Department of Paediatric Surgery, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa
- Vídeo - 12th SPCMIN Congress, 18 - 19 de outubro de 2019, Coimbra
Introduction: Pulmonary sequestrations (PS) correspond to 10–30% of the cystic bronchopulmonary foregut malformations. The 2 types are classified in intralobar (IS) and extralobar (ES) and can be diagnosed during prenatal period. In both clinical presentations there are no communication with the normal tracheobronchial tree and the arterial blood supply comes from aberrant systemic arterial vessels; for venous drainage, the pulmonary vein and/or the systemic circulation. Regarding the clinic, IS can cause high output cardiac failure and pulmonary infection and ES pleural effusion; morbidity is low in both. Postnatal management include contrast-enhanced CT to all patients, to understand the anatomy of the malformation and to define diagnose. Generally, IS has indication for resection, but the decision should be individualised in ES. Thoracoscopic lobectomy is becoming the preferred approach.
Case Report: Two years old child with a second trimester prenatal diagnosis of PS in right lung, that did not evolve on subsequent testing. At birth, there was no RDS, no need for ventilation or supplemental O2. During posterior follow-up, she stayed most of the time asymptomatic, with some sporadic mild respiratory infection. The malformation stayed stable on image examinations; CT scan showed an IS localized on the posterior and basal segments of the right lower lobe, with 27x15x25 mm, arterial supply of descending thoracic aorta and venous drainage for pulmonary veins and inferior cava vein, without a well defined hyperinflation or cystic adjacent area. Elective surgery by thoracoscopic approach, without complications. During the hospitalization, there was a small residual pneumothorax on the right hemithorax, but the patient stayed asymptomatic and clinical stable. After two months of follow-up, no symptoms nor respiratory infections.
Conclusions: Congenital lung lesions are rare, the thoracoscopic approach in small children is a big challenge and has several benefits when compared to open surgery.
Palavras Chave: Intralobar Pulmonary Sequestration; Thoracoscopic Approach