Diagnóstico diferencial y cirugía mínimamente invasiva de un tumor suprarrenal de hallazgo antenatal / Differential diagnosis and minimally invasive surgery of an antenatal adrenal mass

Resumen: Introducción: Las masas suprarrenales en recién nacidos son infrecuentes. El diagnóstico diferen cial incluye masas benignas (hemorragia suprarrenal o secuestro pulmonar extralobar) y malignas (neuroblastoma), y pueden ser un hallazgo durante la ecografía obstétrica. El uso de imágenes com plementarias en el periodo postnatal permite una mejor aproximación diagnóstica, con implicancias en el manejo de estos pacientes. Objetivos: comunicar el caso de una recién nacida portadora de una masa suprarrenal, discutir los diagnósticos diferenciales y el manejo de lesiones suprarrenales en recién nacidos. Caso Clínico: Lactante de 2 meses de edad, derivada para estudio de tumor supra rrenal de diagnóstico antenatal a las 22 semanas de edad gestacional. El estudio imagenológico con ecografía postnatal mostró un tumor compatible con neuroblastoma. Paciente asintomática, estudios de laboratorios sin hallazgos relevantes. Se realizó resección laparoscópica de la lesión. El estudio histológico confirmó un secuestro pulmonar. Conclusión: El secuestro pulmonar extralobar debe ser considerado en el diagnóstico diferencial de una masa suprarenal del recién nacido. La cirugía mínimamente invasiva debiera considerarse como el abordaje de elección en casos como este, donde existe factibilidad técnica y beneficios en la recuperación y secuelas cosméticas del paciente.

Abstract: Introduction: Adrenal masses are uncommon in newborns. The differential diagnosis includes be nign masses (adrenal hemorrhage, extralobar pulmonary sequestration) and malignant ones (neuro blastoma) that may be a finding during an obstetric ultrasound. The use of complementary imaging methods allows a better diagnosis approach during the postnatal period, with implications for the management of these patients. Objective: To report the case of a female newborn with diagnosis of an adrenal mass, and to discuss differential diagnoses and management alternatives of adrenal lesions in newborns. Case report: Two-month-old female infant, referred for adrenal tumor study diagnosed at 22 weeks gestational age. Postnatal ultrasound showed a tumor compatible with neuroblastoma. The patient was asymptomatic, and the laboratory studies showed no relevant findings. The lesion was excised by laparoscopy. A histological study confirmed pulmonary sequestration. Conclusions: Extralobar pulmonary sequestration should be considered in the differential diagnosis of an adrenal mass in the newborn. Minimally invasive surgery should be the preferred surgical technique choice in these cases, given the technical feasibility and benefits in the recovery and cosmetic issues of the patient.

Prenatal diagnosis of intraabdominal extralobar pulmonary sequestration by ultrasound / 中华超声影像学杂志

Objective To describe the diagnostic approach and clinical outcomes of fetal intraabdominal extralobar pulmonary sequestration (IEPS).Methods Three cases of IEPS were diagnosed prenatally by ultrasound in our center.The data of these 3 cases and 43 cases in prior studies from 1986 to 2016 were retrospectively reviewed.The prenatal sonographic features,treatment,and outcomes were collected.Results The gestational age of diagnosis IEPS was (24.5±5.9)weeks,the male-to-female ratio was 3-4∶1,78.3% (36/46) of IEPS masses located on the left side,47.8% (22/46) of lesions were homogenous and hyperechoic,8.7% (4/46) of cases associated anomalies,78.3% (36/46) of patients were preformed resection and postoperative recovery and subsequent course were uncomplicated.Feeding arteries were detected in 15.2% (7/46) cases and confirmed by surgery or autopsy.Conclusions Prenatal ultrasound has the diagnostic accuracy of IEPS.Feeding arteries noted on color Doppler are strongly indicators of IEPS.Postsurgical outcomes are favorable.

Secuestro pulmonar extralobular como causa de hemorragia pulmonar recurrente en un recién nacido / Extralobar pulmonary sequestration as a cause of recurrent pulmonary hemorrhage in a neonate

El secuestro pulmonar es una malformación pulmonar congenita, quística o sólida, compuesta de tejido pulmonar no funcional sin conexión con el árbol traqueobronquial y que recibe sangre arterial de la circulación sistemica. Existen dos formas de secuestro: intralobular y extralobular. El tratamiento se realiza mediante resección quirúrgica. Se describe el caso de un recién nacido prematuro con secuestro pulmonar extralobular que presentó insuficiencia respiratoria y hemorragia pulmonar recurrente. Luego de la cirugía, el paciente mejoró en forma clínicamente significativa.

Pulmonary sequestration is acystic or solid congenital lung malformation comprised of non functional lung tissue that does not communicate with the normal tracheobronchial tree and has a systemic arterial blood supply. There aretwo forms of sequestration: intralobar and extralobar. Its treatment is surgical resection. Here we presented a case of premature neonate with extralobar pulmonary sequestration who had respiratory failure and recurrent pulmonary hemorrhage. Following surgery, the patient showed significant clinical improvement.

