Relationship between intralobar pulmonary sequestration and type A aortic dissection:A case report

BACKGROUND Pulmonary sequestrations often lead to serious complications such as infections,tuberculosis,fatal hemoptysis,cardiovascular problems,and even malignant degeneration,but it is rarely documented with medium and large vessel vasculitis,which is likely to result in acute aortic syndromes.CASE SUMMARY A 44-year-old man with a history of acute Stanford type A aortic dissection status post-reconstructive surgery five years ago.The contrast-enhanced computed tomography of the chest at that time had also revealed an intralobar pulmonary sequestration in the left lower lung region,and the angiography also presented perivascular changes with mild mural thickening and wall enhancement,which indicated mild vasculitis.The intralobar pulmonary sequestration in the left lower lung region was long-term unprocessed,which was probably associated with his intermittent chest tightness since no specific medical findings were detected but only positive sputum culture with mycobacterium avium-intracellular complex and Aspergillus.We performed uniportal video-assisted thoracoscopic surgery with wedge resection of the left lower lung.Hypervascularity over the parietal pleura,engorgement of the bronchus due to a moderate amount of mucus,and firm adhesion of the lesion to the thoracic aorta were histopathologically noticed.CONCLUSION We hypothesized that a long-term pulmonary sequestration-related bacterial or fungal infection can result in focal infectious aortitis gradually,which may threateningly aggravate the formation of aortic dissection.

Posterior mediastinal extralobar pulmonary sequestration misdiagnosed as a neurogenic tumor:A case report

BACKGROUND Pulmonary sequestration-both intralobar and extralobar-is a rare congenital developmental malformation.Extralobar pulmonary sequestrations(EPS)have their own pleura but are separated from the bronchus and usually occur in the left lung.They are mainly found mainly between the lower lobe and the mediastinum.EPS is rarely found within the mediastinum itself,even rarer so in the posterior mediastinum.CASE SUMMARY We report the case of a 27-year-old man who was misdiagnosed with a neurogenic tumor based on preoperative contrast-enhanced computed tomography(CT)and magnetic resonance imaging findings.Contrast-enhanced chest CT revealed a posterior mediastinal mass measuring 1.2 cm×1.4 cm×3.3 cm,which consisted of some cystic areas and showed slight enhancement.The mass was in the 11th paravertebral region and attached to the 11th thoracic vertebra behind the descending aorta in the posterior mediastinum.An arteriole originating from the intercostal artery and a vein originating directly from the hemiazygos vein were found in the pedicle of the mass.The mass was resected in a uniport videoassisted thoracoscopic surgery.During the operation,the pyramid-shaped mass appeared well-encapsulated.Postoperative histopathology established a diagnosis of EPS.One month later,a follow-up CT of the thorax showed good recovery.CONCLUSION Although EPS rarely occurs in the posterior mediastinum,its diagnosis should be considered when posterior mediastinal tumors are suspected.

Pulmonary Sequestration: Three Dimensional Dynamic Contrast-enhanced MR Angiography and MRI

In order to evaluate the diagnostic value of three dimentional contrast enhanced MR angiography and MRI for pulmonary sequestration, 5 patients with pulmonary sequestration underwent 3D fast imaging by steady state precession (FISP) with a contrast medium and breath holding following chest radiography, CT and MR scans. The reconstructed MR angiography was performed using maximum intensity projection (MIP) and multiplanar reconstruction (MPR) techniques. It was found that the chest radiography showed pulmonary sequestration as a persistent area of opacity in the posterior basal segment of the left lower lobe, which was close to mediastinum in 2 cases and close to diaphragma in 3 cases. CT revealed a soft issue mass beyond descending aorta and lobar emphysema around the pulmonary sequestration. And the supplying vessel was documented in 2 cases on enhanced CT. MRI demonstrated a hyperintensity mass with respect to normal lung parenchyma on T1WI and T2WI, and the origin of the supplying vessel in 3 cases. The reconstructed CE MRA using MIP or MRP techniques clearly showed the supplying vessel and its course, branches as well as draining vessels. It was concluded that 3D CE MRA of demonstrating the supplying and draining vessels to pulmonary sequestration, together with plain MRI, can provide a diagnosis and aid in surgical planning without the need for DSA.

