Tumor carcinoide e sequestro pulmonar

Abstract

Pulmonary sequestration is defined as a mass of lung tissue separated from the tracheobronchial tree and irrigated by an anomalous systemic artery. It is rarely seen in conjunction with lung neoplasms. We report the case of a 39-year-old female patient diagnosed with a carcinoid tumor, located in the intermediate bronchus and accompanied by bronchiectasis in the right lower lobe. The patient underwent thoracotomy for the resection of the affected area. During surgery, she presented with significant hemorrhage resulting from the transection of the anomalous artery that irrigated an intralobar pulmonary sequestration, which was located in right lower lobe and had not been identified in pre-operative examinations.Keywords: Bronchopulmonary sequestration; Hemorrhage; Carcinoid tumor. ResumoO sequestro pulmonar é definido como uma massa de tecido pulmonar separada da árvore traqueobrônquica e irrigada por uma artéria sistêmica anômala. Sua associação com neoplasias pulmonares é rara. Relatamos o caso de uma paciente de 39 anos com o diagnóstico de tumor carcinoide localizado no brônquio intermediário, associado a alterações caracterizadas como bronquiectasias em lobo inferior direito. A paciente foi submetida à toracotomia para ressecção da área acometida e, durante a cirurgia, apresentou hemorragia importante decorrente da transecção da artéria anômala que nutria o sequestro pulmonar intralobar localizado em lobo inferior direito, não identificado nos exames pré-operatórios. Depending on its pleural covering, PS is classically divided into intralobar and extralobar. An intralobar PS (ILPS) share the pleural covering with the rest of the lung, whereas an extralobar PS (ELPS) is completely covered by its own visceral pleura. Descritores(5) Although the extralobar form is well defined as a congenital abnormality, the intralobar form has a controversial pathogenesis, with some evidence indicating that, in many cases, it is an acquired disease. (6,7) Accounting for approximately 75% of all cases of PS, ILPS is more common in the lower lobes and on the left, involving the posterior basal segment. (5,8) Its arterial supply is nearly always derived from the aorta or from one of its branches, typically one of a large diameter. Venous drainage is via the pulmonary veins into the left atrium, creating a left-to-left shunt. In a minority of cases, drainage is via the inferior vena cava or via the azygos system. (9) In the case presented here, the PS was located in the right lower lobe and the blood supply came from an anomalous branch derived from the thoracic aorta.Cases of ILPS typically occur in adolescents and young adults with a history of recurrent infections of the respiratory tract, hemoptysis, and dyspnea. Some ILPS patients develop cardiac symptoms, which are a consequence of the lefthemoptysis. In the preoperative investigation, a CT scan of the chest revealed a lesion in the intermediate bronchus (Figure 1), as well as cystic bronchiectasis in the right lower lobe (Figure 2). Fiberoptic bronchoscopy confirme...

Sequestro pulmonar e tratamento endovascular: um relato de caso

“…The most common malformations include cystic adenomatoid malformation, pulmonary sequestration, congenital lobar emphysema, bronchogenic cysts, and pulmonary arteriovenous malformations. 1 Of these, pulmonary sequestration accounts for 0.15 to 6.45% of pulmonary malformation cases. [1][2][3] Pulmonary sequestration is thus a rare congenital anomaly.…”

“…1 Of these, pulmonary sequestration accounts for 0.15 to 6.45% of pulmonary malformation cases. [1][2][3] Pulmonary sequestration is thus a rare congenital anomaly. It consists of a non-functional mass of pulmonary parenchyma that does not communicate with the normal tracheobronchial tree and which receives its blood supply from an anomalous systemic artery, generally from the descending aorta, although other sources of arterial supply are possible.…”

“…Drainage may be via systemic veins or pulmonary veins. [1][2][3] The tissue is embryonic cystic tissue and non-aerated and disorganized alveoli, in addition to other respiratory tract components. 1 The malformation can be classified as one of two distinct forms, intralobar or extralobar, on the basis of whether it has its own pleural envelope.…”

“…[1][2][3] The tissue is embryonic cystic tissue and non-aerated and disorganized alveoli, in addition to other respiratory tract components. 1 The malformation can be classified as one of two distinct forms, intralobar or extralobar, on the basis of whether it has its own pleural envelope. [1][2][3] Intralobar pulmonary sequestration is present when the sequestrated area is surrounded by the visceral pleura of a normal pulmonary lobe.…”

“…1 The malformation can be classified as one of two distinct forms, intralobar or extralobar, on the basis of whether it has its own pleural envelope. [1][2][3] Intralobar pulmonary sequestration is present when the sequestrated area is surrounded by the visceral pleura of a normal pulmonary lobe. [1][2][3] This form accounts for approximately 75% of sequestration cases, and most commonly involves the inferior left lobe, with equal distribution by sex.…”