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Morphological features of the pulmonary sequestration.Rev
Port Pneumol. 2003 Mar-Apr;9(2):153-60.
The pulmonary
sequestration corresponds to pulmonary tissue intra or extra-lobar
with systemic arterial nutrition and collateral bronchial
ramification. It is infrequent and the intra-lobar identification
depends on the correct clinical signs and morphology. The correct
study includes imagiologic identification of the systemic artery and
morphological characterization of parenchymal changes. These allow
identification of abnormal pulmonary parenchyma in intra-lobar cases
and were observed using histochemical and immunohistochemical routine
methods, both in intra and extra-lobar cases. Four cases of
intra-lobar sequestration and four cases of extra-lobar sequestration
were studied with application of histochemical techniques--Movat's
pentachrome stain and Verhoeff--and immunolabelling with CK7 and TTF1.
The parenchymal inflammatory distortion by collagenization was
constantly seen as was BALT hyperplasia and pleuritis. By using
Movat's pentachrome stain we characterized the sequestration by
identifying the artery and the parenchymal changes. The CK7 was useful
in the identification of parenchymal damage, together with the
antibody anti-TTF1 that had a variable expression, stronger in areas
of inflammation because of PII hyperplasia.
Pulmonary
sequestration: a single-institutional series composed of 27 cases.J
Thorac Cardiovasc Surg. 2007
Apr;133(4):955-9.
OBJECTIVE:
Large series about pulmonary sequestration from a single institute are
rare in the literature. In this study, we aimed to evaluate diagnosis,
treatment, and outcomes of pulmonary sequestration in a single
institute. METHODS: Records of patients with pulmonary sequestration
between January 1982 and January 2006 were reviewed retrospectively.
Age, sex, symptoms, diagnostic procedures, operative findings,
operative techniques, postoperative complications, and follow-up
results were evaluated. RESULTS: Twenty-seven patients, 17 male and 10
female, with an average age of 23.3 were operated on for pulmonary
sequestration. Twenty patients had preoperative symptoms including
recurrent pneumonia attacks, chest pain, hemoptysis, and shortness of
breath. Chest radiography, thoracic computed tomography, aortography,
magnetic resonance imaging, and bronchoscopy were used as diagnostic
methods. Of the cases, 19 (70%) were intralobar pulmonary
sequestration and 8 (30%) were extralobar pulmonary sequestration.
Surgical procedures were lower lobectomy in 18 and segmentectomy in 1
of the patients with intralobar pulmonary sequestration and simple
mass excision in all of those with extralobar pulmonary sequestration.
Postoperative histopathologic examinations excluded any other
alternative diagnosis. Furthermore, it detected an aspergilloma ball
in 1 of the intralobar pulmonary sequestration specimens. Two patients
had a postoperative complication (prolonged air leak in 1 patient and
empyema in the other). During the follow-up period (mean 2.3 years),
none of the patients presented a problem. No mortality was
encountered. CONCLUSION: Owing to the potentially severe complications
they can cause, pulmonary sequestrations should be removed whenever
they are diagnosed. Since careful dissection provides sufficient
surgical comfort, preoperative identification of the aberrant vessels
is not a rule for the success of the operation.
Infradiaphragmatic extralobar pulmonary sequestration.Rofo.
2006 Nov;178(11):1115-20.
PURPOSE: To
demonstrate characteristic imaging findings in infradiaphragmatic
extralobar pulmonary sequestration (IEPS) with special emphasis on
ultrasound (US). MATERIALS AND METHODS: The imaging material (pre- and
postnatal US in all cases, magnetic resonance imaging (MRI) in 2
cases) for 4 infants (3 girls, 1 boy) was reviewed. 2 patients
underwent surgery (after birth and at 4 months of age, respectively)
and the diagnosis of IEPS was confirmed. The other 2 patients were
monitored conservatively using US for up to 15 months. RESULTS: All 4
left-side suprarenal masses exhibited the same characteristic sono-morphology,
leading to the suspected diagnosis of IEPS. The masses were small
(max. 10 ml), hyperechoic with cystic components and without
calcifications, well demarcated and separate from the normal kidney
and the suprarenal gland, and without any change in prenatal and
directly postnatal size. Doppler US showed low-grade perfusion in all
cases and an aberrant systemic artery originating from the abdominal
aorta in 2 cases. MRI did not add any fundamental information. Despite
the suspected imaging diagnosis of IEPS and negative urinalyses for
neuroblastoma, 2 patients underwent surgery for histological
confirmation. The lesions in the other 2 patients were monitored via
US. A complete disappearance after 4 months in one patient and a
continuous decrease in size over 15 months in the other patient were
documented. CONCLUSION: Based on the characteristic findings of
prenatal and postnatal US, IEPS can be diagnosed reliably. With the
knowledge of its benign spontaneously regressing behavior, suspected
suprarenal lesions should be treated conservatively via US monitoring.
