Diagnosis Of Pulmonary Sequestration Research Articles

RARE CASE OF PULMONARY SEQUESTRATION DIAGNOSED ANTENATALLY.

Iind trimester anomaly scans play a vital role in identifying the anatomical abnormalities in the fetus and thus help in planning and prognosis of pregnancy. Pulmonary sequestration is an not a common condition in which a separate lung tissue is formed, which is not a anatomical structures of the lung tissue, not its blood supply, neither perform any function also. A 26 years old mother, visited our department for routine anomaly scan. Transabdominal ultrasound examination revealed a well-dened echogenic mass seen just below the left hemidiaphragm which showed vascular supply directly from the aorta. This conrmed our diagnosis of pulmonary sequestration. We further evaluated with Fetal MRI which showed T2 high signal and T1 iso signal mass, suspicion of sequestration and esophageal duplication cyst was considered. The pregnancy was carefully followed by serial scans and a male baby delivered without any complications. Postnatally abdominal ultrasonography performed showed echogenic mass seen below the left diagram which showed feeding artery from the aorta.

Posterior mediastinal neurilemmoma accompanied by intrapulmonary sequestration in the left lower lobe

Rationale:The presence of a mediastinal neurilemmoma accompanied by intrapulmonary sequestration is a rare occurrence. The clinical symptoms of a neurilemmoma depend on the site of the tumor. Diagnosis of pulmonary sequestration mainly depends on the presence of aberrant feeding arteries.Patient concerns:A 78-year-old woman was admitted to our hospital with a mediastinal space-occupying lesion of 50 years. Computed tomography and magnetic resonance imaging showed 2 roundish low-density shadows in the left posterior mediastinum.Diagnosis:The pathological findings of the upper cystic mass support the diagnosis of neurilemmoma. A branch of aorta was found supplying blood to the lower mass; it was considered a pulmonary sequestration.Interventions:Left-sided thoracotomy was planned to remove the chest space-occupying lesions. Two masses were completely removed. Severe adhesion between the left lower lobe and the diaphragm was successfully separated, the aberrant feeding vessel was properly managed, and the lower lobe was resected completely.Outcomes:The patient experienced remission of symptoms, had no significant postoperative complications, and was discharged from the hospital.Lessons:Special attention should be paid to neurological involvement of the neurilemmoma and the fragile feeding arteries of the intrapulmonary sequestration. Early diagnosis and treatment are important in such cases.

Pulmonary sequestration in children. postnatal course, diagnosis and surgical treatment

The aim — to optimize the diagnostic and treatment of pulmonary sequestration in children on the basis of clinical and diagnostic data and treatment results study.Materials and methods. The study included 14 patients aged 8 days to 17 years, 3 of which were newborns, 4 — from 1 to 12 months, 3 — from 1 to 3 years, 2 — 7­8 years, and 2 — 15 — 17 years old. There were 8 (57.1 %) boys and 6 (42.9 %) girls. Postnatal diagnosis was based on contrast computed tomography or angiography. In all cases the surgical treatment was performed. In 5 cases, the diagnosis of pulmonary sequestration was established intraoperatively during the surgery for mediastinal tumor, congenital diaphragmatic hernia or polycystic lung.Results and discussion. Ten (71.4 %) patients had intralobar sequestration and another 4 (28.6 %), extralobar one (p = 0.099), left­side localization was in 9 (64.3 %) cases, right­side in 5 (35.7 %). Associated malformations were found in 7 (50.0 %) patients and included polycystic lung (n = 3), lung hypoplasia (n = 2), diaphragmatic hernia (n = 2), pericardial defect (n = 1), thoracic dystopia of kidney (n = 1), Waardenburg syndrome (n = 1). Twelve (85.7 %) patients had a symptomatic disease presented with respiratory or hemodynamic disorders, signs of inflammation and hemophtysis. Lobectomy (n = 4), segmental lung resection (n = 4) or division of aberrant vessels (n = 2) were used in cases of intralobar disease depending on the extent of lesion while sequesterectomy (n = 4) was performed in extralobar sequestration. Simultaneous diaphragmoplasty, including that with use of bounded autopericardial flap (n = 1) was performed in 2 cases of associated diaphragmatic hernia. There were no postoperative complications and mortality. Late follow­up examination within the period from 4 to 22 years after the operation showed positive results in all 100 % of cases.Conclusions. Pulmonary sequestration, since the diagnosis is established, is subject to compulsory surgical correction, the effectiveness of which reaches 100 %. Correction of intralobar sequestration consists of lobectomy or segmental resection of the lungs, in the case of extralobar disease sequesterectomy is indicated. Associated congenital diaphragmatic hernia can be effectively corrected by diaphragmoplasty, including that with use of autopericardium.

