Evaluation of pulmonary sequestration with multidetector computed tomography angiography in a select cohort of patients: A retrospective study

OBJECTIVES: This study aimed to evaluate the role of multidetector computed tomography angiography in diagnosing patients with pulmonary sequestration. METHODS: We retrospectively analyzed the computed tomography studies and clinical materials of 43 patients who had undergone preoperative multidetector computed tomography angiography in our hospital and had pathologically proven pulmonary sequestration. Each examination of pulmonary sequestration was reviewed for type, location, parenchymal changes, arterial supply and venous drainage on two-dimensional and three-dimensional computed tomography images. RESULTS: Multidetector computed tomography successfully detected all pulmonary sequestrations in the 43 patients (100%). This included 40 patients (93.0%) with intralobar sequestration and 3 patients (7.0%) with extralobar sequestration. The locations of pulmonary sequestration were left lower lobe (28 cases, 70% of intralobar sequestrations), right lower lobe (12 cases, 30% of intralobar sequestrations) and costodiaphragmatic sulcus (3 cases). Cases of sequestered lung presented as mass lesions (37.2%), cystic lesions (32.6%), pneumonic lesions (16.3%), cavitary lesions (9.3%) and bronchiectasis (4.6%). The angioarchitecture of pulmonary sequestration, including feeding arteries from the thoracic aorta (86.1%), celiac truck (9.3%), abdominal aorta (2.3%) and left gastric artery (2.3%) and venous drainage into inferior pulmonary veins (86.0%) and the azygos vein system (14.0%), was visualized on multidetector computed tomography. Finally, the multidetector computed tomography angiography results of the sequestered lungs and angioarchitectures were surgically confirmed in all the patients. CONCLUSIONS: As a noninvasive modality, multidetector computed tomography angiography is helpful for making diagnostic decisions regarding pulmonary sequestration with high confidence and for visualizing the related parenchymal characteristics, arterial supply, and venous drainage features to help plan surgical strategies.

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.

Intralobar pulmonary sequestration in right lower lobe with secondary infection in an adult male

Pulmonary sequestration is a rare congenital bronchopulmonary foregut malformation in which a segment of lung parenchyma is not connected to the tracheobronchial tree. This abnormal segment receives blood supply from the systemic circulation. Varying clinical techniques have been utilized to manage this disease process including surgical intervention, endovascular procedures and operative approaches. The most common presentation of this entity is involvement of the left lower lobe. We present a rare case of intralobar pulmonary sequestration in an adult male involving the right lower lobe with secondary infection

Intralobar bronchopulmonary sequestration with large aberrant vessel presenting as recurrent pneumonias

Bronchopulmonary sequestration is a rare congenital malformation of the lower respiratory tract comprising of a nonfunctioning lung tissue mass that lacks normal communication with the tracheobronchial tree. The diagnosis may be easily missed as many of the symptoms of bronchopulmonary sequestration overlap with that of other pulmonary diseases. Bronchopulmonary sequestration can be complicated by recurrent infections, hemorrhage and malignant transformation and, therefore, needs to be timely diagnosed and resected to decrease both morbidity and mortality. A high degree of suspicion in the differential diagnosis helps diagnose the positive cases. The parenchymal abnormalities associated with bronchopulmonary sequestration are best visualized using computed tomography, although their appearance is variable. We report the case of a 14 years old boy with intralobar bronchopulmonary sequestration with the sole manifestation of recurrent pneumonias

Tumor carcinoide e sequestro pulmonar / Carcinoid tumor and pulmonary sequestration

O sequestro pulmonar é definido como uma massa de tecido pulmonar separada da árvore traqueobrônquica e irrigada por uma artéria sistêmica anômala. Sua associação com neoplasias pulmonares é rara. Relatamos o caso de uma paciente de 39 anos com o diagnóstico de tumor carcinoide localizado no brônquio intermediário, associado a alterações caracterizadas como bronquiectasias em lobo inferior direito. A paciente foi submetida à toracotomia para ressecção da área acometida e, durante a cirurgia, apresentou hemorragia importante decorrente da transecção da artéria anômala que nutria o sequestro pulmonar intralobar localizado em lobo inferior direito, não identificado nos exames pré-operatórios.

Pulmonary sequestration is defined as a mass of lung tissue separated from the tracheobronchial tree and irrigated by an anomalous systemic artery. It is rarely seen in conjunction with lung neoplasms. We report the case of a 39-year-old female patient diagnosed with a carcinoid tumor, located in the intermediate bronchus and accompanied by bronchiectasis in the right lower lobe. The patient underwent thoracotomy for the resection of the affected area. During surgery, she presented with significant hemorrhage resulting from the transection of the anomalous artery that irrigated an intralobar pulmonary sequestration, which was located in right lower lobe and had not been identified in pre-operative examinations.