Bronchopulmonary sequestration--a 12-year experience.Rev
Port Pneumol. 2006 Sep-Oct;12(5):489-501.
Bronchopulmonary sequestration (BPS) is a rare malformation of the
lower respiratory tract. It consists of a non-functioning mass of lung
tissue that lacks normal communication with the tracheobronchial tree
and that receives arterial blood supply from the systemic circulation.
It is classified as intralobar (ILS) or extralobar (ELS) according to
its location within or outside the normal lung. Most sequestrations
are intralobar (75%) and occur predominantly in the left lower lobe.
Pulmonary
sequestration--a review of 8 cases treated with lobectomy.
Scand J Surg. 2006;95(3):190-4
BACKGROUND AND
AIMS: Pulmonary sequestration (PS) is a rare congenital malformation
where non-functioning lung tissue is separated from the bronchial tree
and vascularised with an aberrant artery from the systemic
circulation. The aim of this report was to study all patients who were
treated for PS at Lund University Hospital between 1994 and 2004, with
emphasis on clinical presentation of the disease and evaluate the
results of surgical treatment. MATERIAL AND METHODS: 8 cases were
identified, 7 females and one male, with a mean age of 7.3 years
(range 25 days -17 years) at the time of diagnosis. RESULTS: Out of 8
patients, seven presented with respiratory symptoms and two with
congestive heart failure. Five patients had other congenitial
malformations; including scimitar syndrome and congenital heart
disease. All the patients underwent a successful lobectomy. There were
no major postoperative complications. At a medium follow-up of 77
months all of the fully treated children were doing well. CONCLUSION:
Respiratory and cardiovascular symptoms are the most common symptoms
related to PS. The wide range of clinical symptoms may cause
diagnostic problems, especially in children and young adults with
concomitant congenital heart disease. Therefore PS should be
considered as a differential diagnosis in children with unexplained
respiratory symptoms or with signs of congestive heart failure. In
patients with PS, lobectomy seems to be a good therapeutic option.
Bronchial atresia is common to extralobar sequestration, intralobar
sequestration, congenital cystic adenomatoid malformation, and lobar
emphysema.Pediatr
Dev Pathol. 2006 Sep-Oct;9(5):361-73.
Congenital
cystic adenomatoid malformation (CCAM), intralobar sequestration (ILS),
extralobar sequestration (ELS), and lobar emphysema (LE) are
well-accepted entities; however, certain findings are common to all,
particularly the parenchymal maldevelopment characterizing CCAM.
Isolated reports have described bronchial atresia (BA) in some
specimens in all 4 entities, but this finding has not been evaluated
in a prospective manner. With the aid of a dissecting microscope, we
prospectively examined 47 lung specimens resected during the past 4
years and submitted with the clinical impression of ELS (n=11), ILS
(n=11), CCAM (n=20), LE (n=4), and airway-esophageal communication
(n=1). Most lesions were detected by prenatal ultrasound and were
resected during infancy. The clinical impression and pathologic
findings were compared. Pathologic examination revealed atresia of a
lobar, segmental, or subsegmental bronchus in 100% of ELS, 82% of ILS,
70% of CCAM, and 50% of LE (those clinically recognized to have BA or
minor CCAM) cases. Parenchymal maldevelopment that characterizes CCAM
was present in 100% of CCAM cases (as expected by definition) as well
as in 91% of ELS, 91% of ILS, and 50% of LE (those with BA) cases.
Bronchial atresia is present in all ELS, most ILS and CCAM, and some
LE cases, and its detection is greatly enhanced with the dissecting
microscope. Bronchial atresia and CCAM nearly always coexist. It may
be that both have the same etiopathogenesis with anatomic differences
accounted for by aberrant genetic programs or other insults, perhaps
modified by time of onset or duration.
Intralobar pulmonary sequestration with high level of serum CEA;
report of a case.Kyobu
Geka. 2006 Jun;59(6):508-11.