Usefulness and Limitations of Multidetector Computed Tomography Angiography for Visualization of Thoracic Aberrant Arteries in Neonates

We describe two neonatal patients where the final diagnosis differed in whom multidetector computed tomography (MDCT) angiography could clearly visualize the intrathoracic aberrant artery. The first case was a infant with a right intrathoracic tumor detected by fetal sonography. MDCT was performed 13 days after birth at a weight of 3492 g. An aberrant arteries arising from the Th10-high aorta toward the right lower lobe was detected. A right lower lobectomy was performed in the diagnosis of pulmonary sequestration. The latter was an infant born at 28 weeks of gestation. MDCT was performed to investigate an abnormal right upper lobar shadow 92 days after birth at a weight of 2906 g. An aberrant arteries arising from the Th5-high aorta toward the right upper lobe was detected. We determined the artery considered aberrant was an inflammatory dilated bronchial artery by conventional angiography. MDCT could visualize ultra-fine aberrant arteries in neonates. However, it cannot explore the artery peripherally or evaluate the area controlled by the artery. Conventional angiography should be performed in cases without a branch defect of the bronchus or pulmonary artery, and in those cases with an aberrant artery arising from Th5-Th6-high thoracic aorta, which cannot be distinguished from the bronchial artery.

Case 1: Secondary Structural Cause of Tachypnea Following Congenital Diaphragmatic Hernia Repair in a Term Neonate

A 39-3/7 weeks’ gestation male infant is born to a 29-year-old gravida 1 para 0 woman via urgent cesarean delivery due to failed induction. Prenatal laboratory tests yielded unremarkable results. Rupture of membranes is for 7 days. Apgar scores are 3, 6, and 8 at 1, 5, and 10 minutes, respectively. In the delivery room, the baby requires positive pressure ventilation for respiratory distress. Initial chest radiography reveals a possible diaphragmatic hernia (Fig 1). The patient is intubated for respiratory distress and placed on a conventional ventilator. After placement of umbilical catheters, the infant is transferred to the NICU for further care. Repeat chest radiography reveals bowel-containing diaphragmatic hernia, stomach visible below the diaphragm, and a crescent opacity in the left upper lung field suggestive of a herniated spleen. Initial echocardiography on postnatal day 2 reveals abnormal ventricular septal motion but no significant tricuspid regurgitation consistent with pulmonary hypertension. The patient is taken to the operating room for repair, reduction, and primary closure of the hernia (Fig 2). Following surgery, the patient is weaned to continuous positive airway pressure on postnatal day 4 and subsequently weaned to room air on postnatal day 6. Figure 1. Chest radiograph revealing a possible diaphragmatic hernia, with the stomach visible below the diaphragm. Figure 2. Chest radiograph status post repair of the left diaphragmatic hernia. Seven days after birth, the patient develops tachypnea during feeding without retractions or desaturations, prompting another chest radiograph. ### Diagnosis The chest radiograph revealed retrocardiac opacity suspicious for a pulmonary sequestration. Chest ultrasonography followed by magnetic resonance imaging/magnetic resonance angiography confirmed the diagnosis of pulmonary sequestration (Figs 3 and 4). The size of the pulmonary sequestration was 4.5 cm anteroposterior × 2.8 cm transverse × 3.6 cm craniocaudal. Figure 3. Magnetic resonance imaging showing …

Role and importance of Doppler ultrasound in the diagnosis of pulmonary sequestration: Report of two adolescent cases.

