Ectopic extralobar pulmonary sequestrations in children: interest of the laparoscopic approach

Joyeux, Luc; Mejean, N.; Rousseau, Thierry; Couaillier, J.F.; Piard, F; Sapin, Emmanuel

doi:10.1016/j.jpedsurg.2010.06.033

Cited by 23 publications

(18 citation statements)

References 16 publications

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“…After reviewing the literature, we found that our case shared most characteristics of prenatal detected RPS: gestational age at detection could be as early as third month; It was typically located in the left suprarenal area; ultrasound study usually showed hyperechogenic lesion, with or without cystic components; It was usually a hyperintense lesion on T2-weighted MRI images, and was a heterogeneous, hypodense mass that increase density with intravenous contrast on CT scan [3]; Prenatal and postnatal natural history of RPS is usually uneventful [4]. It was a pity that the information about the feeding systemic arterial vessel(s), the most distinctive characteristic of RPS, remained unclear in our case.…”

Section: Discussionsupporting

confidence: 59%

“…The treatment remains controversial, mainly because the prenatal detected RPS has potential to resolve spontaneously [10], as well as to malignant transformation especially when coexists with congenital cystic adenomatoid malformation (CCAM) [11]. Most RPS are asymptomatic, although they link to potential complications, like compression of the normal structures [4] causing dysphagia, GERD, and RDS, pheochromocytoma-like symptoms [12], or high flow heart failure caused by the systemic blood supply [4]. We agree with the surgical indication of symptomatic lesions.…”

Section: Discussionmentioning

confidence: 99%

“…Since CCAM, with which ELS is frequently associated [13], may experience the malignant transformation, and the transformation can be found as early as 22 months after born [9], it is worrying to apply the strategy of "wait and see" so long. Surgery removal is also required to avoid some future problems like infection [4], abdominal pain [14]. When surgery is decided, laparoscopic approach is better for the sake of minimal invasive.…”

Section: Discussionmentioning

confidence: 99%

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Prenatal detected retroperitoneal pulmonary sequestration with elevated serum levels of CA 19-9 – Case report and review of the literature

Zhao

Zhang

et al. 2013

Journal of Pediatric Surgery Case Reports

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a b s t r a c tWe present a case of prenatal detected retroperitoneal pulmonary sequestration (RPS) with an interesting finding. Immunohistochemical staining of the specimen indicated that the elevated carbohydrate antigen (CA) 19-9 serum level was very likely caused by the sequestration. A review of the literature was made. RPS is an infrequent congenital malformation, which can be detected by routine obstetric sonographic screening during prenatal life. It can be misdiagnosed as neuroblastoma. The differential diagnosis can be tricky, which we hope our finding can help with. The management remains controversial.Ó 2013 Elsevier Inc. All rights reserved. Case reportA left suprarenal fetal mass was discovered at 5 months' gestation on routine prenatal ultrasound scan of a 31-year-old gravida 1, para 0 woman. The mass was hyperechoic, measured 2.3 Â 1.8 cm at 28 weeks' gestation ( Fig. 1A). An magnetic resonance imaging (MRI) scan at the same time showed the lesion was hyperintense on T2-weighted ( Fig. 1B). To our knowledge, the most possible diagnosis was either neuroblastoma or adrenal hematoma. We applied the strategy of "wait and see." Three repeat ultrasound scans at 37 weeks' gestation, 1 week after born (full-term normal delivery at 38 week's gestation, mother and child didn't show any abnormal symptoms and physical signs), 4 weeks showed the persistence of the lesion. Further evaluation was performed because of the suspicion of malignancy at 6 weeks after birth. The urinary catecholamines assay, AFP, b-HCG were all normal. The carbohydrate antigen (CA) 19-9 was 53 ng/ml, when the normal upper limit was 38 ng/ml. The detection for neuroblastoma minimal residual disease in bone marrow from posterior superior iliac spine was negative. Computerized tomography (CT) showed a non-calcified heterogeneously enhanced solid mass in the left adrenal gland region (Fig. 1C). We made the decision of surgery for that neuroblastoma couldn't be excluded. At laparotomy, a 3 Â 2 Â 2 cm solid mass with capsule, rich in blood supply, was found in the retroperitoneal left suprarenal region. It was superior, posterior, medial to the adrenal gland, clinging to adrenal gland without any adhesion or infiltration. A complete dissection and removal was achieved. The histologic study of the specimen revealed the presence of dysplastic lung tissue (Fig. 1D). The diagnosis of retroperitoneal pulmonary sequestration (RPS) was finally made. Immunohistochemical staining of the specimen with a specific monoclonal antibody against CA 19-9 showed immunoreactivity (Fig. 1E). The postoperative course has been uneventful by 3 months follow-up. DiscussionPulmonary sequestration (PS) is a segment of lung that has no communication with the normal bronchial tree and receives blood supply from systemic arteries. The incidence is about 0.15e1.8% [1]. Extralobar pulmonary sequestrations (ELS), which account for 25% of prenatal detected lung lesions [1], are masses of lung parenchyma that have a distinct pleura. About 10e15% of ELS will occur in retroper...

