Lung resections in children for congenital and acquired lesions

Abstract

We reviewed a single-center experience of pediatric lung resections for various congenital and acquired benign lung conditions. Thirty-five children underwent lung resections between 1998 and 2006, their age ranging from 8 days to 12 years (mean 3 years), with a male:female ratio of 4:1. Twelve patients were neonates. Antenatal diagnosis was available in only one patient. The presenting symptoms were respiratory distress and respiratory tract infections. Imaging with chest X-ray with/without a CT scan picked up the lesion in all cases. Preoperative ventilation was required for five patients. One patient had pneumothorax at presentation; however, ten patients had inadvertent intercostal tube insertion before surgical referral. The surgical procedures performed included lobectomy (28), segmentectomy (3), and pneumonectomy in 4 cases. Twenty-one patients underwent emergency surgery. Six patients required postoperative ventilation. The histopathological diagnosis was congenital lobar emphysema (CLE) (9), congenital cystic adenomatoid malformation (CCAM) (9), bronchiectasis (9), sequestration (3), atelectasis (1), lung abscess (1), unilobar tuberculosis (1), hydatid cyst (1), and foreign body with collapse (1). There was considerable discrepancy between the preoperative diagnosis based on imaging and the postoperative histopathological diagnosis. Postoperative complications included atelectasis (2), pneumothorax (2) and fluid collection (4 cases). Three patients died, one from compromised cardiac function, one from overwhelming sepsis and one from respiratory failure due to severe bilateral CCAM; the rest of the patients made a satisfactory recovery. At short-term follow-up all patients were doing well. Pulmonary resections are necessary for various congenital and acquired lung lesions in children and can be done safely in a pediatric hospital setup. Proper preoperative diagnosis can avoid inadvertent intercostal tube insertion in patients with congenital cystic lung lesions. The histopathological diagnosis often differs from the radiological diagnosis. Emergency lobectomies for acute respiratory distress, even in neonates, result in a satisfactory outcome.

Congenital lobar emphysema: 30-year case series in two university hospitals

“…( 27 ) Some authors have reported that the symptoms are more intense when there is upper lobe involvement than when there is middle lobe involvement. ( 15 , 16 , 22 ) However, no such difference was found in our sample of patients. …”

“…In both cases, the upper right and middle lobes in the right hemithorax were affected. This facilitated the surgical approach–as previously discussed by other authors( 15 , 22 )–which would have been more difficult had there been bilateral involvement. ( 27 ) Some authors have reported that the symptoms are more intense when there is upper lobe involvement than when there is middle lobe involvement.…”

“…This, in association with symptoms of respiratory distress, can mimic pneumonia, thus delaying diagnosis. The main differential diagnosis on routine chest X-rays is still tension pneumothorax, which is evidenced by the high radiolucency of the affected lung and which can, in association with respiratory distress, lead to unnecessary invasive procedures( 6 , 21 , 22 ) that can worsen the condition of patients. In such cases, chest CT is useful in order to confirm the X-ray findings, to determine the affected lobe more accurately, and to exclude other malformations, such as vascular ring, masses, and cysts, which can compress the bronchi.…”

Thoracoscopic segmentectomy for treatment of congenital lung malformations

“…Lobectomy is considered by some to be the procedure of choice for removal of CLMs [12][13][14][15] because complete resection of the diseased lobe leaves no possibility for residual disease [16,17] and the resultant risk of recurrent infection or malignant transformation [18][19][20][21][22]. In addition, some authors have speculated that the rate of postoperative air leak is less with lobectomy [3].…”

Not all infantile respiratory distress in winter is bronchiolitis: congenital lobar emphysema

“…Studies have concluded that surgical management is appropriate for all infants <2 months and for those over 2 months with severe respiratory distress, medistinal shift +/− lobar collapse on CXR or abnormal bronchoscopy findings 6–9. The appropriate surgical management is excision of the affected lobe 6 7. Conservative management involves serial clinical review with interval CXR’s to monitor progression.…”