Pulmonary sequestration is a rare pulmonary parenchymal anomaly. The localization of the aberrant artery and its relation with sequestration are of importance in the process of diagnosis in the preoperative period. The feeding artery can be identified by color Doppler ultrasonography. We report two cases of pulmonary sequestration in two adolescents, aged 11 and 13 years old, and this report documents the use of in which color Doppler ultrasound demonstrated the abnormal feeding artery. Color Doppler ultrasonography, a noninvasive and radiation-free imaging modality should be considered in the diagnostic algorithm of pulmonary sequestration.

A Fighter Pilot Case of Pulmonary Sequestration

Pulmonary sequestration is a rare congenital malformation. The diagnosis of pulmonary sequestration is based on the identification of an abnormal arterial supply. Conventional treatment for pulmonary sequestration is surgical removal of the tissue, which may induce serious trauma and requires a long recovery time. Recently, endovascular treatment has become feasible as a safer and less invasive method to treat pulmonary sequestration. To the best of our knowledge, pulmonary sequestration has not been reported in pilots. In this study, we report a fighter pilot case of intralobar pulmonary sequestration detected with the assistance of spiral computed tomography (CT) and digital subtraction angiography. The young fighter pilot had experienced recurrent hemoptysis and pulmonary infections for approximately 10 yr before the pulmonary sequestration was diagnosed. We performed a transcatheter arterial embolization and a subsequent CT angiography confirmed complete infarction of the sequestration. After the treatment, no clinical complications were observed and the patient, with normal lung function restored, was qualified to serve as a fighter pilot again. Compared with conventional removal surgery, endovascular treatment is a superior treatment for pulmonary sequestration in a fighter pilot in maintenance of pilot qualification.

Evaluation of diagnostic accuracy of computed tomography to assess the angioarchitecture of pulmonary sequestration

Bronchopulmonary sequestration is an unusual congenital malformation consisting of abnormal lung tissue that lacks normal communication with the tracheobronchial tree. The diagnosis of pulmonary sequestration is based on identifying this systemic arterial supply. We aimed to evaluate the sensitivity of multidetector computed tomography in demonstrating the feeding artery and draining veins. Between 2003 and 2008, 8 patients (6 males, 2 females) ranging in age from 5 to 49 years with a diagnosis of pulmonary sequestration were identified. All patients underwent evaluation with chest tomography (spiral or multi detector tomography) and digital subtraction angiography. Aberrant systemic arterial supply was demonstrated in all cases: from the descending thoracic aorta (n= 6); arcus aorta (n= 1), internal mammarial artery (n= 1), intercostal arteries (n= 2) and celiac axis (n= 1). Four patients underwent surgery which confirmed the angioarchitecture depicted on angiography. One patient underwent angiography with embolization using. Computed tomography especially multidetector computed tomography is a powerful noninvasive technique for the detection of pulmonary sequestration.

Intralobar pulmonary sequestration masquerading as congenital lobar emphysema

Intrapulmonary sequestrations are quite uncommon in pediatric age group. The preoperative diagnosis of pulmonary sequestration is not possible in most of the cases. A 2-year-old boy presented with recurrent episodes of chest infections and respiratory distress. A preoperative diagnosis of congenital lobar emphysema was made on the basis of chest radiograph and computed tomography scan. At operation, an intralobar pulmonary sequestration was found. The sequestration cyst was excised with uneventful recovery.

Role of Doppler sonography in the diagnosis of pulmonary sequestration in an elderly patient: A case report

An 83-year-old man presented with an asymptomatic mass-like lesion in left lower lobe on chest radiograph and CT, with no change over the past 7 years. Because of discrepancy between clinical and radiological manifestations, chest color Doppler sonography was done and identified a large tortuous pulsating vessel with systemic arterial waveform flowing toward the probe and entering the lesion at its apex. Subsequent contrast-enhanced reconstructed CT scans of the chest with angiography confirmed the diagnosis of intralobar pulmonary sequestration.

