Intralobar pulmonary sequestration associated with an aneurysmal aberrant aortic branch

Intralobar sequestration a missed diagnosis

ABSTRACTINTRODUCTIONCoexisting bilateral intralobar and extralobar pulmonary sequestration has rarely been reported, with no previous reports indicating that simultaneous resection is necessary because of a common drainage vein.CASE PRESENTATIONA 1-year-old boy was prenatally suspected to have right pulmonary sequestration. A preoperative contrast-enhanced CT scan revealed coexisting right intralobar and left extralobar pulmonary sequestrations. The left extralobar sequestration drained into the right inferior pulmonary vein, which was shared by the right intralobar sequestration. The patient had a history of infection with right intralobar pulmonary sequestration during infancy, so a right lower lobectomy was considered. Although an isolated right lower lobectomy would have resulted in congestion of the left sequestrated lung, simultaneous bilateral thoracoscopic surgery was performed. First, thoracoscopic resection of the left sequestrated lung and ligation of the right feeding artery of the right sequestrated lung were performed with right differential lung ventilation, followed by thoracoscopic right lower lobectomy with left differential lung ventilation after repositioning the patient. The intra- and postoperative courses were uneventful.CONCLUSIONSSimultaneous thoracoscopic surgery for bilateral pulmonary sequestration in infants with a common drainage vein is a reasonable strategy, as unilateral lesion resection may lead to postoperative complications.

El secuestro pulmonar intralobar es una masa de tejido pulmonar que tiene riego sanguíneo propio proveniente de arterias sistémicas, no tiene comunicación con el árbol bronquial y tiene drenaje venoso hacia las venas pulmonares o aurícula izquierda. A diferencia del secuestro pulmonar extralobar, al que se le atribuye un origen congénito, el secuestro intralobar no tiene aún un origen definido (congénito o adquirido), ya que normalmente se diagnostica después de la primera década de la vida. Presentamos el caso de un paciente de 3 años de edad con diagnóstico repetitivo de neumonía basal derecha, en el que por arteriografía se diagnosticó secuestro pulmonar intralobar derecho. Se debe tener en cuenta a esta entidad dentro del diagnóstico diferencial en niños con cuadro clínico- radiológico de neumonía que no responde a tratamiento convencional, sea ésta derecha o izquierda. Se discute también la importancia de los diferentes métodos de imágenes para el diagnóstico.

Introduction: Pulmonary sequestration is a congenital anomaly of the foregut which accounts for 0.15-6.4% of all the congenital lung malformations. It is a nonfunctional lung tissue. It is divided into intra lobar and extra lobar sequestration. Extra-lobar can manifest in infancy and intra-lobar sequestration gets diagnosed in the adult as an incidental finding. Case presentation: Patient is a 50-year-old female with a medical history of asthma presented to the pulmonary Clinic for the incidental lung nodule. On the computerized tomography (CT) of the chest without contrast showed 1.9 cm irregularly shaped nodule in the left lower lobe of the lung. Patient did not have any shortness of breath, cough, no hemoptysis, appetite stable and intentional weight loss of 15 lb over the past 6 months. Patient uses fluticasone salmeterol inhaler every alternate day and as-needed albuterol inhaler. Patient has less than 20 pack years of smoking and quit more than 15 years ago. Based on the solitary pulmonary nodule lung-cancer risk calculator showed patient is moderate risk for malignancy and hence positron emission tomography (PET-CT) was ordered. Subsequently the scan did not reveal any hypermetabolic uptake of the 1.9 cm lung nodule of stable size. During the next office visit, CT angiography of the chest was ordered to rule out any pulmonary arteriovenous malformations. CT angiography of the chest revealed stable size irregular opacity in the left lower lobe is noted and an arterial vessel arising from the left lateral wall of the abdominal aorta coursing into and supplying this opacity, findings compatible with pulmonary sequestration is noted. Discussion: It is a nonfunctional lung tissue in which the segment or lobe of dysplastic lung has no communication with the rest of the tracheobronchial tree and receives anomalous systemic vascular supply. In intra-lobar sequestration, part of lung is within the visceral pleura of the functioning lung and the venous drainage is into the pulmonary vein unlike extra lobar where it has a separate visceral pleura and venous drainage into the systemic vein. Patients usually present with recurrent pneumonia in the same segment of the lung. Diagnosis in the adults is achieved through CT chest with contrast or an alternative being MR angiography, which are done to exclude any other thoracic pathologies and to see abnormal arterial supply. Treatment includes conservative management, treatment of choice is pulmonary lobectomy but recent advancements like endovascular embolization and coiling are provided as alternative management.

