Possible Approach to Esophageal Lung with Long Tracheobronchial Gap.

Andrea Zanini,Lorenza Pugni,Martina Ichino,Fabio Mosca,Anna Morandi,Francesco Macchini

doi:10.1055/s-0039-1692407

Abstract

Esophageal lung is a rare bronchopulmonary foregut malformation characterized by an anomalous origin of one of the main bronchi which arises from the esophagus. Less than 30 cases are reported in the literature. Therefore, there are no standardized guidelines for the treatment of this condition. We report a case of right esophageal lung diagnosed in a neonate. The patient was treated with thoracoscopic closure of the ectopic main bronchus in the neonatal period, followed by delayed pneumonectomy at 5 months of age. No prosthetic substitute was implanted in the ipsilateral hemithorax after pneumonectomy. The patient is now 4 years old and doing well, postpneumonectomy syndrome was never observed. Our strategy and the possible alternatives are discussed here.

Highlights

Esophageal lung is an extremely rare malformation characterized by an anomalous origin of one of the main bronchi, which arises from the esophagus
We report a case of right esophageal lung diagnosed in a neonate and discuss our management and possible alternative treatment strategies
We judged that a tracheobronchial anastomosis was unfeasible due to the long tracheobronchial gap, the position of the right main bronchus was very low in the thorax with a gap of four vertebral bodies between its origin and the end of the trachea, as it is well evidenced by the three-dimensional computed tomography (CT) reconstruction of the anatomy of our patient (►Fig. 1B–C)

Summary

Introduction

Esophageal lung is an extremely rare malformation characterized by an anomalous origin of one of the main bronchi, which arises from the esophagus. On day 3 of her life, a chest computed tomography (CT) scan (►Fig. 1A–C) was performed and revealed an anomalous origin of the right main bronchus from the distal esophagus received December 13, 2018 accepted after revision April 28, 2019. An esophageal contrast study was performed which revealed a partial recanalization of the right main bronchus with a small leakage toward the right lung past the endoclips (►Fig. 1E). The postoperative course was characterized by a minor esophageal leakage diagnosed by a contrast study performed on the 6th post-operative day due to salivary leak from the chest drain. It was successfully treated conservatively with fasting and antibiotics. The patient is 5 years old and has a normal life, needing respiratory physiotherapy cycles for high airways resistance

Discussion

Conclusion