Une infection pleuropulmonaire non résolutive chez une femme jeune

Bronchopulmonary sequestration is a rare malformation characterized by lung tissue fed by one or several aberrant systemic arteries. The authors present the case of a 35-year-old woman in whom extralobar sequestration was fortuitously detected at the time of persistent pleuropneumopathy. Computed tomography was used in the diagnosis of pulmonary sequestration. The most common and recommended treatment is the surgical removal of the pulmonary sequestration.

Perinatal Imaging in Bronchopulmonary Sequestration

Received September 2, 2008, from the Fetal Medicine Center, Department of Obstetrics and Gynecology, Clinica Las Condes, Santiago, Chile. Revision requested September 8, 2008. Revised manuscript accepted for publication October 7, 2008. I thank Ximena Ortega, MD, for evaluating the prenatal magnetic resonance imaging; Jose M. Cortes, MT, and Juan A. Escaffi, MD, for performing and evaluating the angiographic computed tomography; and Angel Blanco, MD, Jose L. Martinez, MD, and Hernan Villalon, MD, for their substantial contribution to the postnatal care of the infant reported here. This work was supported by the Sociedad Profesional de Medicina Fetal “Fetalmed” Limitada, Chile. Address correspondence to Waldo Sepulveda, MD, Fetal Medicine Center, Clinica Las Condes, Casilla 208, Santiago 20, Chile. E-mail fetalmed@yahoo.com Abbreviations CCAM, cystic congenital adenomatoid malformation; CT, computed tomography; MRI, magnetic resonance imaging 30-year-old woman, gravida 2, para 1, was referred to our center at 21 weeks’ gestation after the prenatal detection of an echogenic mass in the right lung during a second-trimester anatomy scan. Her medical and obstetric histories were unremarkable; the current pregnancy had been otherwise uncomplicated; and the first-trimester scan at 11 weeks confirmed the dates and a normal nuchal translucency thickness measurement. Sonographic examination at referral showed adequate fetal growth and a normal amniotic fluid volume. Detailed examination of the fetal anatomy revealed a predominantly solid echogenic lesion with several small cysts, the largest measuring 3 mm, occupying the lower two-thirds of the right lung (Figure 1, A and B). There were no signs of a mediastinal shift, cardiac compression, abnormal venous return, or additional fetal structural anomalies. Color Doppler sonography depicted a large arterial vessel feeding the mass, which originated from the abdominal aorta (Figure 1C). The diagnosis of pulmonary sequestration was entertained, but the presence of small cysts within the mass also suggested a hybrid lesion associated with cystic congenital adenomatoid malformation (CCAM) of the lung. The pregnancy was followed with serial scans, which showed a slight reduction of the size of the mass, a normal amniotic fluid volume, and no signs of fetal hydrops. Fetal magnetic resonance imaging (MRI), performed at 31 weeks, confirmed the presence of a predominantly solid mass with small cysts in the fetal right lung and a feeding vessel arising from the abdominal aorta and crossing the diaphragm (Figure 2). At 38 weeks, a male neonate was delivered vaginally, weighing 3200 g and with Apgar scores of 9 and 10 at 1 and 5 minutes, respectively. There were no neonatal respiratory complications and the infant remained asymptomatic. Angiographic computed tomography (CT) was per-

Diagnosis and surgical treatment of pulmonary sequestration

To investigate the classification, incidence, clinical characteristics, diagnosis and surgical treatment of pulmonary sequestration. The clinical data of 23 patients with pulmonary sequestration, 13 males and 10 females, aged 39 (12 - 71), with a course of 3 days to 9 years, hospitalized during the period from May 1974 to November 2006, were reviewed retrospectively. The cases of sequestration were presents which were resected and confirmed by pathology in our department. The incident rate of pulmonary sequestration was 0.29% among the patients who underwent operation during that period. Nineteen (83%) of the 23 patients suffered from interloper pulmonary sequestration and 4 suffered from extralobar pulmonary sequestration. Eighteen of the 23 patients had recurrent pneumonia with the clinical manifestations of cough, fever, and hemoptysis. Fourteen cases got confirmed diagnosis before operation. The diagnosis of pulmonary sequestration mainly depends on X-ray, CT and MRI. The sequestration should be removed whenever it is diagnosed.

