Abstract
BackgroundThe potential complications of pulmonary sequestration are serious and may include recurrent pulmonary infection, hemoptysis, and tumorigenesis. Therefore, the gold standard of treatment has been surgery. Although an adequate boundary between the nonfunctional lung and normal lung is required for the resection of pulmonary sequestration, the boundaries have been conventionally identified intraoperatively with inflation/deflation of the target segment by clamping and unclamping the relevant bronchus. The technique of visualizing the demarcation line based on near-infrared fluorescence imaging with indocyanine green was recently developed.Case presentationA 42-year-old Japanese woman with right Pryce III intralobar sequestration was admitted to our hospital. We planned video-assisted thoracoscopic wedge resection of the right sequestration using near-infrared fluorescence imaging with indocyanine green because of the small volume of the nonfunctional region. The aberrant artery was recognized in the pulmonary ligament; the artery was cut off after ligation. Indocyanine green at 5 mg/body was rapidly injected into the peripheral vein, and the boundary of the sequestration was clearly identified under near-infrared fluorescence imaging.ConclusionNear-infrared fluorescence imaging with indocyanine green is safe and useful for the identification of the boundary of a pulmonary sequestration.
Highlights
The potential complications of pulmonary sequestration are serious and may include recurrent pulmonary infection, hemoptysis, and tumorigenesis
We report the safety and utility of indocyanine green (ICG) fluorescenceguided thoracoscopic pulmonary resection for intralobar pulmonary sequestration
Several studies have reported the utility of identifying the segmental line using NIR fluorescence imaging with ICG [3,4,5,6,7,8,9,10,11,12,13], there are few reports in which ICG was used for identification of demarcation line of intralobar pulmonary sequestration [11]
Summary
Pulmonary sequestration is a rare congenital malformation characterized by nonfunctional lung tissue separated from the normal lung tissue and fed by an aberrant systemic artery [1]. Case presentation An abnormal shadow was detected in a 42-year-old Japanese woman by medical checkup X-ray and she was admitted to our hospital She had no symptoms and had Motono et al Journal of Medical Case Reports (2019) 13:228 no medical, social, environmental, obstetrical, family and employment history. She had never smoked tobacco and she occasionally drank alcohol Her blood pressure was 112/60 mmHg, pulse was 72 beats per minute, and body temperature was 36.4 degrees Celsius. Because the nonfunctional lung region was covered by normal visceral pleura, she was diagnosed as having Pryce III intralobar sequestration. One and a half months after the first visit, we planned videoassisted thoracoscopic wedge resection of the right sequestration using NIR fluorescence imaging with ICG because of the small volume of the nonfunctional region. This patient has shown no complications in the 1 year since surgery
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