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Bronchopulmonary sequestration with associated nonimmune hydrops has been previously reported with generally poor prognosis for the neonate. We report a case of bronchopulmonary sequestration and associated pleural effusion successfully managed with a transthoracic catheter placement. The embryology and clinical pathophysiology of bronchopulmonary sequestration are discussed.
Bronchopulmonary sequestration is an area of lung parenchyma that is devoid of normal connection to the trachebronchial tree. Arterial supply is from an aberrant systemic artery, usually a branch of the aorta. There are two broad types of bronchopulmonary sequestration: intralobar and extralobar. The former shares a common pleura with the lung while the latter is separated by its own pleura. Definitive therapy requires pulmonary resection.
Bronchopulmonary sequestration is a rare lesion making up less than 10% of all congenital pulmonary malformations. The two classic types, extralobar and intralobar, can be distinguished by whether or not the sequestered pulmonary tissue is enclosed by a separate visceral pleural lining. A case of intralobar bronchopulmonary sequestration is presented. At present, aortography is necessary to establish the diagnosis, but other imaging modalities including computed tomography, ultrasound, and magnetic resonance imaging offer the potential for additional useful information.
Bronchopulmonary sequestration (BPS), a congenital malformation that usually presents as a chest mass in childhood, may be identified by its characteristic primary derivation of pulmonary blood supply from the systemic circulation. Five children with BPS were evaluated by radionuclide angiography from 1970 to 1974. In each instance the systemic origin of the vascular supply was correctly indicated. In those lesions where the artery originates below the hemidiaphragm, the aberrant source, when identified as such, provides a characteristic radionuclide appearance of BPS. The scimitar syndrome may be indistinguishable from BPS with this technique.
BACKGROUND: Sequestrations represent bronchopulmonary malformations that are increasingly diagnosed antenatally. After birth, the therapeutic approach in asymptomatic children is debated, as some may spontaneously regress. OBJECTIVE: To evaluate the efficacy of embolisation of the feeding systemic artery in the treatment of bronchopulmonary sequestration. MATERIALS AND METHODS: Sixteen children with bronchopulmonary sequestration were treated by endovascular embolisation of the feeding systemic artery. RESULTS: Ten patients were considered cured by embolisation alone. One patient was operated on after unsuccessful embolisation, three had partial regression of the lung mass and two are still under follow-up. CONCLUSIONS: Our experience indicates that bronchopulmonary sequestrations in children can be treated by embolisation alone.
Bronchopulmonary sequestration (BPS) is usually a rare congenital anomaly, which is most frequently extralobar or intralobar. The case of a patient with positional congenital anomaly--dextrocardia (situs thoracalis inversus) and intrapulmonary sequestration (IPS) is presented. Clinical and radiological characteristics of EPS and IPS are discussed, and new combinations of congenital anomalies with bronchopulmonary sequestration are described, dextrocardia and intrapulmonary sequestration. The importance of the algorithm of diagnostic examinations is emphasized, from detection of bronchopulmonary sequestration on the chest roentgenogram to establishing a definite diagnosis by means of angiography.
Bronchopulmonary sequestration (BPS) is a nonfunctioning bronchopulmonary tissue that is separate from the tracheobronchial tree and receives arterial blood from the systemic circulation. BPS has a wide spectrum of imaging findings. Surgery is generally indicated for the treatment of BPS. It is important to demonstrate the arterial supply and venous drainage of the sequestered segment preoperatively. Today, with the help of noninvasive imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI), preoperative diagnosis of BPS can be made easily, so, invasive techniques such as angiography are not required frequently. In this report, radiological findings of BPS were retrospectively reviewed.
Bronchopulmonary sequestration is a rare congenital anomaly in which part of the pulmonary tissue is detached from the normal lung without normal connection with tracheobronchial trees and pulmonary artery. It is supplied by anomalous systemic artery. Pseudosequestration is referred as the combination of systemic arterial supply to lung with normal bronchial connection and coexistent infection. It is presumed that chronically inflamed lung may activate neovascularization from systemic circulation in this strage, we reported 15 cases of all pulmonary sequestration and 1 case of pseudosequestration. Most of the cases were young adults with the mean age of 24.6 years old. The intralobar type comprised 86.6% of all cases. In 84.6% of the cases, the aberrant artery originated from the thoracic aorta. Preoperative diagnosis was gained in 47% of cases. In 80% of all cases, the chest mainly characterized with homogeneous mass lesion or cyst(s) with air-fluid level. The distinction between sequestration and pseudosequestration is a diagnostic challenge because the radiologic findings are similar between both conditions. There are clinically significant complications, such as recurrent infections or massive bleeding during operation.
Bronchopulmonary sequestration (BPS), a non-functional pulmonary tissue mass, when complicated by fetal hydrops, carries a high risk of perinatal mortality. However, a limited number of cases of BPS complicated by fetal hydrops with an informative clinical course have been reported. We report here on three cases of BPS complicated by fetal hydrothorax and hydrops that were successfully treated by pleuroamniotic shunting, which should be considered as a treatment option for fetal hydrothorax and hydrops associated with BPS.
