Intradiaphragmatic extralobar pulmonary sequestration in adult
Jang-Hoon Lee
0
Mi-Jin Kim
1
0
Department of Thoracic and Cardiovascular Surgery, College of Medicine, Yeungnam University
,
Daemyeong 5-dong, Nam-gu, Daegu Zip code 705-717
,
Korea
1
Department of Pathology, College of Medicine, Yeungnam University
,
Daegu
,
Korea
Extralobar pulmonary sequestrations may be located in intrathoracic or extrathoracic areas. Extrathoracic intradiaphragmatic extralobar pulmonary sequestrations are an extremely rare subset of bronchopulmonary sequestrations and there have been very few reported cases until now. We describe a 48-year-old Korean woman found to have left peridiaphragmatic lesion on computed tomography. We performed thoracoscopic surgery and successfully resected the tumor. Based on the histological findings, it was diagnosed as an intradiaphragmatic extralobar pulmonary sequestration. Postoperative course was uneventful. Intradiaphragmatic extralobar pulmonary sequestration in adult is extremely rare, so we report the case with a literature review.
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Background
Extralobar pulmonary sequestrations are most
commonly found within the thoracic cavity, but have been
described in extrathoracic areas as so called
extrathoracic extralobar pulmonary sequestrations. Sequestrations
within the diaphragm (intradiaphragmatic extralobar
sequestration) are extremely rare. In this case, the
tumor was resected using thoracoscopic surgery, and
based on the histological findings, it was diagnosed as
an intradiaphragmatic extralobar pulmonary
sequestration. We herein report a case of an extrathoracic
intradiaphragmatic extralobar pulmonary
sequestration in a 48-year-old Korean woman.
Case presentation
A 48-year-old Korean female patient presented with an
abnormal mass lesion that was detected by abdominal
computed tomography in a visit to our hospital. She had
experienced intermittent abdominal pain for several
months. She had no other specific past medical history
and no history of trauma. The patients vital signs were
stable and laboratory tests were normal. Chest X-ray
showed no abnormal findings and the computed
tomography of her chest showed a 4-cm-sized round mass
with areas of calcification in the left hemidiaphragmatic
area (Figure 1). After a review of the diagnostic imaging,
we were still unable to localize the mass, but we
concluded that the lesion was most likely located in the
left pleural space based on its proximity to the
diaphragm. We decided to remove the mass. The patient
was taken to the operating room for thoracoscopic
surgery. General anesthesia with double lumen
endotracheal tube intubation and one lung ventilation was
done. Two 5-mm ports and one 10-mm port were
placed in the left chest (fifth intercostal space in the
midclavicular line, sixth intercostal space in the
anterior axillary line, and eighth intercostal space in the
posterior axillary line) for the thoracoscopic approach.
No mass was visualized in the pleural space, but a
bulge was visualized in the diaphragm consistent with
the location of the lesion noted on chest computed
tomography. The diaphragm was opened with
electrocautery around the mass lesion. Then we identified the
mass in the diaphragm (Figure 2). The mass was
adhered to the crucial fibers of the diaphragm but was
relatively well marginated. We dissected carefully, and
a small feeding vessel was noted and clipped. The
dissection was relatively easy and the mass was removed.
The diaphragm defect was closed with interrupted
polyester sutures and one chest tube was placed. The
postoperative course was uneventful. The chest tube was
removed on the third postoperative day and the patient
Figure 1 Preoperative chest computed tomography findings.
was discharged the following day. The specimen
measured about 4 cm in diameter, 9.4 gram in weight, and
was well-defined and reddish. Cut sections of the mass
showed sponge-like appearance with cartilage and
yellowcolored mucoid materials. Histologic evaluation of the
specimen was consistent with the diagnosis of an
extralobar sequestration (Figure 3).
Discussion
Pulmonary sequestration was first defined by Pryce in
1949 [1] as characterized by a non-functional lung
without communication with the bronchial tree and the
presence of an aberrant blood supply. On the basis of
morphological patterns, they are divided into two types:
intralobar and extralobar. An intralobar sequestration
Figure 2 Intraoperative thoracoscopic images. (A) Incision of diaphragm (black arrow), Intradiaphragmatic mass (red arrow) was identified. (B)
Diaphragmatic bulge (black arrow). Incision site of diaphragm (red arrow). (C) Small aberrant vessels were clipped (black arrow). (D) Yellowish
mucoid materials were drained (black arrow).
Figure 3 Pathologic findings of the resected specimen. (A) Gross findings. (B) Dilated mucin-filled airways and remnants of cartilaginous
bronchi (x 100, hematoxylin and eosin stain). (C) Normal lung tissue is not observed (x 100, hematoxylin and eosin stain). (D) Dilated airways are
lined by (...truncated)