Back to Annual Meeting Program

INTRODUCTION:: Pulmonary sequestration is an uncommon developmental anomaly characterized by non-functioning lung tissue that does not usually communicate with the native bronchial tree and its blood supply is derived from a variety of systemic arterial sources. We present a case of a symptomatic pulmonary sequestration, complicated by an aneurysmal feeding vessel, treated with a combined minimally invasive endovascular and thorascopic approach.
Case Report:The patient is a 35 year old woman with a pulmonary sequestration of the right lower lobe. She had a history of recurrent pulmonary infections. CT scan to evaluate abdominal pain revealed a pulmonary sequestration of the medial aspect of the right lower lobe. The feeding vessel originated from the left gastric artery and was aneurysmal (1.8 cm) at the level of the diaphragm. A combined endovascular and thorascopic procedure was chosen. Through common femoral artery access, the left gastric artery and feeding vessel was catheterized. Coil embolization was performed distal to the aneurysm and into the aneurysmal sac using detachable coils. Completion angiogram showed no flow in the aneurysm or feeding vessel. Thoracic surgery then proceeded with resection of the sequestration via video-assisted thoroscopy. A thickened pale area of lung that did not deflate with single lung ventilation was identified (Video). The sequestration was resected completely. The patient’s post-operative course was uneventful and she has remained asymptomatic at 24 months.
CONCLUSIONS: Pulmonary sequestration is an uncommon developmental anomaly that may present with recurrent pulmonary infections. Resection is curative. We have speculated that the aneurysm was related to shearing of the feeding vessel as it penetrated the diaphragm. Combined endovascular and thorascopic treatment represents a minimally-invasive alternative to conventional open thoracotomy.