Infradiaphragmatic extralobar pulmonary sequestration: Masquerading as suprarenal mass

Abstract

Pulmonary sequestration is a rare malformation, wherein a portion of lung is non-functional and is not in normal continuity with the tracheo-bronchial tree, and may derive its blood supply from systemic vessels. Two types are described: Intralobar and extralobar types. Intralobar sequestration is more common type, which shares visceral pleura of the involved lobe and is localized within the normal pulmonary parenchyma. Whereas extralobar forms are uncommon and are totally separate from the lung and usually have own covering. Infra-diaphragmatic pulmonary sequestration is of extralobar type and is extremely rare, and usually is associated with other congenital malformations. We present an extremely rare case of isolated infra-diaphragmatic pulmonary sequestration which was antenatally detected and followed up with postnatal CT scan, where it masqueraded as suprarenal mass, and was surgically treated. This case emphasises to add a differential diagnosis of malformation in congenital supra-renal masses, which remain stable in size and appearance, and hence avoid immediate surgery.

Diagnóstico diferencial y cirugía mínimamente invasiva de un tumor suprarrenal de hallazgo antenatal

“…Adicionalmente, Kalenahalli y cols. reportaron un caso de SPE con presentación atípica, dado la ausencia de otras malformaciones asociadas, las que estarían presentes hasta en un 65% de los casos de SPE 14 . Algunos elementos orientadores de SPE en la ecografía son: localización en el espacio suprarrenal izquierdo, visualización de una arteria aberrante (generalmente desde la aorta) al Doppler, glándula suprarrenal desplazada, visible como una entidad separada, y diagnóstico durante el segundo trimestre del embarazo.…”

“…La mayor parte de los SPE son izquierdos y se ubican entre el lóbulo inferior del pulmón y el diafragma. Es aceptado que el 50% de ellos se asocia a otras anomalías congénitas 11,14 . Cada vez es más frecuente el diagnóstico antenatal por ultrasonido 3 .…”

Intradiaphragmatic extralobar pulmonary sequestration in adult

“…Intralobar sequestrations are more common (75-85% of cases), while only 25% are extralobar sequestrations [ 2 , 3 ]. Extralobar sequestrations are most commonly found in the thorax, usually on the left side [ 4 ]. Only 10-15% of extralobar sequestrations are located in the abdomen [ 3 , 5 ].…”

“…Only 10-15% of extralobar sequestrations are located in the abdomen [ 3 , 5 ]. Usually, extrathoracic extralobar pulmonary sequestrations are infradiaphragmatic, masquerading as suprarenal masses [ 4 , 6 - 8 ]. Intradiaphragmatic extralobar pulmonary sequestration is rare and there have been very few reported cases until now [ 9 - 11 ].…”

A Rare Case of Diaphragmatic Extralobar Pulmonary Sequestration

“…Usually, extrathoracic extralobar pulmonary sequestrations are infradiaphragmatic, masquerading as suprarenal masses [3] [4] [5] [6]. Intradiaphragmatic extralobar pulmonary sequestration is rare and there have been very few reported cases until now [7] [8] [9].…”