Secuestro pulmonar intralobar / Intralobar Pulmonary Sequestration

Introducción: El secuestro pulmonar está representado por masas de tejido pulmonar displásico, no funcionante, sin comunicación con el árbol bronquial. Objetivo: Presentar tres casos de secuestro pulmonar intralobar tratados por el autor. Caso clínico: Se presentan tres pacientes tratados entre 2013 y 2018 con diagnóstico de secuestro pulmonar. Dos fueron del sexo masculino (44 y 60 años de edad) y una del femenino (20 años de edad). Los síntomas fueron dolor torácico (1) y cuadro de infección pulmonar grave (2). En dos enfermos el secuestro se localizó en el lóbulo inferior derecho y en uno en el inferior izquierdo. Las operaciones fueron lobectomías inferiores derecha (1) e izquierda (1) y bilobectomía inferior y media derechas por afectación del lóbulo medio. Dos tuvieron una evolución satisfactoria y uno presentó un empiema pleural que resolvió con tratamiento antibiótico. Conclusiones: Los secuestros pulmonares son raros y los síntomas suelen asociarse con infección pulmonar. En la mayoría de los casos es necesario realizar una lobectomía. La evolución postoperatoria suele ser buena(AU)

Introduction: Pulmonary sequestration is characterized by masses of dysplastic, nonfunctioning lung tissue, without any communication with the bronchial tree. Objective: To present three cases of intralobar pulmonary sequestration treated by the author. Clinical case: The respective cases are presented of three patients with a diagnosis of pulmonary sequestration treated between 2013 and 2018. Two were male (44 and 60 years old, respectively) and one was female (20 years old). Their symptoms were chest pain (1) and severe lung infection (2). In two patients, the sequestration was located in the lower right lobe, while, in one, it was in the lower left lobe. The operations were right (1) and left (1) lower lobectomies and right lower and middle bilobectomy due to middle lobe involvement. Two had a satisfactory evolution, while one presented a pleural empyema healed with antibiotic treatment. Conclusions: Pulmonary sequestration is rare and their symptoms are usually associated with pulmonary infection. In most cases, a lobectomy is necessary. The postoperative evolution is usually good(AU)

Secuestro pulmonar intralobar / Intralobar pulmonary sequestration

El secuestro pulmonar es una malformación congénita del tracto respiratorio inferior, rara e importante. En niños y adultos suele presentarse con infecciones pulmonares a repetición o crónicas severas. Se describió un caso de una paciente de 19 años de edad que tuvo un cuadro de sepsis respiratoria bajas a repetición. En los estudios de imágenes de tórax se evidenció opacidad homogénea en hemitórax derecho. Fue intervenida quirúrgicamente; se le realizó una lobectomía inferior derecha la cual fue diagnóstica para secuestro pulmonar, con evolución satisfactoria(AU)

Pulmonary sequestration is a rare and important congenital malformation of the lower respiratory tract. In children and adults, it usually presents with severe chronic or repeated lung infections. A case of a female 19-year-old patient who had recurrent lower respiratory sepsis is reported. Homogeneous opacity was evident in the chest imaging studies in the right hemithorax. She underwent surgery. A lower right lobectomy was performed, which was diagnostic for pulmonary sequestration, with satisfactory evolution(AU)

Secuestro pulmonar intralobar: hallazgo clínico-radiológico. presentación de un caso / Intralobar pulmonary sequestration. presentation of the case

Se presentó una mujer de 40 años con antecedentes de asma bronquial atendida en el Hospital Clínico Quirúrgico "Hermanos Ameijeiras" de La Habana. Refirió historia de un mes de evolución de tos seca, dolor torácico en hemitórax izquierdo, falta de aire y en dos ocasiones fiebre de 38 °C. Cumplió tratamiento para el proceso infeccioso respiratorio sin resolución. En la radiografía de tórax se evidenció una lesión radiopaca en el lóbulo inferior izquierdo y se confirmó el secuestro pulmonar intralobar con la angiotomografía pulmonar. En el secuestro pulmonar se requiere del uso adecuado de método clínico para su diagnóstico y la toma de decisiones terapéuticas definitivas(AU)

