Treatment of abdominal extralobar pulmonary sequestration utilizing targeted arterial blockage through a catheter procedure
Intra-abdominal Extralobar Pulmonary Sequestration in Newborns: A Rare Case
Intra-abdominal extralobar pulmonary sequestration (IEPS) is a rare form of pulmonary sequestration, typically diagnosed within the first few months of life. This condition involves a nonfunctioning mass of lung tissue that has no normal connection to the tracheobronchial tree and receives systemic arterial blood supply, located outside the normal lung and sometimes below the diaphragm.
A recent case of IEPS was reported in a term neonate with a history of recurrent left-sided pleural effusion. The newborn, now 30 days old, was found to have an intra-abdominal IEPS associated with left diaphragmatic agenesis.
Symptoms and Diagnosis
IEPS commonly presents with symptoms related to an abdominal mass and respiratory distress, but may also be asymptomatic and detected incidentally on prenatal imaging or postnatal scans. In this case, the neonate showed symptoms of respiratory distress due to the mass effect and feeding difficulties.
A diagnostic arteriogram revealed a hypervascular image of the IEPS without signs of a systemic venous shunt. A CT scan with venous contrast identified an intrabdominal extralobar pulmonary sequestration on the left, associated with a diaphragmatic hernia.
Treatment
Surgical excision is the definitive treatment for IEPS, usually in the neonatal period or early infancy. In this case, the patient underwent left thoracotomy with excision of the accessory lung and reconstruction of the diaphragm using bovine pericardium.
To prevent excessive bleeding during the surgery, the artery feeding the IEPS was embolized. Access for the embolization procedure was gained through the right common femoral artery. Catheterization and superselective microcatheterization were done with a 4F vertebral catheter, Terumo, and a Renegade STC microcatheter and a Fathon 0.016" microguide, both from Boston Scientific. Embolization was performed using 0.018" Interlock coils.
Outcome
The patient was discharged from the hospital after 4 days without complications. At 8 months of follow-up, the patient remained asymptomatic and showed appropriate development for his age.
In conclusion, IEPS is a rare subtype of pulmonary sequestration that can present with respiratory distress or abdominal mass symptoms, but some are asymptomatic. Surgical removal is the standard treatment to prevent complications and ensure normal development. In this case, the neonate underwent successful surgery and is now thriving.
Science delves into the intricacies of medical-conditions, such as Intra-abdominal Extralobar Pulmonary Sequestration (IEPS), a rare form diagnosed in newborns. Cancer, respiratory-conditions, digestive-health, eye-health, hearing, and skin-conditions are examples of fields that study various maladies.
IEPS, typically diagnosed within the first months of life, involves a nonfunctioning lung tissue with no tracheobronchial connection, receiving systemic arterial blood supply and sometimes located below the diaphragm.
A recent case of IEPS was reported in a neonate with recurrent pleural effusion, now 30 days old, who had an IEPS associated with left diaphragmatic agenesis.
IEPS symptoms can include abdominal mass and respiratory distress, but it can also be asymptomatic. In this case, the neonate showed respiratory distress and feeding difficulties.
A diagnostic arteriogram revealed a hypervascular image of the IEPS without a systemic venous shunt. Imaging technologies like CT scans are crucial for diagnosing such conditions.
The standard treatment for IEPS is surgical excision, often in the neonatal period or early infancy. Manufacturing industries produce medical instruments used in these surgeries.
In this case, the patient underwent left thoracotomy and reconstruction of the diaphragm using bovine pericardium.
To prevent excessive bleeding during the surgery, the artery feeding the IEPS was embolized. This embolization was done via the right common femoral artery using catheterization technology from companies like Terumo and Boston Scientific.
IEPS patients can experience big-wins with successful surgeries, leading to normal development. In this case, the patient was discharged after 4 days without complications and thriving at 8 months of follow-up.
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