A case of pulmonary sequestration between the left hemidiaphragm and the left adrenal gland is reported, first detected at 16 weeks' gestation on routine prenatal ul· trasound examination. The echogenic rounded mass was again observed on ultrasound at 33 weeks' gestation. Postnatal ultrasound showed the mass adjacent to and compressing the left adrenal gland. Two weeks after birth, ultrasound*guided fine·needle aspiration biopsy was performed. Cytology showed respiratory epithelium and pulmonary sequestration was suggested; this was later confirmed surgically.The combination of ultrasound appearance and aspi· ration biopsy result can provide a diagnosis of infradiaphragmatic pulmonary sequestration, allowing conservative management while asymptomatic.The presence of extralobar sequestration should prompt detailed examination for further anomalies, which may be present in up to 60% of cases. These include diaphragmatic herniation and various congeni• tal abnormalities of the gastrointestinal tract.
CASE REPORTRoutine ultrasound examination of a fetus at 16 weeks ges· tation showed an echogenic mass measuring 13 mm in diameter situated posteriorly in the region of the stomach (Fig. 1). A further ultrasound examination at 34 weeks' gestation confirmed the presence of a uniformly echogenic mass measuring 18 X 15 mm. This mas11 was situated posteriorly and, although the diaphragm was not visualized direct)~ the position of the mass in relation to the heart and bony structures suggested a subdiaphragmatic location. Cesarean section was performed at 37 weeks for severe preeclampsic toxemia. No abdominal man was palpable and there was no other abnormality on clinical examination.A follow-up ultrasound examination at 3 days of age showed a uniformly echogenic ovoid mass (approximately 2 em in diameter) situated posteriorly between the left kidney and the diaphragm, medial to the spleen (Fig. 2). The left adrenal gland was compressed and displaced inferiorly by the echogenic mass. On real-time examination a small, cylindrical echo-free structure was seen within the mass and was thought to represent a vascular structure.The differential diagnosis at this time included neuroblas· toma, a foregut duplication, and congenital teratoma or other adrenal tumor. A computed tomography (CT) examination of the upper abdomen showed no evidence of calcification associated with the mass. Laboratory investigations included uri· nary catecholamine estimation, alpha feto-protein, 8-HCG, androgen, cortisol, and 16-hydroxy-DHEA levels; all of which were within the normal range.A fine-needle aspiration biopsy was performed under gen~ eral anesthesia with real-time ultrasound guidance. A 22 g