Seqüestro pulmonar extralobar: análise anatomopatológica de dois casos em natimortos e revisão da literatura / Extralobar pulmonary sequestration: anatomical analysis of two cases in stillbirths and review of literature

O seqüestro pulmonar é definido como uma massa anormal de tecido pulmonar sem comunicação com a árvore brônquica. É anomalia rara, responsável por 0,15-6,45 por cento das malformações pulmonares congênitas. Quando possui revestimento pleural próprio, chama-se seqüestro pulmonar extralobar (SPE). Este trabalho descreve dois casos de SPE em natimortos (NM) com 32 (1) e 34 (2) semanas de gestação com diagnóstico clínico de hipoxia intra-uterina e adenomatose cística, respectivamente, e faz revisão da literatura. O diagnóstico envolveu análise ultra-sonográfica, sindrômica, macroscópica e microscópica dos NM. Foi observada massa supradiafragmática no hemitórax esquerdo ligada à aorta torácica (1) e ao diafragma (2). As MFs associadas foram agenesia tímica (2), hipoplasia pulmonar (2), pé torto congênito (1) e acondroplasia de membros (2). A microscopia evidenciou, nos dois casos, tecido pulmonar imaturo e pedículo vascularizado e inervado.

Pulmonary sequestration represents an abnormal pulmonary mass that does not communicate with the tracheobronchial tree. It is a rare malformation (MF), accountable for 0.15 percent-6.45 percent of pulmonary congenital MFs. When it has its own pleural covering, it is called extralobar (EBPS). This work describes two cases of EBPS in stillbirths (SB), at 32 (1) and 34 (2) weeks' gestation, with clinical diagnosis of intrauterine hypoxia and cystic adenomatosis, respectively. It also reviews the literature on the subject. The diagnosis involved ultrasonographic, syndromic, macroscopic and microscopic analysis. The macroscopy showed a supradiaphragmatic mass in the left hemithorax linked to thoracic aorta (1) and diaphragm (2). The associated MFs were: thymic agenesis (2), pulmonary hypoplasia (2), clubfoot (1) and achondroplasia (2). Microscopy demonstrated, in both cases, immature pulmonary tissue and vascularized and innervated pedicle.

Pulmonary Sequestration with Right Coronary Artery Supply

Pulmonary sequestration is an unusual malformation consisting of isolated nonfunctioning lung segments lacking communication with functional tracheobronchial trees. Systemic blood supply is commonly from the thoracic aorta, but arteries occasionally arise from other sites. We report a rare form of pulmonary sequestration with arterial supply from the right coronary artery.

In utero demonstration of aberrant systemic blood supply in lung sequestration: a case report

Prenatal diagnosis of a potentially lethal condition as shown and confirmed with color flow Doppler; demonstration of an aberrant systemic blood supply

Sequestraçäo pulmonar - aspectos radiológicos / Pulmonary sequestration - radiological findings

Resumo: Foram analisados os dados clínicos e radiológicos de oito pacientes com sequestraçäo pulmonar, sendo seis da forma intralobar e dois da forma extralobar. Em sete pacientes a sequestraçäo encontrava-se em lobos inferiores e em um paciente a lesäo era intradiagmática. Realizou-se diagnóstico pré-operatório por meio de arteriografia em todos os pacientes. Neste artigo, os autores apresentam os vários aspectos do diagnóstico por imagem encontrados nessa doença, bem como discutem os métodos que devem ser empregados para odiagnóstico apropriado.

Seqüestro pulmonar extralobar intra-abdominal congênito / Congenital pulmonary extralobar intra-abdominal sequestration

Seqüestro pulmonar é uma rara anomalia congênita caracterizada por tecido pulmonar embrionário näo funcionante, a qual perfaz 0,15 por cento a 6,4 por cento de todas as malformaçäes pulmonares congênitas. O tecido seqüestrado näo tem nenhuma comunicaçäo com a árvore traqueobrônquica normal. Os seqüestros pulmonares säo classificados em intralobar e extralobar, sendo o extralobar o mais raro, perfazendo apenas 25 por cento do total dos seqüestros pulmonares. A variante extralobar está freqüentemente associada com hérnia diafragmática, eventraçäo retroperitoneal com apresentaçäo clínica de neoplasia de glândula adrenal, cujo diagnóstico definitivo foi feito por exame anátomo-patológico. No presente caso relatado, näo havia nenhuma anormalidade congênita associada.

Sequestro pulmonar calcificado - relato de um caso / Calcified pulmonary sequestration - a case report

Neste trabalho é descrito o caso de uma paciente de 49 anos, que apresntava, nas telerradiografias do tórax, massa de contornos bem definidos no lobo inferior do pulmão direito. A tomografia linear e posteriormente a tomografia computadorizada evidenciaram a presença de calcificações amorfas no seu interior. Foi realizada a lobectomia inferior direita, na qual, pelo padrão de vascularização, definiu-se a massa como sequestro pulmonar intralobar. As análises radiológica e anatomapatológica da peça cirúrgica ratificaram a existência de calcificações no interior do sequestro.

Extralobar bronchopulmonary sequestration: a case report.

Bronchopulmonary sequestration of the lung is a rare but well recognised congenital abnormality, which is clinically important because of the potential for medical and surgical complications. We report a case of extralobar bronchopulmonary sequestration on the left side in a newborn infant.

Secuestro pulmonar: comentario sobre 14 casos operados / Pulmonary sequestration: experience with 14 cases operated

Se presenta una serie de 14 enfermos operados por secuestro pulmonar. En uno de ellos hay que señalar la coexistencia con secuestro extralobar. Todos ingresaron con síntomas. Se resalta la importancia de la aortografía en el diagnóstico y en la resección del secuestro