Non-operative management of extralobar pulmonary sequestration: a safe alternative to resection?

Robson, Victoria; Shieh, Hester F.; Wilson, Jay M.; Buchmiller, Terry L.

doi:10.1007/s00383-019-04590-2

Cited by 19 publications

(15 citation statements)

References 53 publications

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“…Two pulmonary sequestrations in this series were no longer visible on the last postnatal imaging and were categorized as undergoing postnatal regression. These findings are consistent with previous reports highlighting the current recommendation of conservative management of these lesions [14, 18-20].…”

Section: Discussion/conclusionsupporting

confidence: 93%

“…In contrast, congenital neuroblastoma represents a lesion with variable prognosis, ranging from requiring resection or chemotherapy to undergoing spontaneous regression without intervention [1, 13]. While infradiaphragmatic extralobar pulmonary sequestration is a benign lesion that is asymptomatic, it may require surgical resection in the setting of an unclear diagnosis versus continued observation [6, 7, 14]. The ability to differentiate between these specific diagnoses based upon prenatal imaging features remains challenging, complicating prenatal counseling regarding the lesion’s anticipated clinical course.…”

Section: Discussion/conclusionmentioning

confidence: 99%

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Prenatal Imaging Diagnosis of Suprarenal Lesions

et al. 2021

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Introduction: Prenatal suprarenal lesions represent diverse pathologies. This study investigated prenatal imaging features and regression patterns associated with specific lesion diagnoses. Methods: This is a multicenter retrospective review of fetuses with prenatally diagnosed suprarenal lesions between 2001 and 2019. Prenatal ultrasound and MRI characteristics, postnatal imaging, and clinical course were reviewed. Prenatal imaging findings were compared by the most common diagnoses and regression patterns. Results: Forty-four fetuses were prenatally diagnosed with suprarenal lesions. Diagnoses included pulmonary sequestration (n = 12; 27.3%), adrenal hemorrhage (n = 12; 27.3%), upper quadrant cyst (including 2 duplication cysts, 1 splenic cyst, and 3 indeterminate cysts), neuroblastoma (n = 4), adrenal hyperplasia (n = 3), bilateral adrenal calcifications (n = 1), and indeterminate lesions (n = 6). Sequestrations were uniformly left-sided (100 vs. 50%; p = 0.014) and diagnosed earlier in gestation than adrenal hemorrhages (p = 0.025). Sequestrations were also significantly more likely to have a prenatal feeding vessel (p = 0.005), low T1 MRI signal (p = 0.015), and no MRI blood products (p = 0.018) compared to adrenal hemorrhages. When comparing all 44 patients, a prenatal feeding vessel and low T1 signal on prenatal MRI were significantly associated with lesion persistence (p = 0.003; p = 0.044). Discussion/Conclusion: Imaging findings on prenatal ultrasound and MRI aid in the diagnosis of suprarenal lesions, including differentiating pulmonary sequestrations and adrenal hemorrhages.

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Section: Discussion/conclusionsupporting

confidence: 93%

Section: Discussion/conclusionmentioning

confidence: 99%

Prenatal Imaging Diagnosis of Suprarenal Lesions

et al. 2021

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“…It is generally accepted that patients diagnosed with ILS whether asymptomatic or not and patients diagnosed with ELS with symptom should receive surgical intervention [10].Non-operative management is better suited for asymptomatic ELS. Studies have shown that ELS is likely to regress spontaneously, supporting the safety of non-operative ELS management [4,9,11].…”

Section: Discussionmentioning

confidence: 90%

“…It is controversial that whether patients with PS should receive surgical intervention because data regarding the surgery outcome, long-term clinical course and quality of life are rare [8][9][10][11].Patients with different symptoms of PS should receive different treatment strategies. It is generally accepted that patients diagnosed with ILS whether asymptomatic or not and patients diagnosed with ELS with symptom should receive surgical intervention [10].Non-operative management is better suited for asymptomatic ELS.…”

Section: Discussionmentioning

confidence: 99%

Aberrant Feeding Artery Mutilation Treatment of Pulmonary Sequestration: A Case Report