Forty years old woman with a history of severe asthma assisted to the Hospital Clínico Quirúrgico "Hermanos Ameijeiras" in Havana, presenting the following symptoms: dry cough, chest pain in left hemithorax, shortness of breath and fever with a temperature of 38°C (100.4°F) twice in the month. The patient was under treatment to control a respiratory infection, with no resolution reported. Radiography of the thorax revealed a radiopaque lesion in the left lower lobe, and lung sequestration was confirmed by pulmonary angiography. An appropiate use of clinical methods is required to diagnose and undertake the right therapy decisions about the intralobar lung sequestration(AU)

Secuestro pulmonar intralobar: hallazgo clínico-radiológico. Presentación de un caso / Intralobar pulmonary sequestration. Presentation of the case

RESUMEN Se presentó una mujer de 40 años con antecedentes de asma bronquial atendida en el Hospital Clínico Quirúrgico Hermanos Ameijeiras de La Habana. Refirió historia de un mes de evolución de tos seca, dolor torácico en hemitórax izquierdo, falta de aire y en dos ocasiones fiebre de 38 °C. Cumplió tratamiento para el proceso infeccioso respiratorio sin resolución. En la radiografía de tórax se evidenció una lesión radiopaca en el lóbulo inferior izquierdo y se confirmó el secuestro pulmonar intralobar con la angiotomografía pulmonar. En el secuestro pulmonar se requiere del uso adecuado de método clínico para su diagnóstico y la toma de decisiones terapéuticas definitivas.

ABSTRACT Forty years old woman with a history of severe asthma assisted to the Hospital Clínico Quirúrgico Hermanos Ameijeiras in Havana, presenting the following symptoms: dry cough, chest pain in left hemithorax, shortness of breath and fever with a temperature of 38°C twice in the month. The patient was under treatment to control a respiratory infection, with no resolution reported. Radiography of the thorax revealed a radiopaque lesion in the left lower lobe, and lung sequestration was confirmed by pulmonary angiography. An appropiate use of clinical methods is required to diagnose and undertake the right therapy decisions about the intralobar lung sequestration.

The relationship between intralobar pulmonary sequestration syndrome with recurrent infection and basal stem cell proliferation / 天津医药

Objective To investigate the proliferation potential of the basal stem cells in intralobar pulmonary sequestration syndrome (ILS) for revealing the pathogenesis of ILS. Methods In this study, lung tissue samples were collected from healthy control subjects(n=4)and abnormal lung lobes of ILS patients(n=4).The pathological changes were compared by HE staining between the two groups.The proportion of goblet cells was compared by PAS staining between the two groups.The expression and secretion of MUC5AC and MUC5B were compared by immunofluorescence staining and real-time PCR between the two groups. The distribution of ciliated cells and the proliferation of basal cells were compared by immunofluorescence staining between the two groups.Results The abnormal lobe of ILS group was filled with inflammatory cells, and the airway epithelium was disrupted. The airway goblet cells of ILS were obviously hyperplastic. The mucin proteins of MUC5AC and MUC5B were hypersecretion in the abnormal lobe of ILS patients.KRT5-positive basal stem cells proliferated only slightly in ILS patients, although there was no significant difference in KRT5 expression between two groups. Conclusion These data suggest that the pathogenesis of ILS may be associated with defects in basal stem cell function. Restoring airway integrity by targeting epithelial regeneration can be a future non-surgical treatment for patients with ILS.

Secuestro pulmonar intralobar en adulto mayor de 50 años / Intralobar pulmonary sequestration in adult older than 50

El secuestro broncopulmonar es una anomalía congénita rara. La variedad intralobar representa el 75 % de los secuestros pulmonares y usualmente se presenta antes de los 20 años de edad. Se reportó una paciente de 59 años, con antecedentes de infecciones respiratorias bajas a repetición. En los estudios de imágenes de tórax se evidenció opacidad de contornos irregulares en hemitórax izquierdo. Fue intervenida quirúrgicamente con la sospecha de cáncer de pulmón y se realizó examen histopatológico del tejido pulmonar cuyos hallazgos macroscópicos y microscópicos se correspondieron con un secuestro intralobar.