Intralobar pulmonary sequestration (a nonentity?).

Intralobar pulmonary sequestration: A clinical and pathological spectrum

* Abbreviations: CHF = : congestive heart failure • ILS = : intralobar sequestration • ELS = : extralobar sequestration • RR = : respiratory rate • HR = : heart rate • MRI = : magnetic resonance imaging • AVM = : arteriovenous malformation • BPFM = : bronchopulmonary foregut malformation • MRA = : magnetic resonance angiography Signs and symptoms of congestive heart failure (CHF) in a newborn include tachycardia, respiratory distress, feeding intolerance, irritability, and a weak cry. The neonate with CHF will usually have hepatosplenomegaly. Wheezing or crackles may be heard. Edema may be generalized, and a chest radiograph will usually reveal cardiomegaly. Differential diagnosis of CHF in a full-term newborn includes congenital heart disease, asphyxial cardiomyopathy, viral myocarditis, supraventricular tachycardia, diabetic cardiomyopathy, and arteriovenous malformations. In this report we describe the first documented newborn with CHF due to a coexisting bilateral intralobar sequestration (ILS) and extralobar sequestration (ELS), and summarize the cases of bilateral sequestrations previously reported in the English literature. A 4117-g full-term boy was born via a spontaneous vaginal delivery to a group B streptococcus-negative 24-year-old woman. Apgar scores were 8/9 at 1 and 5 minutes. After the first 4 hours of life the patient remained tachypneic with a respiratory rate (RR) of 60 to 100 and tachycardic with a heart rate (HR) of 160 to 200. In room air the oxygen percent saturation was 100%. There were no maternal infectious risk factors, and the child was feeding well and otherwise asymptomatic. After 48 hours of observation, his RR remained at 70 to 80 and his HR remained at 170 to 190. He had a normal complete blood count and chest radiograph. The patient was discharged and was seen daily without resolution of the tachypnea or tachycardia and without developing any signs of sepsis. On the eighth day of life, in addition to his tachypnea and tachycardia, his liver was noted to be palpable 4 cm below the right costal margin. He was then admitted for observation and an evaluation by pediatric cardiology for suspected CHF. On admission the patient was afebrile. His weight was 4553 g; RR 68; HR 164; blood …

Pulmonary sequestration is a rare congenital malformation involving non-functioning lung tissue that is isolated from the normal tracheobronchial tree and receives its arterial supply from an aberrant systemic artery, usually originating from the aorta. This condition is typically diagnosed in childhood but can remain asymptomatic and unrecognized until adulthood, when recurrent pulmonary infections or other complications prompt evaluation. In this case report, we present a 37-year-old male who immigrated from Ecuador in 2005 and had no significant past medical history. The patient initially presented to the emergency department in 2020 with symptoms of cough, dyspnea, and fever lasting for a week. Imaging studies revealed a large left lower lobe abscess (8.8 x 9.3 cm) with consolidation and a small pleural effusion. Tuberculosis was ruled out and patient was treated with prolonged course of antibiotics with a plan to repeat imaging after improvement, but the patient was lost to follow-up for three years. In 2023, the patient presented with hemoptysis and a history of trauma after falling from a roof. A repeat chest CT revealed hyperdense mass in the left lower lobe, at the site of the previous abscess, along with surrounding ground-glass opacities indicative of pneumonia. At this point, the possibility of a congenital anomaly, such as pulmonary sequestration, was raised, though no definitive diagnosis was made. The patient's pneumonia was managed with IV antibiotics, and repeat imaging after treatment revealed a persistent 12 cm complex mass in the left lower lobe. Despite the recommendation for surgical intervention due to suspected sequestration or an underlying infectious process, financial constraints led to the patient declining surgery at that time. In 2024, the patient returned with another episode of pneumonia and hemoptysis. Imaging findings were consistent with the previous observations, showing a complex cystic mass with areas of consolidation and air, suggestive of a recurrent pulmonary abscess. A thoracic surgery consultation led to an open thoracotomy and left lower lobectomy, during which cystic changes and aberrant vascular anatomy, consistent with pulmonary sequestration, were observed. Histopathological report also confirmed the diagnosis of pulmonary sequestration, a condition that likely contributed to his recurrent infections and pulmonary abscess formation over the years. This case underscores the importance of considering rare congenital anomalies like pulmonary sequestration in patients with recurrent pulmonary infections, particularly when imaging suggests a persistent or complex lung lesion. Early recognition and surgical intervention are essential in preventing recurrent infections and long-term complications.

