, Children's Hospital Boston and Harvard Medical School, 300 Longwood Ave, Boston, MA 02115
- Department of Medicine, Pulmonary Division, Children's Hospital Boston and Harvard Medical School, Boston, MA
| | - Donald A. Tracy
- Department of Radiology, Children's Hospital Boston and Harvard Medical School, 300 Longwood Ave, Boston, MA 02115
| | - Soran A. Mahmood
- Department of Radiology, Children's Hospital Boston and Harvard Medical School, 300 Longwood Ave, Boston, MA 02115
| | - Christopher B. Weldon
- Department of Surgery, Children's Hospital Boston and Harvard Medical School, Boston, MA
| | - David Zurakowski
- Department of Anesthesiology, Children's Hospital Boston and Harvard Medical School, Boston, MA
| | - Phillip M. Boiselle
- Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
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Marwah R, Nair JR, Singal A, Talwar I. 3D multidetector CT angiographic evaluation of intralobular bronchopulmonary sequestration. J Indian Assoc Pediatr Surg 2010; 15:39-41. [PMID: 21180507 PMCID: PMC2998671 DOI: 10.4103/0971-9261.69144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We report a case of intralobar pulmonary sequestration with special emphasis on computed tomography (CT) angiography in determining the arterial supply and venous drainage, thus providing a detailed knowledge of the vasculature, which is of vital importance in surgery. The 3D volume rendering technique and maximum intensity projection images provide the vascular road map for the surgeon.
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Affiliation(s)
- Ruchira Marwah
- Department of Radiodiagnosis and Imaging, Bombay Hospital and Research Centre, Mumbai, India
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10
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Yu H, Li HM, Liu SY, Xiao XS. Diagnosis of arterial sequestration using multidetector CT angiography. Eur J Radiol 2010; 76:274-8. [DOI: 10.1016/j.ejrad.2009.05.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Revised: 05/15/2009] [Accepted: 05/19/2009] [Indexed: 11/30/2022]
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Multidetector computed tomography evaluation of secondary hepatopulmonary fusion in a neonate. Clin Imaging 2010; 34:234-8. [PMID: 20416490 DOI: 10.1016/j.clinimag.2009.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Accepted: 07/20/2009] [Indexed: 11/21/2022]
Abstract
Hepatopulmonary fusion is a rare condition in which a dense adhesion occurs between the right lung and herniated hepatic parenchyma in patients with right-sided congenital diaphragmatic hernia. Plain radiographic and magnetic resonance imaging (MRI) findings of hepatopulmonary fusion in a neonate have been reported in a retrospective study with a small patient population and a case report. However, to our knowledge, there is no report regarding the secondary hepatopulmonary fusion (after right-sided congenital diaphragmatic hernia repair) evaluated with multidetector computed tomography (MDCT) in a neonate. We report a case of secondary hepatopulmonary fusion in a neonate, in which multiplanar and three-dimensional (3D) images were helpful in delineating the precise anatomy for preoperative evaluation. Understanding the diagnostic limitations of plain radiographs and MRI, the use of MDCT with its multiplanar and 3D imaging may emerge as a useful noninvasive imaging modality in the evaluation of possible hepatopulmonary fusion in pediatric patients with right-sided congenital diaphragmatic hernia.
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Lee EY, Boiselle PM, Cleveland RH. Multidetector CT evaluation of congenital lung anomalies. Radiology 2008; 247:632-48. [PMID: 18487532 DOI: 10.1148/radiol.2473062124] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Congenital lung anomalies vary widely in their clinical manifestation and imaging appearance. Although radiographs play a role in the incidental detection and initial imaging evaluation in patients with clinical suspicion of congenital lung anomalies, cross-sectional imaging such as computer tomography (CT) is frequently required for confirmation of diagnosis, further characterization, and preoperative evaluation in the case of surgical lesions. Recently, with the development and widespread availability of multidetector CT scanners, CT has assumed a greater role in the noninvasive evaluation of congenital lung anomalies. The combination of fast speed, high spatial resolution, and enhanced quality of multiplanar reformation and three-dimensional reconstructions makes multidetector CT an ideal noninvasive method for evaluating congenital lung anomalies. In this article, the authors review the multidetector CT technique for evaluation of congenital lung anomalies. Important clinical aspects, characteristic imaging features, and key points that allow differentiation among various anomalies are highlighted for a variety of common and uncommon conditions.
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Affiliation(s)
- Edward Y Lee
- Departments of Radiology and Medicine, Pulmonary Division, Children's Hospital Boston and Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA.
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CT imaging of mass-like nonvascular pulmonary lesions in children. Pediatr Radiol 2007; 37:1253-63. [PMID: 17972072 DOI: 10.1007/s00247-007-0637-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2007] [Revised: 08/02/2007] [Accepted: 08/24/2007] [Indexed: 10/22/2022]
Abstract
The purpose of this pictorial essay is to review the CT imaging findings of both common and rare mass-like nonvascular pulmonary lesions in children. Understanding the characteristic CT appearance of mass-like nonvascular pulmonary lesions in children aids in accurate diagnosis and allows unnecessary or inadvisable interventions (biopsies and/or surgery) to be avoided in specific cases.
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MDCT and 3D Evaluation of Type 2 Hypoplastic Pulmonary Artery Sling Associated With Right Lung Agenesis, Hypoplastic Aortic Arch, and Long Segment Tracheal Stenosis. J Thorac Imaging 2007; 22:346-50. [DOI: 10.1097/rti.0b013e31813fabca] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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