Liu

Han

Wang

et al. 2020

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Background: Pulmonary sequestration (PS) is a rare congenital pulmonary pulmonary malformation. In this study, we reported a case of PS treated with aberrant feeding artery mutilation in our center.Case Presentation: A 29 –year-old female patient presented to our center in March 2020 due to repeated hemoptysis for more than 15 years, she received CTA examination which showed an aberrant feeding artery from the thoracic aorta into the left lower lobe of the lung and was therefore diagnosed with left lower lung pulmonary sequestration. Given that she complained with no infectious symptoms, she was treated with thoracoscopic feeding artery mutilation in June 2020 . She and experienced an uneventful postoperative course and was discharged 2 days postoperatively. On the postoperative follow-up of 4 months, thise patient’s physical condition was excellent and free of any symptoms such as hemoptysis or cough.Conclusion: Surgery is still the first choose for the treatment of PS. When pulmonary lesion is small-sized,for PS patients with non-infectious symptoms, aberrant feeding artery mutilation can be attempted as an alternative to intravascular technology for the treatment of PS. Future large studies are required to further verify its long-term efficacy and scope of application.

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“…Stanton et al [8] found that the rate of postoperative complications of symptomatic PS were signi cantly higher than that of asymptomatic PS patitents undergoing elective surgery. However, some studies [18][19][20] demonstrated that an EPS may remain asymptomatic throughout life and even involute over time, suggesting the safety of just following up EPS without surgery management. In currently, VATS has become the main surgical technique with the advantage of minimally invasive, accurate and rapid recovery.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and Surgical Treatment of Intradiaphragmatic Extralobar Pulmonary Sequestration: a Report of 10 Cases

Gao

Tan

2021

Preprint

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Background Intradiaphragmatic extralobar pulmonary sequestration(IDEPS) is a rare type of pulmonary sequestration (PS) and has been reported in very few studies. The purpose of this study is to access diagnosis and operative treatment of an IDEPS.Methods Patients with PS who were diagnosed and treated in our center from January 2015 to December 2020 were retrospectively analyzed, in order to identify patients with IDEPS. Clinical datas regarding diagnosis, surgical procedures and outcomes were documented.Results From January 2015 to December 2020, 215 patients with PS were surgically treated in our center, including 87 patients with extralobar pulmonary sequestration(EPS). 10 cases were identifed as IDEPS ( 2 males, 8 females; age, 5 months to 21 months). Prenatal ultrasounds and enhanced computed tomography (CT) showed the presence of IDEPS in 4 cases and 7 cases, respectively, and a three-dimensional (3D) reconstruction software was perfectly performed to identify the location of the lesions in 3 cases. The surgeries were smoothly performed by laparoscopic surgery in 1 case, video-assisted thoracic surgery (VATS) in 5 cases(Group 1) and Da Vinci robot-assisted thoracoscopic surgery(DVRATS) in 4 cases(Group 2). In Group 1 (5 females; the mean age, 8.0 months), the average operative duration, intraoperative blood loss volume, length of stay after operation, and postoperative thoracic catheter indwelling duration were 48 minutes, 3.8ml, 6.4 days and 2.2 days, respectively. That of Group 2(1 male, 3 females; the mean age, 9.5 months) were 80 minutes, 3.5ml, 4.3 days and 1.5 days, respectively. The IDEPS cases who followed up rang from 3 months to 36 months were included in this retrospective study and no side effect had appeared.Conclusions It’s challenging to diagnose an IDEPS through prenatal ultrasound or CT, and a 3D reconstruction software was proved to be capable to assist on the assessment of an IDEPS. We suggested early surgery to removel of an IDEPS, and the best path was accessing the mass from the chest. DVRATS or VATS for the treatment of an IDEPS is safe, feasible and effective. Furthermore, compared with VATS, DVRATS is 3D magnified view, more flexibility and precision.

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Non-operative management of extralobar pulmonary sequestration: a safe alternative to resection?

Cited by 19 publications

References 53 publications

Prenatal Imaging Diagnosis of Suprarenal Lesions

Prenatal Imaging Diagnosis of Suprarenal Lesions

Aberrant Feeding Artery Mutilation Treatment of Pulmonary Sequestration: A Case Report

Diagnosis and Surgical Treatment of Intradiaphragmatic Extralobar Pulmonary Sequestration: a Report of 10 Cases

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