The clinical management of extralobar pulmonary sequestration in children

Huang, Dongmei; Habuding, Aerxin; Miao, Yuan; Yang, Gang; Cheng, Kaisheng; Luo, Dengke; Xu, Chang

doi:10.1002/ppul.25433

Cited by 11 publications

(18 citation statements)

References 22 publications

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“…The method also needs a larger sample size and multiple centers of data to be evaluated more precisely. The IDEPS is rarely reported 3 5 7 12 16 24 25. It has the risk of infection,3 lung ventilation disorder24 or malignancy 3 5.…”

Section: Discussionmentioning

confidence: 99%

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Ten cases of intradiaphragmatic extralobar pulmonary sequestration: a single-center experience

Gao

Jin

Tan

2022

World Jnl Ped Surgery

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BackgroundIntradiaphragmatic extralobar pulmonary sequestration (IDEPS) is a rare type of pulmonary sequestration (PS). The purpose of this study is to assess diagnosis and operative treatment of IDEPS.MethodsPatients with PS who were diagnosed and treated in our center from January 2015 to December 2020 were analyzed retrospectively to identify patients with IDEPS.ResultsTotally, 215 patients with PS were treated surgically, including 10 cases with IDEPS. Prenatal ultrasounds and postnatal-enhanced CT showed the presence of IDEPS in four cases and in seven cases, respectively. The three-dimensional (3D) reconstruction software was performed perfectly to identify the location of the lesions in 10 cases. The surgeries were performed smoothly by laparoscopic surgery in one case, video-assisted thoracic surgery (VATS) in five cases and Da Vinci robot-assisted thoracoscopic surgery (DVRATS) in four cases. In the VATS group, the average operative duration, intraoperative blood loss volume, length of stay after operation, and postoperative thoracic catheter indwelling duration were 48 min, 3.8 mL, 6.4 days and 2.2 days, respectively. That of the DVRATS group were 80 min, 3.5 mL, 4.3 days and 1.5 days, respectively. No side effects had appeared.ConclusionsThe 3D reconstruction software was proven to be capable in assisting the assessment of IDEPS. We suggested early surgery to treat IDEPS, and the best path was accessing the mass from the chest. Both DVRATS and VATS for the treatment of an IDEPS are safe, feasible, and effective. Furthermore, DVRATS provides a 3D magnified view, more flexibility and precision.

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Section: Discussionmentioning

confidence: 99%

“…The IDEPS is rarely reported 3 5 7 12 16 24 25. It has the risk of infection,3 lung ventilation disorder24 or malignancy 3 5. In addition, once an infection occurs, the surgical difficulty is significantly increased owing to the adhesions and edema of the diaphragm, which may result in more complications 5 25.…”

Section: Discussionmentioning

confidence: 99%

Ten cases of intradiaphragmatic extralobar pulmonary sequestration: a single-center experience

Gao

Jin

Tan

2022

World Jnl Ped Surgery

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“…Більшість ПЛС маніфестує в перші 6 місяців життя і частіше зустрічається у хлопчиків (3-4:1) [26]. Основними клінічними проявами ПЛС є дихальні розлади та порушення годування невдовзі після народження або застійна серцева недостатність у більш старших дітей, а також біль і симптоми запалення [8,9,14]. Існує думка, що вада може лишатися безсимптомною протягом життя або мати рідкісні ускладнення, зокрема, гемоторакс, перекрут та малігнізація [21,28].…”

Section: випадок №4 (відповідно до таблиці 1)unclassified

“…З іншого боку, описані випадки летальності в пацієнтів з ЛС, пов'язані з серцевими ускладненнями (cor pulmonale, легенева гіпертензія) [3], свідчать на користь активної хірургічної тактики. Такий підхід рекомендований більшістю авторів, одні з яких рекомендують відкриту або торакоскопічну резекцію в усіх випадках ЛС [3,[12][13][14][15]17,28,30], зважаючи на невизначеність діагнозу та можливу наявність асоційованих аномалій, зокрема ВКАМ, інші пропонують просту перев'язку аберантної артерії або її емболізацію [4,9]. Останню рекомендують у разі серцевої декомпенсації [8,9,27] як самостійне лікування або в комбінації з резекцією легень.…”

