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

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.

Extralobar pulmonary sequestrations hiding congenital diaphragmatic defects: A case series

Background: Association between pulmonary sequestration and diaphragmatic hernia is well known. Extralobar sequestrations are masses of the non-functioning lung, surrounded by separate pleura, without bronchial communication, and with a systemic arterial blood supply. They may be placed in the thorax, within the diaphragm, or rarely in a sub-diaphragmatic position. Case Series: We present three cases of extra-lobar extra-thoracic pulmonary sequestrations associated with different types of diaphragmatic defects. In none of the three cases, the diaphragmatic defect was detected prenatally. Conclusion: Pulmonary sequestration may be involved in the embryological origin of the diaphragmatic defect. Simultaneously, it acts as an anatomical barrier and prevents the herniation of the abdominal content into the thorax. If extralobar pulmonary sequestration is diagnosed prenatally, a coexistent diaphragmatic hernia should always be considered.

Concurrent bronchopulmonary foregut malformations: a rare case of right-sided extralobar pulmonary sequestration and bronchogenic cyst

Background Bronchopulmonary foregut malformations are rare congenital malformations. It is extremely rare to have malformations that occur simultaneously. There is literature to show that extralobar sequestration is associated with other congenital anomalies, most commonly diaphragmatic hernias, and also with other bronchopulmonary foregut malformations (e.g., extralobar sequestration and congenital pulmonary airway malformations). However, very few case reports were found that reported extralobar sequestration and foregut duplication cysts and only one report of a right-sided complex foregut malformation with pulmonary sequestration. Case presentation We present a case of a 3-month-old male infant with a prenatal diagnosis of a cystic lung lesion who, after developing symptoms of respiratory distress, was found to have concurrent right-sided extralobar pulmonary sequestration and a mediastinal bronchogenic cyst. Conclusions The concurrent occurrence of these malformations in one patient could help support the theory that these malformations result from an early error in development during the time when both the lung buds and foregut are developing simultaneously.