Treatment for hemoptysis after percutaneous closure of a large intralobar pulmonary sequestration in elderly patient

Pulmonary sequestration is a rare congenital cardiovascular malformation.[1,2]Open surgical excision is the usual treatment,although thorascopic intervention and transcatheter embolization have been reported.However,only a limited number of articles involving percutaneous closure the rare pulmonary malformations have been published in the literature.[3]What’s more,previous studies involving percutaneous pulmonary sequestration closure with repeated respiratory symptoms at the very young age suggested that the optimal therapeutic strategy has yet to be determined.[4]We hereby describe a particular case of percutaneous closure of a large intralobar pulmonary sequestration at elderly age.

Nocardia cyriacigeorgica infection in a patient with pulmonary sequestration: A case report

BACKGROUND Nocardia cyriacigeorgica (N. cyriacigeorgica) infection is uncommon in clinicalpractice. Pulmonary sequestration complicated with N. cyriacigeorgica has notbeen reported in the literature. Here, we present a case of pulmonary sequestrationcomplicated with N. cyriacigeorgica infection in an immunocom-petentwoman.CASE SUMMARYA 37-year-old woman complaining of a recurrent cough was admitted to ourhospital. Pulmonary sequestration in the lower lobe of the left lung wasdiagnosed by enhanced computed tomography. Bronchoalveolar lavage fluid wasthen collected, which showed gram positive bacilli with weakly positive modifiedacid-fast staining. The pathogen was identified as N. cyriacigeorgica after bacterialculture and mass spectrometry analysis. The patient was diagnosed withpulmonary sequestration complicated with N. cyriacigeorgica infection, and hersymptoms quickly improved following anti-infective therapy.CONCLUSION Nocardiosis is considered to be an opportunistic infection. This is the first reportof pulmonary sequestration complicated with N. cyriacigeorgica infection in apatient with normal immunity.

Intralobar Pulmonary Sequestration with Rete Mirabile as Part of Its Systemic Artery

Intralobar sequestration (ILS) is a complex lung lesion where part of a lower lobe lacks communication with the tracheobronchial tree and receives an aberrant arterial blood supply from the systemic circulation. That systemic artery is usually large, originating from the thoracic aorta or the abdominal aorta and its upper branches. We describe a case of ILS where a large systemic artery coming up from below the diaphragm is formed by the convergence of many very small serpiginous arteries coming up from the area of the celiac trunk and common hepatic artery: a kind of “rete mirabile”. This peculiar morphology was not described before.

Patterns of Blood Supply and Venous Drainage in Pediatric Intralobar Pulmonary Sequestration: A Retrospective Analysis of 30 Pediatric Cases from a Single Center

Purposes: Intralobar pulmonary sequestration is a rare congenital anomaly that causes nonspecific respiratory symptoms. This report presented our surgical experience for pediatric cases of intralobar pulmonary sequestration in our institute. Methods: Between 2002 and 2014, 30 pediatric patients with intralobar pulmonary sequestration underwent lobectomy. The clinical characteristics of patients were retrospectively analyzed using medical records and imaging data. Results: The median age at operation was 23 months. The sequestered lung was situated in the right lower lung in 15 cases and in the left lower lung in 15 cases. Eight cases were prenatally diagnosed by fetal ultrasound and magnetic resonance imaging. One aberrant artery was seen in 26 cases and two aberrant arteries in 4 cases. The drainage vein from the sequestered lung was: 1) the pulmonary vein in 27 cases;2) the inferior vena cava in 1 case;and 3) the azygos vein and the pulmonary vein in 2 cases. All patients underwent lower lobectomy of the affected side without postoperative early and long-term complications. Conclusion: Due to the increased rate of prenatal diagnoses, the age at operation has decreased. With respect to safety, it is vital to ascertain the number of aberrant arteries and the venous drainage route before lobectomy.

A Rare Case of Diaphragmatic Extralobar Pulmonary Sequestration

Context: Bronchopulmonary sequestration is defined as a congenital malformation in which a portion of lung tissue does not communicate with the normal bronchial tree and the pulmonary arteries. Case Report: We present a case of a 35-year-old male complaining of left lower back pain and with a mass in the left thoracoabdominal transition. Imaging studies have suggested a pulmonary sequestration and its diagnosis was confirmed by histopathological study. Conclusion: Diaphragmatic extralobar pulmonary sequestration is a rare anomaly whose radiological diagnosis is difficult. This case is illustrative and demonstrates the importance of imaging methods to the correct diagnosis and effective treatment.