Section: випадок №4 (відповідно до таблиці 1)unclassified

Surgical treatment of pulmonary sequestration in children

Krivchenya¹,

Rudenko²,

Prytula³

et al. 2022

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Pulmonary sequestration is a complex malformation of the lungs, which is based on a violation of the development of their bronchopulmonary and vascular components. The multifactorial nature of morphological and functional disorders is clinically manifested by respiratory distress syndrome and heart failure with a threat of a critical outcome for a newborn child, despite the sufficient development of the respiratory system as a whole. Purpose - optimization of diagnosis and treatment of lung sequestration in children based on the study of clinical and diagnostic data, as well as the results of surgical treatment. Materials and methods. The study included 18 patients aged from 8 days to 18 years, including newborns - 6, children from 1 to 12 months - 5, from 1 to 3 years - 3, from 7 to 9 years - 2 and from 15 to 18 years - 2. Median age was 4.5 months. Research methods included evaluation of clinical symptoms, chest X-ray, contrast-enhanced CT, and angiography. Prenatal diagnosis was carried out using ultrasonography and fetal MRI. In all cases, open surgical treatment was used. Results. Intrapulmonary sequestration was diagnosed in 13 (72.2%) patients, extrapulmonary - in 5 (27.8%), p=0.082. Left-sided localization in 11 (61.1%) patients, right-sided localization in 7 (38.9%) patients, р=0.3. Associated malformations had 9 (50%) patients: polycystic (n=4) or hypoplasia (n=2) of the lung, diaphragmatic hernia (n=3), pericardial defect (n=1), thoracic dystopia of the kidney (n=2), Waardenburg syndrome (n=1), ventricular septal defect (n=1), innominate artery tracheal compression (n=1). Symptomatic course was noted in 15 (83.3%) patients, asymptomatic - in 3 (16.7%) cases (p=0.021). Main symptoms were as follows: pulmonary bleeding, hemophthisis, respiratory and hemodynamic disorders, signs of inflammation. Lobectomy (n=8), atypical segmental lung resection (n=4) and transection of aberrant vessels (n=1) were performed for intrapulmonary sequestration, and sequestrectomy (n=4) for extrapulmonary sequestration. In cases of associated diaphragmatic hernia (n=3), simultaneous diaphragmatic plasty was performed, including using a non-free pericardial flap (n=1) or a PTFE patch (n=1), and in case of innominate artery compression of the trachea, aortopexy (n=1). In 17 (94.4%) cases, a positive result of surgical treatment was noted. Postoperative complications (intrathoracic bleeding) and lethality were observed in 1 (5.6%) case. Patients were examined in the long-term period from 2 months to 30 years after surgery. Conclusions. Surgical correction of pulmonary sequestration is appropriate as the diagnosis is made, mainly in the neonatal period. Given the complexity of the pathology, especially in the presence of associated malformations, and the expediency of early correction in the neonatal period, thoracotomy access should be preferred as safer for sequential division of arterial and then venous vessels, and for atypical segmental lung resection or lobectomy, depending on peculiarities of sequester. The presence of associated defects requires simultaneous correction. In the case of associated diaphragmatic hernia, autopericardial defect plastics or a synthetic patch are appropriate as an alternative to simple suturing. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Keywords: congenital malformations of the lungs, lung sequestration, surgical treatment, children.

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“…Pulmonary sequestration (PS) is an uncommon congenital pulmonary malformation, accounting for 1.5% of all congenital pulmonary malformations [ 1 ]. It is characterized by a nonfunctioning mass of lung tissue that shows no normal communication with the tracheobronchial tree and receives its vascular supply from the systemic circulation [ 2 ]. PS is anatomically divided into intralobar pulmonary sequestrations (ILS) and extralobar pulmonary sequestrations (ELS) according to whether there is a complete visceral pleura.…”

Section: Introductionmentioning

confidence: 99%

Clinical analysis of extralobar pulmonary sequestration with torsion in children: report of 6 cases

Wang

Huang

et al. 2022

J Cardiothorac Surg

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Background Extralobar pulmonary sequestration is an uncommon congenital pulmonary malformation. Clinically, pedicle torsion of extralobar pulmonary sequestration is extremely rare. Due to inadequate awareness of its atypical presentation and imaging characteristics, clinical diagnosis is very difficult, and it is extremely easy to misdiagnose. Case presentation There were 6 children (3 males and 3 females), aged 3–12 years old. The main clinical symptoms of the children were abdominal and chest pain (3 cases), abdominal pain (1 case), chest pain (1 case), and vomiting and abdominal distension (1 case). Two cases were accompanied by fever. Preoperative ultrasound revealed a well-bordered mass with soft-tissue density, accompanied by pleural effusion. On contrast-enhanced computed tomography scans, the mass showed no obvious enhancement. A blood supply was only present in 1 case, and there was no feeding artery shown in the other 5 cases. Extralobar pulmonary sequestration with haemorrhagic infarction was pathologically confirmed. On postoperative days 2–6, the children were discharged uneventfully. There were no complications during the median follow-up of 4 months. Conclusions Torsed extralobar pulmonary sequestration usually occurs in childhood or adolescence, with abdominal and/or chest pain as the primary symptoms. Imaging examination shows a well-defined soft-tissue mass without enhancement. The feeding vessel is not clearly displayed in the mass, and extralobar pulmonary sequestration is accompanied by varying amounts of pleural effusion. Video-assisted thoracoscopic surgical resection is associated with excellent prognosis.

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The clinical management of extralobar pulmonary sequestration in children

Cited by 11 publications

References 22 publications

Ten cases of intradiaphragmatic extralobar pulmonary sequestration: a single-center experience

Ten cases of intradiaphragmatic extralobar pulmonary sequestration: a single-center experience

Surgical treatment of pulmonary sequestration in children

Clinical analysis of extralobar pulmonary sequestration with torsion in children: report of 6 cases

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