Intralobar pulmonary sequestration masquerading as congenital lobar emphysema

A clinical guideline for structured assessment of CT-imaging in congenital lung abnormalities

OBJECTIVES

To develop a clinical guideline for structured assessment and uniform reporting of congenital lung abnormalities (CLA) on Computed Tomography (CT)-scans.

MATERIALS AND METHODS

A systematic literature search was conducted for articles describing CT-scan abnormalities of congenital pulmonary airway malformation (CPAM), bronchopulmonary sequestration (BPS), congenital lobar emphysema (CLE) and bronchogenic cyst (BC). A structured report using objective features of CLA was developed after consensus between a pediatric pulmonologist, radiologist and surgeon.

RESULTS

Of 1581 articles identified, 158 remained after title-abstract screening by two independent reviewers. After assessing full-texts, we included 28 retrospective cohort-studies. Air-containing cysts and soft tissue masses are described in both CPAM and BPS while anomalous arterial blood supply is only found in BPS. Perilesional low-attenuation areas, atelectasis and mediastinal shift may be found in all aforementioned abnormalities and can also be seen in CLE as a cause of a hyperinflated lobe. We have developed a structured report, subdivided into five sections: Location & Extent, Airway, Lesion, Vascularization and Surrounding tissue.

CONCLUSIONS

CT-imaging findings in CLA are broad and nomenclature is variable. Overlap is seen between and within abnormalities, possibly due to definitions often being based on pathological findings, which is an unsuitable approach for CT imaging. We propose a structured assessment of CLA using objective radiological features and uniform nomenclature to improve reporting.

Extralobar pulmonary sequestration in a 55-year-old man

Pulmonary sequestration is a rare congenital lung malformation that more commonly occurs in the left lung, mainly near the lower mediastinum. It is rarely observed in patients with extralobar sequestration in adulthood. We report the case of a 55-year-old man with recurrent fever and cough lasting for about 1 month, who was admitted to our hospital. His past history was unremarkable. The final diagnosis of extralobar sequestration was dependent on three-dimensional computed tomography angiography (3D CTA), which showed an abnormal blood supply vessel to the consolidation from the aortic arch. The patient underwent a left pulmonary sequestration resection, and the pathological examination also verified the diagnosis postoperatively. 3D CTA images can provide an aberrant vessel anatomy map for the surgeon and play a decisive role in the detection of pulmonary sequestration.

Pulmonary sequestration cyst in a patient of cerebral palsy

Pulmonary sequestration cyst is a rare entity in pediatric patients. Most of the time, it is diagnosed as an incidental finding. It is associated with other congenital anomalies, especially congenital diaphragmatic hernia. We report a patient of cerebral palsy presented with vomiting and recurrent chest infections. He was diagnosed to have hiatal hernia on computed tomography scan of chest. At operation, a pulmonary sequestration cyst along with hiatal hernia, malrotation, and meckel's diverticulum was encountered. The sequestration cyst was managed through transhiatal approach.