低線量ラセンCTによる肺癌検診にて発見された肺葉内肺分画症の一例

A 52-year-old man underwent lung cancer screening with low-dose spiral computed tomography (CT) in a medical check-up at the Japanese Red Cross Kumamoto Health Care Center. He was asymptomatic. Chest x-ray on a medical check-up showed no abnormal shadows. CT scans revealed a nodule in the right lower lung, suggestive of its connection to the descending thoracic aorta. A diagnosis of pulmonary sequestration was considered. He was transferred to Kumamoto University Hospital for further examination. Contrast enhanced multidetector CT images demonstrated that a nodule in the right lower lobe and an anomalous artery ran from the descending thoracic aorta, flowed through the right lower lobe and returned to the right inferior pulmonary vein. Intralobar pulmonary sequestration was confirmed by contrast enhanced multidetector CT. We report this case of asymptomatic intralobar pulmonary sequestration diagnosed using contrast enhanced multidetector CT.

Doppler echocardiography and MR angiography for diagnosis of systolic murmurs in pulmonary sequestration

A 1-month-old boy was referred from another institution because of a systolic murmur. A grade 2 systolic murmur was heard at the left lower sternal border with radiation to the left chest and back. A chest radiograph showed slight cardiomegaly and theelectrocardiogram showed mild left ventricular volume overload. Echocardiography showed no cardiac abnormalities, except for mild left ventricular volume overload. Meticulous color Doppler examination of the aorta showed anteriorly directed arterial blood flow arising from the descending aorta in the retrocardiac region above the left hemidiaphragm (Figure, A). Magnetic resonance angiography (MRA) with contrast enhancement revealed a single large artery that ran leftward and downward from the descending aorta in the retrocardiac region above the left hemidiaphragm (Figure, B and D). Abnormal vessels were also observed to the left of the descending aorta in the retrocardiac region (Figure, B and C). The left lower pulmonary vein was dilated, so venous drainage was considered to occur through this vein. From these findings, a diagnosis of sequestration of the left lower lobe was strongly suspected. Aortography displayed a single large artery (diameter, 8 mm; length, 20 mm) arising from the descending aorta. Surgery revealed an intralobar sequestration in the left lower lobe that showed normal communication with the tracheobroncheal tree and received its arterial blood supply from the descending aorta via a single large artery (diameter; 8 mm, length; 20 mm) (Pryce type 1). 1 Venous drainage was through the left lower pulmonary vein. Lobectomy of the left lower lobe was performed. The definitive diagnosis of pulmonary sequestration is usually made by aortography, but noninvasive methods are preferable, especially in young patients such as neonates or infants. Doppler echocardiography and MRA were useful for the diagnosis of pulmonary sequestration presenting as a vascular murmur in an infant.

Evaluation of angioarchitecture of pulmonary sequestration in pediatric patients using 3D MDCT angiography.

The goal of this study was to show the ability of 3D MDCT angiography to display the arterial and venous vascular anatomy of pulmonary sequestration in children. MDCT angiography with 3D rendering shows the anomalous feeding artery and the draining veins that allow a diagnosis of pulmonary sequestration. These features may prove useful in distinguishing intra- and extralobar sequestration and in surgical planning.

Pulmonary sequestration children: is the thoracoscopic approach a good option?