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Section: Discussionsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Prenatal detected retroperitoneal pulmonary sequestration with elevated serum levels of CA 19-9 – Case report and review of the literature

Zhao

Zhang

et al. 2013

Journal of Pediatric Surgery Case Reports

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“…Sequestrectomy with careful dissection of the vascular pedicle, which can be done by means of videothoracoscopy, is the preferred surgical treatment [10]. In our case, sequestrectomy was performed by means of a laparotomic approach, with complete removal of the pulmonary tissue.…”

Section: Discussionmentioning

confidence: 98%

Diagnosis of Intra-Abdominal Extralobar Pulmonary Sequestration by means of Ultrasound in a Neonate

Pires¹,

Czapkowski²,

Júnior³

et al. 2013

Case Reports in Pediatrics

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Pulmonary sequestration is a congenital abnormality consisting of a mass of pulmonary tissue that presents an abnormal connection with the tracheobronchial tree, with a blood supply coming from an anomalous artery derived from the systemic circulation. Extralobar pulmonary sequestration is characterized by having pleural coverings that are independent of the normal lungs, with vascular supply usually coming from the aorta or from one of its branches. This diagnosis can be suspected prenatally if an abdominal mass, generally below the diaphragm, is seen. Here, we present a case of a neonate on the second day of life, with ultrasonography showing extralobar pulmonary sequestration located above the left adrenal gland that prenatally simulated a neuroblastoma.

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“…Al parecer, los SP infradiafragmáticos no tienen influencia en la salud fetal, no se han asociado a hidrops y tienden a ser asintomáticos tras el nacimiento 3 . En los SP infradiafragmáticos las opciones terapéuticas son la cirugía convencional y la laparoscópica, técnica segura y factible en recién nacidos y lactantes menores 14 . También se ha indicado a la embolización de la arteria nutricia como una alternativa terapéutica a la cirugía 15 .…”

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Secuestro pulmonar extralobar infradiafragmático: a proposito de un caso

Escobar

Estigarribia

2015

Rev. Nac. (Itauguá)

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RESUMENSe presenta un caso de secuestro pulmonar extralobar infradiafragmático como hallazgo ultrasonográfico prenatal, confirmado posteriormente por anatomía patológica. Palabras claves: secuestro pulmonar extralobar infradiafragmático, malformaciones congénitas, ecografía. ABSTRACT A case of pulmonary sequestration occurs extralobar infradiaphragmatic as prenatal ultrasonographic finding, subsequently confirmed by pathology. Keywords: extralobar infradiaphragmatic pulmonary sequestration, congenital malformations, ultrasonography. INTRODUCCIÓN Los secuestros pulmonares (SP) son malformaciones congénitas de origen mixto, bronquial y arterial, que se caracterizan por tener una zona de tejido pulmonar embrionario no funcionante, sin comunicación identificable con el árbol traqueobronquial normal, vascularizada a través de una arteria sistémica anómala 1,2 . Existen dos variedades de SP dependiendo de la presencia de revestimiento pleural: intralobar y extralobar. En el SP intralobar, que representa del 75% al 85% de los casos diagnosticados en el adulto y raramente diagnosticado en el feto, la masa es contigua al parénquima pulmonar normal y se halla revestida por la pleura. Sin embargo, en el SP extralobar, que supone casi todos los SP diagnosticados prenatalmente, la masa se encuentra anatómicamente separada del tejido pulmonar normal, por fuera de la pleura visceral y recibe irrigación de la aorta torácica o abdominal 3,4 . Aproximadamente 90% de los SP extralobares ocurren en el hemitórax izquierdo y son generalmente asintomáticos durante el periodo neonatal 5 . El SP extralobar puede tener una localización extratorácica, a nivel del diafragma o infradiafragmático, es excepcionalmente raro, tiene una incidencia estimada de 0,5% a 1,7% 3,6 . Los avances en las técnicas ecográficas han permitido realizar el diagnóstico inicial del SP extralobar en la etapa prenatal. Se caracteriza por la presencia de una masa ecogénica, bien circunscripta, de forma lobular o triangular, de volumen extremadamente variable, con patrón quístico o pseudoumoral, de localización preferentemente izquierda y puede identificarse en el segundo trimestre 3,7,8 . Una vez que se sospecha el diagnóstico se debe tratar de identificar la circulación arterial mediante Doppler color para exponer los vasos sistémicos que nutren el SP. Esto es de mucha importancia ya que las otras lesiones pulmonares (malformación adenomatoide quística, enfisema lobular y atresia bronquial) obtienen su irrigación de los vasos pulmonares 9 . La resonancia magnética prenatal puede proporcionar una mejor resolución anatómica, pero por lo general sólo ayuda en la confirmación de los hallazgos ecográficos. En el periodo postnatal, la técnica de elección para caracterizar la lesión es la angiotomografía. Una masa ecogénica suprarrenal en el abdomen izquierdo suele ser un SP extralobar, pero también puede sugerir una hemorragia suprarrenal o un neuroblastoma. Éste suele ser quístico, derecho y con mayor frecuencia se visualiza en el tercer trimestre 3,10 . Existen estudi...

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Ectopic extralobar pulmonary sequestrations in children: interest of the laparoscopic approach

Cited by 23 publications

References 16 publications

Prenatal detected retroperitoneal pulmonary sequestration with elevated serum levels of CA 19-9 – Case report and review of the literature

Prenatal detected retroperitoneal pulmonary sequestration with elevated serum levels of CA 19-9 – Case report and review of the literature

Diagnosis of Intra-Abdominal Extralobar Pulmonary Sequestration by means of Ultrasound in a Neonate

Secuestro pulmonar extralobar infradiafragmático: a proposito de un caso

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