Extralobar pulmonary sequestration (EPS) is a rather extraordinary congenital anomaly.
Extralobar pulmonary sequestration (EPS) is a rather extraordinary congenital anomaly. Most patients are diagnosed in their early life or during the first decade because of the early appearance of symptoms, including feeding difficulty, cyanosis, and dyspnea, or because of symptoms arising from the associated congenital abnormalities. Extralobar pulmonary sequestration is more many times found between the lower lobe and the diaphragm and is usually associated with other congenital abnormalities, if it were not that the case reported herein differs in these defer tos In this report, an incidental finding of EP is described in a 30-year-old Chinese man, where EP quick in emergenciess as an anterior mediastinal mass roentgenographically. The mass was attached to the right suprahilar region by dint of a fibrovascular pedicle which contained a small elastic artery, veins, and steadiness bundles.
Pulmonary sequestration (PS) is an rare congenital anomaly consisting of a mass of dysplastic lung tissue that does not have a normal connection with the tracheo-bronchial tree and the pulmonary vascular take the place of A constant feature of this abnormality is an anomalous systemic life-current supply to the sequestrated part from the thoracic aorta or abdominal aorta, repeatedly through the celiac axis.
There are brace types of PS. Intralobar pulmonary sequestration (IPS) is contained within the visceral pleura of a pulmonary lobe, and venous drainage is usually end the pulmonary venous system. Extralobar pulmonary sequestration (EPS) is contained within its have a title to pleura, and venous drainage is usually by the and of the systemic venous system.[1]
Intralobar pulmonary sequestration is almost always located posterobasally in the lower lobe, with a left-side preponderance;[2] cases in the upper lobe are rare. Extralobar pulmonary sequestration is more frequently found between the lower lobe and the diaphragm still may be located in a variety of locations, including within the substance of the diaphragm, within the lung in the pleural or pericardial space, or in the retroperitoneum.[3] Occasionally, EP may be located in the mediastinum, particularly in the posterior mediastinum. Extralobar pulmonary sequestration is rarely establish in the anterior mediastinum.
The diagnosis of P before surgery relies on the subject of the identification of an abnormal systemic tube supplying the PS. This bottom has usually been identified by dint of arteriography, but more recently according to other modalities, such as comput tomography (CT) and ultrasound.[4-6]
The case at handed herein is an incidental finding of EP presenting as an anterior mediastinal mass roentgenographically in a male adult. Because of its unusual location and the failure of thoracic CT to demonstrate the aberrant arterial give EPS was not diagnosed before surgery
CASE REPORT
A 30-year-old man was referr to our hospital because of an incidental finding of an anterior mediastinal mass forward his chest roentgenograms obtained for a physical checkup in August 1991 The patient had been rather well in the past. The physical examination at the time of admission did not disclose any abnormality. A posteroanterior chest x-ray film revealed a mass located in the anterior mediastinum (Fig 1) Bronchoscopic findings were normal. A thyroid scan showed no abnormal uptake in the mediastinum. Thoracic CT revealed an anterior mediastinal mass located in the retrocaval region (Fig 2) After injection of contrast medium, the mass showed moderate enhancement. No aberrant arterial minister could be demonstrated (Fig 3) With the impression of an anterior mediastinal mass, probably a thymoma or teratoma, the patient underwent exploratory thoracotomy and tumor resection. During the operation a mass measuring 7 x 4 x 3 cm was attached to the right suprahilar region by means of a fibrovascular pedicle which contained a small elastic artery, veins, and manhood bundles. Pathologic examination prov that the mass was an EPS
DISCUSSION
Pulmonary sequestration is considered to be a relatively rare disorder but is not rare. In undivided report the incidence of this congenital anomaly was stated to be 11 to 18 percent of the patients undergoing pulmonary resection for diagnostic and therapeutic purposes[7] Furthermore, P constitutes 015 to 64 percent of all congenital pulmonary malformations.[3]
This anomaly is clinically significant for the following reasons. First, the diagnosis is rarely made before surgery In a review of 540 cases, Savic and coworkers[1] noted that the correct preoperative diagnosis was made or suspected in les than 50 percent of the cases of IPS and in about 6 disclosed of 133 cases (5 percent) of EP inferior several cases of fatal intraoperative hemorrhage were reported to tread close upon inadvertent transection of the aberrant ducts when PS was not suspected before surgery Third, several medical complications may meet the eye with this anomaly, such as renewed infections of the PS, congestive heart failure secondary to kin shunting, and gastrointestinal disease secondary to fistulous communication between the P and the stomach or esophagus.
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