Intrapericardial extralobar pulmonary sequestration in a neonate

Intrapericardial extralobar pulmonary sequestration detected as an intrathoracic cystic mass by using prenatal ultrasonography: case report and review of the literature

Intrapericardial extralobar pulmonary sequestration is a very rare congenital lung anomaly. We report a case of this condition, detected as an intrathoracic cystic lesion by using prenatal ultrasonography. The neonate was born at 38 weeks of gestation with no progression of the lesion and no respiratory or cardiac symptoms. Ultrasonography and computed tomography (CT) revealed a 40 × 17 × 17-mm intrapericardial lesion, composed of cystic components and a solid component. Intrapericardial extrapulmonary sequestration was suspected largely because CT showed a vague aberrant artery. At the age of 3 months, elective surgery was performed, and the postoperative course was uneventful.

Cystic lung disease

Cystic lung disease is divided into congenital and acquired lesions. Congenital cystic lung disease includes several malformations with distinct anatomical and histological features. There is significant overlap between these lesions to suggest a common pathologic mechanism for their occurrence. Congenital cystic lung lesions include cystic adenomatoid malformations, pulmonary sequestrations, congenital lobar emphysema, and peripheral bronchogenic cysts. These lesions are commonly diagnosed prenatally with high accuracy. Prenatal imaging has allowed us to better understand their natural history and devise strategies for prenatal and postnatal management. Some lesions warrant resection (even prenatally), whereas others can be managed expectantly.

Intrapericardial extralobar pulmonary sequestration presenting as a prenatal intrathoracic mass

An intrathoracic mass, which persisted during the remaining pregnancy, was first seen during routine ultrasound examination performed at 20 weeks gestation. After birth, the child was asymptomatic. Echocardiography showed the mass to be located intrapericardially. The mass was electively resected via sternotomy 3 weeks after the birth. Microscopic examination showed normal lung tissue surrounded by pleura corresponding to the diagnosis of extralobar pulmonary sequestration. To the authors' knowledge, this is the earliest described detection of such a lesion. Furthermore, this article reports the unique finding of a feeding vessel from the right pulmonary artery.

Recent advances in fetal surgery

Fetal surgery is now an accepted modality for treatment of a variety of lethal and non-lethal congenital conditions. It represents a new, fast-moving frontier of medicine in which cooperative mulitdisciplinary effort and input are required to assure both fetal and maternal welfare. A wide range of therapeutic strategies from percutaneous to open invasive techniques has led to a complex list of different procedures for different diseases. This review identifies the most common disease entities managed by fetal intervention, examines the evolution in development of techniques to those currently used, and describes the prospective, randomized trials presently underway that are designed to establish the safety and determine true efficacy of treatment. Fetal surgery as a (multi)discipline continues to strive to minimize maternal and fetal risk. Undoubtedly, as tocolytic therapy and neonatal intensive efforts improve, fetal therapy will expand.

Intrapericardial extralobar pulmonary sequestration-ultrasound and magnetic resonance prenatal diagnosis

Extralobar pulmonary sequestrations are usually thoracic or abdominal lesions. A 29-week fetus demonstrated a 3.1 x 2.1 x 2.3 cm intrapericardial mass on ultrasonography. Magnetic resonance imaging demonstrated an extracardiac origin and suggested a pulmonary sequestration, which was confirmed after successful postnatal resection. Extralobar pulmonary sequestration should be considered in the presence of a fetal intrapericardial mass.

A rare intrapericardial mass in a neonate

We describe a rare case of a neonate born with an intrapericardial mass composed of extralobar pulmonary sequestration and a cyst of bronchogenic origin. After an uneventful delivery, this full-term newborn was noted to be grunting and indrawing. He remained tachypneic despite adequate management for bilateral pneumothoraces. Diagnostic studies showed a 3 x 3 x 4 cm diameter cystic lesion in the anterior mediastinum causing posterior-lateral displacement of the superior vena cava. The heart itself was structurally normal. Bronchoscopy and esophagoscopy failed to detect any structural abnormalities. At 3 weeks of age, sternotomy and resection of the lesion was performed. The mass was clearly intrapericardial and consisted of sequestrated pulmonary tissue with a unilocular mucus filled bronchogenic cyst. Small systemic tributaries fed the lesion from the posterior-superior aspect. There was no connection with the heart or great vessels. Postoperative recovery was uneventful.

A case of intrapericardial extralobar pulmonary sequestration--first case in Korea

Extralobar pulmonary sequestration, known as accessory lung, is a rare congenital anomaly and intrapericardial lung sequestration is extremely rare. To the best of our knowledge, only four reported cases were intrapericardial. We report a case with intrapericardial extralobar pulmonary sequestration confirmed by operation and morphologic basis.