Thoracoscopic pneumonectomy for an esophageal lung in a newborn: A case report

Abstract

IntroductionThe esophageal lung is an extremely infrequent congenital malformation within the broncho-pulmonary foregut malformations (CBPFM) spectrum, characterized by the presence of a communication between the esophagus and the lung tissue. Case presentationA 9-day-old male newborn was transferred from a secondary center to our center on suspicion of a tracheo-esophageal fistula after a chest x-ray revealed opacification of the entire right lung, along with tracheal deviation and mediastinal shift, indicating severe right lung atelectasis. A non-contrast chest tomography showed right lung atelectasis and a bronchus-esophagus communication. The patient was asymptomatic on arrival. A bronchoscopy was done on day of life 10, and revealed absence of a carina and a single left-sided main bronchus. Additionally the patient underwent an esophagoscopy that revealed an opening on the right side of the distal third of the esophagus. Contrast studies confirmed the broncho-esophageal communication and the absence of a right main stem bronchus arising from the trachea. At 17 days of age the patient underwent a thoracoscopy. The esophageal bronchus was identified and a pneumonectomy was completed. The patient was extubated 1 day after the operation. At 6 months of follow up he is thriving well and has no oxygen requirements. ConclusionThis case emphasizes the importance of early diagnosis in cases of esophageal lung, which can be accomplished by a combination of radiological and endoscopic studies. Pneumonectomy is the treatment of choice.