Intralobar sequestration associated with gastric enterogenous cyst: gastric lung!!

Intralobar sequestration (ILS) is a rare anomaly that may manifest as recurrent pneumonia or rarely as haemoptysis. The co-existence of ILS with enterogenous cyst is extremely rare with only a single case reported. We describe a 6-month-old male infant, with haemoptysis. Evaluation revealed a consolidated segment of the left lung with a pseudoaneurysm of the pulmonary artery and spina bifida. Thoracoscopic excision of the lesion revealed ILS. Recurrent haemoptysis led to re-evaluation and thoracotomy for excision of the cyst which contained gastric mucosal content. We report a rare case of concomitant ILS with an enterogenous cyst and review the relevant literature.

An uncommon cause of massive haemothorax and treatment under cardiopulmonary bypass

Pulmonary sequestration is defined as nonfunctioning lung tissue that is not in normal continuity with the tracheobronchial tree and that has a systemic arterial blood supply. Herein, we aimed to present a case of a 34-year-old male patient who had massive left-sided haemothorax on admission due to a giant intralobar pulmonary sequestration. An emergent repair was performed under cardiopulmonary bypass with axillofemoral cannulation.

[Endovascular embolization in the treatment of the pulmonary intralobar sequestration]

INTRODUCTION

Up to date the classical therapeutic approach for intralobar sequestrations (IS) has been surgical excision. However, systemic arteries embolization is presented as an alternative, and even constitutes the first line of treatment in some centers. We summarize our experience in selected cases with the aim of preserving the maximum lung parenchyma.

MATERIAL AND METHODS

Retrospective study of IS who underwent endovascular embolization at our institution between 2013 and 2014.

RESULTS

Three patients of 12, 14 and 21 months old were treated. Two patients had unilateral IS, one in the left lower lobe (LLL) and the other in the right lower lobe (RLL); the third one had bilateral lesions (a CAM-S complex in the RLL and a IS in the LII). The embolization of the four lesions was performed via right femoral artery. The case with bilateral lesions underwent thoracoscopic lobectomy of the CAM-S 7 months after embolization, finding adherences to the diaphragm. None of the patients had immediate complications and were discharged within 48 hours after embolization. In successive ultrasound and plain radiographs controls, with a follow-up of 6, 18 and 30 months, no complications were found.

CONCLUSIONS

Systemic vessels embolization is a treatment option for the treatment of IS that avoids surgery, preserves lung parenchyma and does not preclude surgical resection in case of treatment failure or presence of parenchymal lesions. Longer follow-up is needed to determine long-term effectiveness.