Pulmonary sequestration is a rare congenital pulmonary malformation. Intralobar sequestrations account for 75% of all pulmonary sequestrations. Patients usually present it before the age of 20. A 59 years old female patient with a history of recurrent lower respiratory infections is reported here. In her chest imaging studies, irregular margins opacity was evident in her left hemithorax. She underwent surgery for suspected lung cancer. Diagnosis of intralobar sequestration was made after histopathological examination of the resected lung.

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.

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.

Bronchial Carcinoid Tumor Arising from an Intralobar Bronchopulmonary Sequestration

We report a rare case of a 38-year-old woman with a bronchial carcinoid tumor arising from an intralobar bronchopulmonary sequestration. The vascular supply to the sequestered left lower lobe originated from the descending thoracic aorta. A left lower lobe lobectomy was performed. The findings of the pathological examination revealed an atypical carcinoid tumor that was immunopositive for chromogranin and synaptophysin. At the 3-year follow-up examination, the patient was healthy.

Infection with Mycobacterium Tuberculosis Complicating an Intralobar Pulmonary Sequestration: A case report / 대한흉부외과학회지

Pulmonary sequestration is a relatively rare malformation. Infection with common pyogenes is a frequent complication in this disease. We report here on a case of intralobar sequestration that was infected with Mycobacterium tuberculosis in the absence of any other site of tuberculous infection. A 40-year man presented with a small amount of hemoptysis, and the man had been previously diagnosed with bronchiectasis 3 years ago. Chest computerized tomography revealed bronchiectasis with pneumonia in the left lower lobe and there was a large feeding artery from the thoracic aorta. A lobectomy of the left lower lobe was conducted via thoracotomy and the final pathologic examination confirmed pulmonary tuberculosis limited to the intralobar sequestrated lung. The patient underwent antituberculous chemotherapy from the postoperative 7th day and he was discharged without any adverse event.

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.

Bilateral Intralobar Pulmonary Sequestration with Horseshoe Lung: A new suggestion about the treatment of pulmonary sequestration / 대한흉부외과학회지

This is a case report of surgical management of a bilateral intralobar pulmonary sequestration with horseshoe lung presenting with frequent URI with productive sputum. Simple chest X-ray showed pneumonic consolidation and infiltration on both lower lobes, and chest CT revealed multiple cystic lesions compatible with pulmonary sequestration. The aortography demonstrated two anomalous systemic arteries arising from the thoracic aorta just above the diaphragm to both sequestrums. Left lower lobectomy was performed through the left thoracotomy with ligations and divisions of the both systemic feeding arteries to the left and right sequestrum, and division of the isthmic portion of horseshoe lung without removal of right sequestrum. The patient was discharged on the postoperative 10th day and followed-up till now without any sequelae and symptoms of residual right sequestration. The recent follow-up chest CT 5 months after the operation revealed spontaneous regression of the residual right sequestrum. Authors would suggested that only division of aberrant artery to sequestrum without lobectomy may be applied in uncomplicated case of intrapulmonary sequestration.

Bilateral Intralobar Pulmonary Sequestration with Horseshoe Lung: A new suggestion about the treatment of pulmonary sequestration / 대한흉부외과학회지

This is a case report of surgical management of a bilateral intralobar pulmonary sequestration with horseshoe lung presenting with frequent URI with productive sputum. Simple chest X-ray showed pneumonic consolidation and infiltration on both lower lobes, and chest CT revealed multiple cystic lesions compatible with pulmonary sequestration. The aortography demonstrated two anomalous systemic arteries arising from the thoracic aorta just above the diaphragm to both sequestrums. Left lower lobectomy was performed through the left thoracotomy with ligations and divisions of the both systemic feeding arteries to the left and right sequestrum, and division of the isthmic portion of horseshoe lung without removal of right sequestrum. The patient was discharged on the postoperative 10th day and followed-up till now without any sequelae and symptoms of residual right sequestration. The recent follow-up chest CT 5 months after the operation revealed spontaneous regression of the residual right sequestrum. Authors would suggested that only division of aberrant artery to sequestrum without lobectomy may be applied in uncomplicated case of intrapulmonary sequestration.