Bronchopulmonary sequestration of the lung is a rare but well recognised congenital abnormality, which is clinically important because of the potential for medical and surgical complications. We report a case of extralobar bronchopulmonary sequestration on the left side in a newborn infant.
Congenital cystic adenomatoid malformation and bronchopulmonary sequestration are congenital lung tumors that are classically described as having distinct embryology, pathology, and natural history. The authors treated six patients who had prenatally diagnosed lung masses that displayed clinicopathologic features of both lesion types. At prenatal diagnosis (19 to 30 weeks' gestation), all six lesions were classified sonographically as congenital cystic adenomatoid malformation, and none of the masses appeared to have a systemic arterial blood supply as seen by color flow Doppler study. Two of the six masses showed size regression antenatally. At the time of surgery, all six lesions had a systemic vessel directly from the aorta--five cases were consistent grossly with an intralobular bronchopulmonary sequestration, and one case was consistent with an extralobular bronchopulmonary sequestration. However, all six lesions displayed congenital cystic adenomatoid malformation histology. Hydrops developed in one fetus with a huge mass, and that fetus underwent successful fetal surgical resection (left lower lobectomy) at 22 weeks' gestation with delivery at 35 weeks' gestation. One neonate with a large extralobular bronchopulmonary sequestration was treated with resection and extracorporeal membrane oxygenation (ECMO) but died of pulmonary hypoplasia. Four other patients who had much smaller masses underwent elective lower lobectomy after birth. These findings emphasize the importance of seeking an anomalous blood supply in patients who have congenital lung lesions. These "hybrid" cases suggest a similar embryological origin for congenital cystic adenomatoid malformation and bronchopulmonary sequestration.
Bronchopulmonary sequestration is a congenital anomaly in which part of the pulmonary tissue is detached from the normal lung and is supplied by anomalous systemic arteries. The sequestered, aberrant lung tissue does not have normal connections with the tracheobronchial tree or pulmonary arteries. In some patients with angiographic characteristics of this disorder, no sequestration is found at the time of surgery. We present three cases in which systemic arterialization of a portion of lung occurred without actual sequestration. Such cases of pseudosequestration can present a diagnostic challenge preoperatively and should be considered whenever angiographic findings compatible with bronchopulmonary sequestration are found.
A case of intralobar bronchopulmonary sequestration is reported in which the sequestered lung was infected with Nocardia sp. Although recurrent pyogenic infections are common in pulmonary sequestrations, this is the first case report with documented nocardiosis.
Bronchopulmonary sequestration (BPS) is a rare malformation of the lower respiratory tract. It consists of a non-functioning mass of lung tissue that lacks normal communication with the tracheobronchial tree and that receives arterial blood supply from the systemic circulation. It is classified as intralobar (ILS) or extralobar (ELS) according to its location within or outside the normal lung. Most sequestrations are intralobar (75%) and occur predominantly in the left lower lobe.
Congenital lung lesions that can be diagnosed on the basis of prenatal sonography include cystic adenomatoid malformations and extrapulmonary bronchopulmonary sequestrations. Intralobar bronchopulmonary sequestration is a rare congenital malformation of the lung. The prenatal sonographic features of this condition are reported here.
A squamous cell carcinoma arising in intralobar bronchopulmonary sequestration of the right lower lobe is described in a 69-year-old man. One other reported case was found. Other complications of bronchopulmonary sequestration include nonspecific infections and tuberculosis.
Computed tomographic (CT) scans of 24 bronchopulmonary sequestrations in 23 patients were reviewed. Seventeen sequestrations were diagnosed at surgery, three at angiography, and four on the basis of radiographic or CT findings combined with appropriate history. Sixteen sequestrations were intralobar, and eight were extralobar; 21 were posterobasal. Seventeen occurred on the left side and seven on the right. Anomalous systemic arterial supply was demonstrated by CT in 16 sequestrations. In the others, a systemic artery was not shown, presumably because of unfavorable orientation or small size of the vessel. The lung abnormalities shown by CT were classified into three types: A = cysts containing air or fluid (n = 8), or soft-tissue masses (n = 2); B = emphysematous lung surrounding cysts, and/or soft-tissue nodules (n = 13); and C = lung hypervascularity (n = 2). In only three cases did the chest radiograph show the emphysematous lung tissue. Such emphysematous lung has rarely before been reported as a CT finding, and lung hypervascularity has not, to the authors' knowledge, been reported. The authors conclude that CT can be helpful in the diagnosis and evaluation of bronchopulmonary sequestration. Characteristic manifestations are (a) a complex lesion containing solid or fluid components combined with emphysematous lung or (b) any basal lesion supplied by a systemic artery.
Bronchopulmonary sequestration is a relatively rare, albeit important, cause of pulmonary disease in the adult. It is characterized by a segment of non-functioning lung parenchyma that receives its blood supply from an anomalous systemic artery. Although chest roentgenography and arteriography are useful in detecting this condition, the most crucial element in diagnosis is a high index of suspicion. Bronchopulmonary sequestration is clinically significant because of its potential for medical and surgical complications. Surgery continues to be the appropriate treatment for symptomatic patients, but experts disagree on the most appropriate management for patients who are asymptomatic.