The thoracoscopic approach for pulmonary sequestration in children seems to be feasible and reproducible. To date, there have been no studies comparing the thoracoscopic approach with the conventional technique in this indication. Therefore, the aim of this study was to compare these two approachs. We performed a retrospective study in patients treated surgically for a prenatal diagnosis of pulmonary sequestration between 2000 and 2003. Three or five ports were used, and single-lung ventilation was required. The clinical, operative, and postoperative data were compared with those for patients operated on during the same period via thoracotomy. For statistical purposes, the children who required conversion to the open proecedure were grouped with those who underwent thoracotomy. The following data were compared: age, and weight, operating time, duration of postoperative drainage via chest tube, duration of postoperative narcotic use, pain scores on the 1(st) and 2(nd) days after the procedure, and length of hospital stay. The Mann-Whitney test was used for statistical analysis. Five infants were operated on via a thoracoscopic approach. Two required conversion to an open procedure. There were four intralobar sequestrations (ILS) and one extralobar sequestration (ELS). The mean age at surgery was 6.2 months (range, 4-9). The mean operating time, excluding the patients who were converted to open, was 155 min (range, 120-190). In the thoracotomy group, there were one ELS and one ILS. Two groups were defined: the exclusively laparoscopy group (EL) (n = 3) and the thoracotomy and conversion group (TC) (n = 4). The duration of postoperative drainage, duration of postoperative narcotic use, and hospital stay seemed to be shorter in the group EL. These times, respectively, were 3.4 vs 2.75 days, 4.1 vs 3.3 days, and 7.5 vs 4.3 days = (p = 0.03). There were two complications in the TC group (one wound abcess and one pleural leak that required a chest tube). The thoracoscopic approach for pulmonary sequestration is feasible. It seems to reduce the duration of postoperative drainage, postoperative narcotic use, hospital and stay. These results need to be confirmed by a prospective and more detailed study.

Pulmonary sequestration: demonstration of blood supply with 2D and 3D MR angiography

Pulmonary sequestration is a relatively rare but clinically significant congenital anomaly. This disease is a spectrum of disorders involving the pulmonary airways, the arterial supply to the lungs, the lung parenchyma and its venous drainage. Traditionally, the diagnosis of pulmonary sequestration has been made definitively with arterial angiography. It is imperative for the preoperative evaluation that the arterial supply and venous drainage of the sequestered segment is identified. Several cases of MR diagnosis and preoperative evaluation of pulmonary sequestration and blood supply have been reported. In this case, MR imaging was able to provide important information about systemic blood supply via intercostal arteries and regular venous drainage. Furthermore this imaging technique revealed a second pulmonary sequestration in the dorsal phrenicocostal sinus that was not diagnosed before.

Nonimmune hydrops fetalis, pulmonary sequestration, and favorable neonatal outcome

The association of pulmonary sequestration and nonimmune fetal hydrops reportedly carries a very poor prognosis for survival. We describe three newborns with good outcomes despite the diagnosis of pulmonary sequestration; two cases were associated with hydrops fetalis and one with isolated fetal ascites. Two neonates with severe hydrops fetalis had pulmonary sequestration diagnosed postnatally. A third infant presented early in gestation with marked fetal ascites that regressed spontaneously before delivery; this infant also had pulmonary sequestration. Despite severe respiratory insufficiency requiring aggressive management, all three infants survived after surgical resection of the sequestered lung mass. These cases demonstrate the difficulties associated with antenatal counseling regarding long-term prognosis for infants with nonimmune hydrops and pulmonary sequestration. With optimal care in a tertiary perinatal center, a less pessimistic outlook than previously described in the literature may be appropriate.

Pulmonary sequestration: diagnosis with color Doppler sonography and a new theory of associated hydrothorax.

The diagnosis of pulmonary sequestration has traditionally relied on angiographic demonstration of a systemic artery to the sequestered lung tissue. Rarely, extralobar sequestration can be associated with tension hydrothorax, which in the past has invariably led to fetal hydrops and death. The authors report the cases of three infants who had initially undergone color and spectral Doppler analysis; in two of them, extralobar sequestrations were associated with congenital hydrothorax. All three patients underwent surgical resection and histopathologic evaluation of their sequestrations. On the basis of the findings, the authors believe that torsion of the sequestration occludes the efferent venous and lymphatic channels, initiating the accumulation of pleural fluid and subsequent hydrops through systemic venous obstruction. Color Doppler made possible the identification of minute feeding vessels, obviating further diagnostic studies.