We reported a
case of intralobar pulmonary sequestration with a high level of the
serum CEA. A 53-year-old woman whose chief complaint was cough was
admitted to our hospital. Enhanced chest computed tomography (CT)
revealed the mass in the left lower lung, lymph-nodes swelling, and
the aberrant artery. Magnetic resonance angiography (MRA) conformed
the aberrant artery from the descending aorta. The level of serum CEA
elevated at 9.6 ng/ml. Left lower lobectomy was performed. A diagnosis
of intralobar pulmonary sequestration (Pryce type II) was established
in this case. Histopathologically, the peribronchial epithelial cells
in pulmonary sequestration showed weak positive for anti-CEA
monoclonal antibody. Postoperative course was uneventful and the serum
CEA level was 3.5 ng/ml in the normal range at the postoperative 17th
day.
Pulmonary
sequestrations: from radiologic to preoperative diagnosis: 2 cases
with review of the literature.Tunis
Med. 2006 Feb;84(2):118-21.
Pulmonary
sequestrations are defined by the presence of a non fonctional
pulmonary parenchyma with an abnormal vascularisation. Their incidence
ranges from 1.1% to 1.8% of all the malformations in the general
population. Two types of sequestrations are described: Intralobar
sequestrations: the most common, localised within a normal parenchyma.
Extralobar sequestrations: totally separate from the lung with their
own pleural covering. We report two cases of sequestrations. In the
first case, the radioclinical presentation was strongly suggestive of
this diagnosis in a 32-year old woman with recurrent hemoptysis,
airspace opacity in the left retrocardiac region and a systemic
vascularisation of this mass on tomodensitometry. Pathological studies
after surgery confirmed the diagnosis of intralobar sequestration type
I in the classification of PRYCE. In the second case a thoracoscopy
performed on a 14-year-old boy who had a serohematic pleural effusion,
revealed a left costodiaphragmatic mass. Surgical removal of this mass
confirmed its extralobar pulmonary nature.
Spontaneous
hemothorax: a rare but serious complication of intralobular pulmonary
sequestration.Rev
Pneumol Clin. 2006 Feb;62(1):30-3
Pulmonary
sequestration is a rare congenital malformation characterized by a
non-functional portion of pulmonary parenchyma devoid of any
connection with the bronchial tree and pulmonary artery. If not
identified antenatally or at birth, the sequestration may not be
discovered until complications, mainly repeated infections, arise.
Hemorrhage is another but much rarer complication which is generally
severe. We report a new case of intralobular pulmonary sequestration
revealed by hemoptysis then massive hemothroax with shock requiring
emergency thoracotomy for hemostasis.
Extralobar pulmonary
sequestration with aberrant lobulation of the lower lobe; report of a
case.Kyobu
Geka. 2005 Feb;58(2):161-4.
An adult case
of extralobar pulmonary sequestration with aberrant lobulation of the
right lower lobe is reported. A 32-year-old woman admitted to our
hospital with a right intrathoracic tumor in the chest computed
tomography (CT). Chest CT showed a mass lesion on the right diaphragm
of a diameter 5 cm and abnormal fissure of the right lower lobe. Under
the diagnosis of pulmonary sequestration without clearly thick
vessels, video-assisted thoracoscopic surgery was performed. The mass
existed between the right diaphragm and posterior lower lobe with a
thin stalk, and the lower lobe had aberrant lobulation. The resected
mass was histopathologically diagnosed as extralobar pulmonary
sequestration.
Intralobar
sequestration of the lung is a congenital anomaly: anatomopathological
analysis of four cases diagnosed in fetal life.Pediatr
Dev Pathol. 2003 Jul-Aug;6(4):314-21.
The origin of
intralobar sequestration of the lung (ILS)-whether congenital or
acquired--has often been controversial, since firm anatomical evidence
of prenatal origin has been sparse. We describe four cases in which
anomalous arterial supply from the aorta to abnormally echogenic lower
lung lobes was demonstrated on routine antenatal ultrasound
examination, and the diagnosis of ILS was subsequently confirmed by
postmortem examination including bronchography of the fetuses at
between 20 and 23 wk. One right-sided lesion was supplied from a
branch of the coeliac axis, and three left-sided lesions were supplied
from the thoracic aorta. In two cases, the arterial supply was shown
to be multiple. All lesions were situated in the lower lobes. They
showed a cystic transformation of the affected lung tissue which was
histologically indistinguishable from cases diagnosed as congenital
cystic adenomatoid lesion (CCAM) at the same gestational age, but
clearly different from that seen in bronchial obstruction due to
laryngeal stenosis at that age. Similar vascular lesions have been
reported in otherwise normal lungs. The character of the anomalous
arterial vessels is consistent with origin from the embryonic
splanchnic plexus. The precise sequence of pathogenetic events is
unclear but there appears to be a close relationship of this condition
not only with CCAM but also with the condition of anomalous arterial
supply to the lower lobe.
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