Secuestro pulmonar extralobar infradiafragmático: a proposito de un caso / Extralobar Infradiaphragmatic Pulmonary sequestration: a case report

Se presenta un caso de secuestro pulmonar extralobar infradiafragmático como hallazgo ultrasonográfico prenatal, confirmado posteriormente por anatomía patológica.

We present a case of extralobar infradiaphragmatic pulmonary sequestration as prenatal ultrasonographic finding, subsequently confirmed by histopathology.

Extralobar Pulmonary Sequestration with Hemorrhagic Infarction in a Child: Preoperative Imaging Diagnosis and Pathological Correlation

We describe a rare case of extralobar pulmonary sequestration with hemorrhagic infarction in a 10-year-old boy who presented with acute abdominal pain and fever. In our case, internal branching linear architecture, lack of enhancement in the peripheral portion of the lesion with internal hemorrhage, and vascular pedicle were well visualized on preoperative magnetic resonance imaging that led to successful preoperative diagnosis of extralobar pulmonary sequestration with hemorrhagic infarction probably due to torsion.

Immunohistochemical analyses of a case of extralobar pulmonary sequestration with chest pain in an adult.

Computed tomography of a Japanese man in his mid-forties with a complaint of right-side chest pain showed a dome-shaped smooth-surfaced mediastinal mass, which was extirpated. The cut surface was highly hemorrhagic and necrotic and not related to the original pulmonary tissues. Although routine sectioning detected bronchial cartilage, immunohistochemical analyses clearly showed the presence of alveolar type II cells; only the alveolar type II cells located at the periphery of this mass showed positive staining for cytokeratins, thyroid transcription factor 1, surfactant protein A, epithelial membrane antigen and Krebs von den Lungen-6. Thus, these analyses are useful for the detection of pulmonary components, even in severely hemorrhagic and necrotic tissues with marked sequestration. The clinical diagnosis was a rare, adult type of extralobar pulmonary sequestration accompanied by chest pain.

Secuestro pulmonar: serie clínica de 16 pacientes / Pulmonary sequestration: clinical report of 16 patients

Objetivo: Describir los hallazgos clínicos de pacientes tratados por secuestro pulmonar en el Hospital de Niños Roberto del Río, entre los años 2000 y 2012. Métodos: Estudio descriptivo retrospectivo. Se revisaron las fichas clínicas de todos los pacientes atendidos en el Hospital entre el año 2000 y 2012 con diagnóstico de secuestro pulmonar confirmado por anatomía patológica. Resultados: Se registraron 16pacientes, 8 niños y 8 niñas. Del total 9 fueron secuestros extralobares y 7 intralobares. La sospecha diagnóstica fue por imagen de neumonía persistente en el 44 por ciento de los casos, distrés respiratorio neonatal en el 25 por ciento, ecografía antenatal en el 19 por ciento y neumonía repetida en el 12 por ciento. El 75 por ciento de los secuestros estaba ubicado en el lóbulo inferior izquierdo, el 19 por ciento en lóbulo inferior derecho y el 6 por ciento en lóbulo superior derecho. La técnica quirúrgica de elección fue la toracotomía abierta. El 56 por ciento de los pacientes se operó antes del año de vida (31,5 por ciento antes de las 2 semanas de vida). La evolución postoperatoria fue buena en el 69 por ciento de los casos, mientras que un 12,5 por ciento presentó atelectasia, 12,5 por ciento fístula broncopleural y 6 por ciento neumotórax residual. La mediana de estadía hospitalaria fue de 9 días. No se registró mortalidad. Conclusiones: Se presenta la experiencia de esta patología en el Hospital Roberto del Río enfatizándose la importancia de la sospecha diagnóstica.

Objective: To describe our experience with sixteen children treated for pulmonary sequestration at the Children 's Hospital Roberto del Rio, between 2000 and 2012. Method: We reviewed retrospectively the clinical charts of all those patients up to 15 years old, who were treated for pathologically proven pulmonary sequestration in our hospital, between 2000 and 2012. Results: Sixteen patients were recorded, 8 boys and 8 girls that were diagnosed and/or treated between the newborn period and 14 years old. Nine of them had extralobar sequestration and 7 intralobar. The diagnosis was suspected for persisting pneumonia in 44%, neonatal respiratory distress in 25%, prenatal ultrasound in 19%, and recurrent pneumonia in 12%. Seventy-five percent of sequestrations were located in the left lower lobe, 19% in the right lower lobe and 6% in the right upper lobe and all of them were operated via thoracotomy. Fifty-six percent underwent surgery before one year of age (31.5% before 2 weeks of life) and 69% of patients did well postoperatively. Postoperative atelectasis were detected in 12.5%, bronchopleural fistula in 12.5% and residual pneumothorax in 6%. The average hospital stay was 9 days and no mortality was registered. Conclusions: Our experience is similar to the previously reported series and emphasizes the importance of early diagnosis in the treatment of pulmonary sequestration in children.

