Sequestration of the Lung

Abstract

A case of neonatal extralobar sequestration of the lung causing severe respiratory distress and associated with ipsilateral eventration of the diaphragm required surgical intervention.It is suggested that sequestration of the lung be included in the differential diagnosis of respiratory distress in the newborn whenever a mass or apparent elevation of the diaphragm is seen radiographically. Thoracoabdominal aortography will demonstrate the vascular supply and thus aid in surgical removal. In addition, upper gastrointestinal series is mandatory since a connection between the esophagus or stomach and the sequestered lung may lead to early death or severe pulmonary disease.A case of extralobar sequestration causing severe respiratory dis¬ tress in the newborn required sur¬ gery for alleviation. Schaffer1 stated that he had not discovered sympto¬ matic cases so early in life. We have found only one such report; in this in¬ stance the preoperative diagnosis was a posterior mediastinal tumor.2 In our case also, we failed to entertain the correct diagnosis preoperatively. If we had done so, thoraco-abdominal aortography would have been helpful to the surgeon. Report of a CaseThis 2,495 gm (5 lb 8 oz) male infant was born at 40 weeks gestation via a breech de¬ livery to a 23-year-old gravida one, para zero mother. The prenatal course was un¬ remarkable. Except for a respiratory rate of 80/min, the physical examination was normal. Chest roentgenogram findings re¬ vealed a large density obscuring the left hemidiaphragm with a shift of the heart and mediastinum to the right (Fig 1). There were no bowel loops in the chest. A barium swallow showed no abnormal re¬ sults. Fluoroscopic examination showed good motion of the left diaphragmatic shadow. A diagnosis of eventration of the left-side of the diaphragm was made. The laboratory findings were all within normal limits. The patient's respiratory distress became progressively worse and at 4 days of age, antibiotics were given prophylactically. When 2 weeks old, respiration in¬ creased to 120/min and the child became cyanotic. Plication for a small eventration of the diaphragm was done through an ab¬ dominal approach. Postoperatively, there was little change in the chest roentgen¬ ogram findings (Fig 2) or in the patient's respiratory distress. An immediate thoracotomy was performed. A large airless mass, occupying more than 80% of the left hemithorax was found displacing the me¬ diastinum to the right and compressing the left upper lobe. The mass was covered by pleura. A vascular pedicle originating from the abdominal aorta was ligated. Postoperatively, the patient did well (Fig 3). Pathological diagnosis was an extralobar sequestration with several bronchioles and pulmonary parenchyma. There was no evidence of bronchial foregut derivative tissue seen in the specimen.The patient had four episodes of ex¬ tensive bronchopneumonia during the six months following surgery. A bronchogram was done to determine whether other anomalies were present within the tracheobronchial tree and ...