Coil embolization of intralobar pulmonary sequestration - an alternative to surgery: a case report

Abstract

BackgroundPulmonary sequestration is a congenital lung disease characterized by nonfunctioning pulmonary tissue that lacks normal communication with the bronchial tree and is supplied by a nonpulmonary systemic artery. Symptomatic bronchopulmonary sequestration is uncommon, seen more frequently in the pediatric population than in adults. It has traditionally been treated with surgical resection; however, a limited but growing number of cases have been treated with angiographic embolization. Given the inherent risks of cardiothoracic surgery, embolization of the anomalous vessel is an enticing alternative treatment. We present a case of a 56-year-old woman with known, symptomatic, intralobar pulmonary sequestration that was successfully treated with coil embolization.Case presentationA 56-year-old Pacific Islander woman with a history of chronic myeloid leukemia was admitted to the hospital with an episode of hemoptysis. Computed tomography of the chest demonstrated left lower lobe intralobar pulmonary sequestration fed by a large tortuous vessel branching off of the descending thoracic aorta. Surgical resection of the sequestration is the current standard treatment strategy of symptomatic intralobar pulmonary sequestration. The cardiothoracic surgeon noted that given the size and location of arterial blood supply, intervention would involve thoracotomy and lobectomy. The interventional radiologist offered embolization of the lesion as an alternative to surgery. Multiple coils, 6–13 mm in size, were used to embolize the sequestration. No considerable flow distal to the coils was noted postembolization.ConclusionsIntralobar pulmonary sequestration is a rare condition that typically requires surgical management. This case demonstrates the efficacy of coil embolization as an alternative management strategy. To date, limited case reports of adults treated with endovascular embolization exist. Treatment of symptomatic pulmonary sequestration with embolization can be considered as an alternative to surgical resection.

Secuestro Pulmonar: Caracterización Y Tratamiento en Pacientes Adultos Y Pediátricos

“…En nuestra serie, los pacientes fueron abordados por toracotomía a excepción de un caso pediátrico cuyo diagnóstico fue un hallazgo en una laparotomía en el contexto de una perforación gástrica y shock. Cabe destacar que se han descrito casos de involución espontánea [25][26][27] y la utilización de tratamientos no quirúrgicos como embolización arterial, tanto en adultos como en pacientes pediátricos [28][29][30][31][32] .…”

“…En nuestra serie la cirugía tuvo baja morbilidad y sin mortalidad, concordante con diversas series que muestran mínima morbilidad y buen pronóstico, con escasa presencia de síntomas tras la resolución quirúrgica 23,24,[28][29][30][31][32][33][34][35][36] .…”

Intralobar pulmonary sequestration: incidental finding in an asymptomatic patient

“…In comparison with an open thoracotomy, VATS is associated with less intraoperative bleeding and shorter postoperative hospital stays [15] . Alternative management options include endovascular embolization and coiling in cases where open thoracotomy is likely to cause high levels of morbidity and mortality [16 , 17] or hybrid thoracic endovascular aortic repair-lobectomy treatment for cases of intralobar PS involving an aneurismal feeding vessel [18 , 19] .…”

A diver’s dilemma – a case report on bronchopulmonary sequestration

“…Extralobar sequestrations are separated from the normal lung by its own pleura, have a 3:1 male predominance, and are more likely to be associated with other congenital anomalies: 43% of all ELS cases compared to 17% of ILS cases [1]. They are therefore usually detected much earlier, either via routine prenatal ultrasound screens, or after patients present symptomatically [5]. Conversely, ILS are located within a normal lobe of the lung, do not have a gender predominance, and are associated with recurrent lung infections due to the increased likelihood of associated anomalous bronchial communications.…”