A case report of extralobar pulmonary sequestration in a dog

Pulmonary sequestration is a rare congenital anomaly in the veterinary literature. This malformation is characterized by a cystic mass of non-functioning primitive lung tissue that does not communicate with the tracheobronchial tree or with the pulmonary arteries. This article describes gross and histopathological characteristics of extralobar pulmonary sequestration in a dog. Grossly, a mass was observed in the left side of the thoracic cavity, closed to the caudal lobes of the lung, without communication with the tracheobronchial tree and the pulmonary arteries that was separated by pleural covering. Histopathologic examination showed emphysematous alveoli and bronchi, hypertrophy of smooth muscles and presence of the undifferentiated mesenchymal tissue. Therefore, based on microscopic findings, extralobar pulmonary sequestration was diagnosed. To the best of our knowledge, this is the first report of extralobar pulmonary sequestration in dog.

Diagnosis and surgical treatment of pulmonary sequestration / 中华胸心血管外科杂志

ObjectiveTo explore the classification,diagnosis,clinical features and surgical treatment of pulmonary sequestration.MethodsThe clinical data of 23 patients with pulmonary sequestration from 1985 to 2011 were retrospectively reviewed.ResultsFrom 1985 to 2011,23 patients with pulmonary sequestration were operated and were pathologically confirmed.There were 15 males and 8 females aged 9-48 years.Their disease course ranged from 1 month to 30 years.The pulmonary sequestration was in left lower lobe in 17 cases and right lower lobe in 6 cases.All cases were in base segment.21 cases suffered from intralobar sequestration and 2 cases suffered from extralobar sequestration.Twelve of 23 cases got confirmed preoperative diagnosis.All cases were cured.Follow-up was performed in 7 patients,and no long-term complication was noted.ConclusionPulmonary sequestration is rare pulmonary congenitaldeformity.CTA is the most helpful for diagnosis.Surgery can achieve good outcomes.

A Case of Pulmonary Sequestration with Pleural Effusion / 소아과

Congenital pleural effusions are uncommon. The majority of cases are due to chylothorax, hydrops fetalis, and infection. Effusions of this nature are, for the most part, self-limited. We experienced a rare case of a congenital unilateral pleural effusion due to an extralobar sequestraion with pulmonary lymphangiectasia. Pleural effusion was found by antenatal ultrasonography and confirmed by CT scans and CT angiography of the chest in the neonatal period. The patient underwent an open thoracotomy where extralobar sequestraion located between the diaphragm and the left lower lobe was removed. His postoperative course was uncomplicated and there was complete resolution of the pleural effusion.

A Case of Type II Congenital Cystic Adenomatoid Malformation of the Lung in a Transdiaphragmatic Extralobar Pulmonary Sequestration / 대한산부인과학회잡지

With the current widespread use of obstetric ultrasonography, increasing cases of congenital malformations have been demonstrated antenatally. Both pulmonary sequestration and congenital cystic adenomatoid malformation of the lung (CCAM) are two infrequent congenital pulmonary diseases. The combination of these entities is rare. In the review of literature, this abnormality is so rare that only 80 cases were reported worldwide. To our knowledge, there has been no report that this combined malformation is located transdiaphragmatically. We report the first case of transdiaphragmatic extralobar pulmonary sequestration (ELS) associated with CCAM which was diagnosed by prenatal ultrasonography at 24 weeks gestational age.

Extralobar Pulmonary Sequestration located in Right Oblique Fissure with Unusual Vascularture / 대한흉부외과학회지

Pulmonary sequestration is an abnormal lung tissue that does not communicate with tracheobronchial tree, and that receives blood supply from anomalous arteries. Pulmonary sequestration is divided into two anatomical forms, intralobar and extralobar. Extralobar pulmonary sequestration is usually located between the diaphragm and the lower lobe and has systemic arterial supply and venous drainage, and most patients are diagnosed in their infancy. We report an extralobar pulmonary sequestration located between the right upper lobe and the lower lobe in a 48-year-old female adult, which has anomalous blood supply from the right pulmonary artery and venous drainage directly into the left atrium.

Case Analysis of Pulmonary Sequestration / 대한흉부외과학회지

BACKGROUND: Pulmonary sequestration is not common and it's diagnosis needs special care such as an aortogram ar tomography. MATERIAL AND METHOD: We have experienced 13 patients who had pulmonary sequestration from January 1990 to September 1997. RESULT: Six men and seven women were treated and their mean age was 25.8+/-14.3 years. Their chief complaints were coughing, chest pain, and no symptoms in decreasing order. There were nine intralobar (ILS) and three extralobar (ELS) pulmonary sequestrations and one patient had both. There was no preference in location of either left or right. They were mainly diagnosed by aortography and their feeding arteries commonly originated from the lower thoracic aorta. The patients with ILS were treated by lobectomy and those with ELS by sequestrectomy. CONCLUSION: to treat pulmonary sequestration properhy, aortogram or chest CT is warranted to iidenty the abnormal origin of feeding artery.