Bronchopulmonary sequestration (BPS) is a rare congenital anomaly due to disturbed embryogenesis with a surplus budding of the lungs. BPS has no communication with the bronchial system. In most cases the blood supply of the sequestration is systemic via the aorta. There are two types of BPS: intralobar sequestration without its own pleural covering and extralobar sequestration with a separate pleura. They are clinically manifested in different ways. Sequestration normally occurs in the left lower lobe. The venous drainage often occurs via the pulmonary veins, producing a large shunt volume. The clinical symptoms are caused by recurrence of infection because of extensive therapy resistance, and rarely by haemoptysis.

<b>Introduction:</b> Pulmonary sequestration (PS) is a rare congenital pulmonary malformation, often found incidentally and can cause repeated respiratory infections. Aberrant vessels from the systemic circulation provide blood supply, commonly the descending aorta. PS can be intra-lobar (ILS) {more common} or extra-lobar (ELS). Outcomes from unresected PS is unknown. <b>Methods:</b> With Caldicott approval, a retrospective review of all CT scans performed between 2005 and Nov 2020 for the words ‘pulmonary or lung or intra-lobar or extra-lobar sequestration’ was performed.&nbsp; 56,247&nbsp;CTs were performed in total. 8 CTs were matched with the search words and 6 had PS. Basic demographics, clinical details and outcomes were collected. Descriptive statistical methodology was applied. <b>Results:</b> There were 4 male and 2 female patients. Mean age was 56.5 years (range 35-82). 3 were incidental findings and 3 were found after investigation for pain, haemoptysis and recurrent infections. 5 out of 6 were ILS and all of those were in the left lower lobe. The 1 ELS was in the right lower lobe. All had their blood supply from the descending aorta. 1 patient requested to have surgery and the ILS was excised with no complication. The 5 others did not require any intervention. 2 have died at the time of analysis due to unrelated medical issues. The incidence based on the total number of scans is 0.0084%. <b>Conclusions:</b> The above is a review of the incidence and outcome of PS in a large district general hospital in the North East of England. The results confirm the existing literature. We have reached out to regional hospitals so that a database can be built and encourage other centres to do the same. A crude incidence rate is 0.011% (11/100,000).

Revising the classification of lung sequestrations

A 46-year-old female with history of asthma, active smoking (20 pack-years), and schizophrenia was evaluated for a persistent asymptomatic pulmonary nodule. Her past medical history was notable for hypertension, obesity, polycystic ovary syndrome, abnormal uterine bleeding, multinodular thyroid gland, and vitamin D deficiency. Seven months before presentation, a chest radiograph (CXR) was obtained to evaluate unintended weight loss, and showed a 3 cm spiculated mass in the left lower lobe concerning for a primary lung malignancy. Follow-up computed tomography (CT) suggested that the left lower lobe mass corresponded to rounded atelectasis; however, at 6 month follow-up, low-dose chest CT scan revealed a 2.1 × 1.2 cm nodule within the central portion of the left lower lobe, with pleural thickening, and arising from or extending into the left lower lobe bronchus. The patient had no recent history of appetite change, exertional dyspnea, chronic cough, wheeze, fever, or other chest complaints. Her examination showed normal vital signs, oxygen saturation of 98% while inspiring room air, and an entirely normal lung and general physical examination, except for diminished breath sounds at the left base with no wheeze. An endobronchial ultrasound (EBUS) with fine-needle aspiration (FNA) and endobronchial biopsy was performed.

Subdiaphragmatic Extralobar Pulmonary Sequestration with Granulomatous Necrotizing Reaction Simulating a Tuberculous Infection: A Case Report

H erein, we report two cases of 2019 novel coronavirus (2019-nCoV).Both patients are believed to have exposure related to Wuhan, China (1-4).We demonstrated change in the course of disease over time on CT scans (5,6).Case 1 A 45-year-old woman living in Wuhan, China, was admitted to the hospital for 2 days due to cough and fever.On admission, her body temperature was elevated (38.2°C [100.76°F]) and there were coarse breath sounds of both lungs at auscultation.Her laboratory studies showed an

CYSTIC ADENOMATOID MALFORMATION OF THE LUNG IN AN ADULT: A CASE REPORT