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Case Reports
. 2020 Jan;8(1):e62-e67.
doi: 10.1055/s-0040-1713901. Epub 2020 Sep 18.

Combined Pre- and Postnatal Minimally Invasive Approach to Complicated Pulmonary Sequestrations

Martina Ichino  1 , Francesco Macchini  1 , Anna Morandi  1 , Nicola Persico  2   3 , Isabella Fabietti  2 , Andrea Zanini  1 , Ernesto Leva  1
Affiliations
Case Reports

Combined Pre- and Postnatal Minimally Invasive Approach to Complicated Pulmonary Sequestrations

Martina Ichino et al. European J Pediatr Surg Rep. 2020 Jan.

Abstract

Pulmonary sequestration (PS) is mostly asymptomatic but there is a proportion of fetuses that develop hydrops, leading to fetal or neonatal death. Fetal treatments are available, but postnatal management of the residual lesions is not uniformly defined. We present two cases of combined pre- and postnatal minimally invasive approach to complicated extra-lobar PS. Patient 1 presented with complicated PS at 31 weeks of gestation. Ultrasound-guided laser coagulation of the anomalous artery was successful. The patient was born asymptomatic at 38 weeks. Neonatal magnetic resonance imaging (MRI) showed a residual mass, confirmed by computed tomography (CT) at 6 months. No systemic artery was described, but perfusion was present. We decided for thoracoscopic resection. A residual artery was identified and sealed. Patient 2 presented with complicated PS at 25 weeks of gestation, underwent laser coagulation of the anomalous artery and was born asymptomatic at 38 weeks. Neonatal MRI showed persistence of the lesion, confirmed by CT scan at 4 months. We proceeded with thoracoscopic resection. A residual vessel was ligated. The patients 1 and 2 are now 24 and 21 months old, respectively, and healthy. Prenatal treatment of complicated PS is a life-saving procedure. Postnatal thoracoscopic resection of the residual lesion is feasible and safe; we believe it is the best course of treatment to grant the complete excision of the malformation.

Keywords: congenital lung malformation; fetal therapy; laser coagulation; pulmonary sequestration; thoracoscopy.

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Conflict of interest statement

Conflict of Interest All authors have no financial disclosures.

Figures

Fig. 1
Fig. 1
Prenatal images of patient described as case 1. Sagittal view of the echogenic mass in the inferior portion of the left fetal lung ( A ) and transverse view showing severe unilateral hydrothorax ( B ).
Fig. 2
Fig. 2
Presence of numerous adhesions between the visceral and the parietal pleura in the patient described as case 1.
Fig. 3
Fig. 3
Prenatal images of patient described as case 2. Transverse view of the fetal thorax illustrating a giant solid lung mass with massive mediastinal shift ( A ) and sagittal view of the thorax showing a systemic feeding artery arising from the aorta ( B ).
Fig. 4
Fig. 4
Residual systemic vessel in the patient described as case 2, closed with Hem-o-Lock clip before division with Just-Right 5-mm stapler.
See this image and copyright information in PMC

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