Endosurgical treatment of a 7-month-old child with extralobaric sequestration of the lung and tracheal bronchus

Abstract

Lung sequestration is a developmental anomaly in the form of a separate non-functioning fragment of lung tissue that does not communicate with the bronchial tree and is supplied with blood by the aorta or arteries of the large circulatory circle.

Lung sequestration is a developmental anomaly characterized by a separate nonfunctioning fragment of lung tissue that does not communicate with the bronchial tree and is supplied with blood by the aorta or arteries of the large circulatory circle. Lung sequestration accounts for 0.15%–6.4% of all lung malformations. This study presents a clinical case of a 7-month-old girl with extralobaric lung sequestration. The patient presented with complaints of cough; noisy, rapid breathing; and a history of gastroesophageal reflux. Gastroenterological pathology was excluded at the place of residence. During physical examination, wet wheezing was heard on both lungs, and the respiratory rate was 36 per minute. Chest X-ray showed a right-sided, upper-lobe pneumonia. Community-acquired right-sided, upper-lobe pneumonia, moderate form, was diagnosed. CT scan of the chest organs with contrast revealed a congenital malformation: tracheal bronchus and extralobar lung sequestration on the right. Indications for minimally invasive intervention were formulated. After surgical treatment, thoracoscopy showed an extrapulmonary sequester in the posterior hemithorax, with a feeding vessel from the thoracic aorta. Then, sequestrectomy was performed. In the postoperative period, positive dynamics was observed against the background of antibacterial, infusion, and symptomatic therapy. The patient was discharged in satisfactory condition. In children with long-term, recurrent lung infections, without positive dynamics against the background of conservative therapy and in the presence of respiratory disorders against the background of normal body temperature and absence of signs of inflammation in blood tests, congenital malformations of the respiratory tract should be excluded. Computed tomography with contrast enhancement and subsequent 3B reconstruction is the most appropriate method for diagnosing lung sequestration. Moreover, thoracoscopic resection of a separate nonfunctioning fragment of lung tissue is an effective minimally invasive surgical treatment method.

Keywords

lung sequestration / extralobar sequestration / tracheal bronchus / case report

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