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    Pulmonary Sequestration

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    Emily Eresuma
    This document presents the case of a 9-year-old boy with recurrent respiratory infections who presents with fever, cough, congestion and difficulty breathing. His past medical history is significant for recurrent pneumonia several times per year since birth. His physical exam reveals tachycardia, respiratory distress, diminished breath sounds on the left lung. Diagnostic studies show leukocytosis with bands. The differential diagnosis includes various causes of pneumonia, immunodeficiencies, lung abnormalities such as pulmonary sequestration. Pulmonary sequestration is discussed in detail, which is a congenital anomaly of embryonic lung tissue that has its own systemic blood supply but does not communicate with the tracheobronchial tree, often presenting with recurrent

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    Pulmonary Sequestration

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    Emily Eresuma
    405 views15 pages
    This document presents the case of a 9-year-old boy with recurrent respiratory infections who presents with fever, cough, congestion and difficulty breathing. His past medical history is significant for recurrent pneumonia several times per year since birth. His physical exam reveals tachycardia, respiratory distress, diminished breath sounds on the left lung. Diagnostic studies show leukocytosis with bands. The differential diagnosis includes various causes of pneumonia, immunodeficiencies, lung abnormalities such as pulmonary sequestration. Pulmonary sequestration is discussed in detail, which is a congenital anomaly of embryonic lung tissue that has its own systemic blood supply but does not communicate with the tracheobronchial tree, often presenting with recurrent

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    Pediatric Morning Report

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    This document presents the case of a 9-year-old boy with recurrent respiratory infections who presents with fever, cough, congestion and difficulty breathing. His past medical history is significant for recurrent pneumonia several times per year since birth. His physical exam reveals tachycardia, respiratory distress, diminished breath sounds on the left lung. Diagnostic studies show leukocytosis with bands. The differential diagnosis includes various causes of pneumonia, immunodeficiencies, lung abnormalities such as pulmonary sequestration. Pulmonary sequestration is discussed in detail, which is a congenital anomaly of embryonic lung tissue that has its own systemic blood supply but does not communicate with the tracheobronchial tree, often presenting with recurrent

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
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    Download as pptx, pdf, or txt
    405 views15 pages

    Pulmonary Sequestration

    Uploaded by

    Emily Eresuma
    This document presents the case of a 9-year-old boy with recurrent respiratory infections who presents with fever, cough, congestion and difficulty breathing. His past medical history is significant for recurrent pneumonia several times per year since birth. His physical exam reveals tachycardia, respiratory distress, diminished breath sounds on the left lung. Diagnostic studies show leukocytosis with bands. The differential diagnosis includes various causes of pneumonia, immunodeficiencies, lung abnormalities such as pulmonary sequestration. Pulmonary sequestration is discussed in detail, which is a congenital anomaly of embryonic lung tissue that has its own systemic blood supply but does not communicate with the tracheobronchial tree, often presenting with recurrent

    Copyright:

    Attribution Non-Commercial (BY-NC)
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    of 15

    Morning Report

    MARCH 4, 2012 ELIZABETH PARSONS, MD

    Case Presentation
    9 year old boy presents to the emergency room with

    a 2 day history of fever, cough, congestion, and difficulty breathing. He has had mild abdominal pain and one episode of vomiting. He also complains of a mild headache. On further questioning, his mother states to you that he has a chronic cough that wont go away and that he always gets pneumonia She feels that he is never well.

    Past Medical History


    Born at 37 weeks gestation without complication.

    He has been treated for pneumonia 2-3 times per

    year by his primary care physician and has had 7 admission in the past for respiratory infections. History of asthma

    History Continued
    FH: Notable for a brother with Trisomy 21. His

    paternal grandfather has hypertension. Otherwise, no chronic illnesses SH: Lives with his parents and 2 siblings No smoke exposure. No sick contacts. Immunizations: Up to date. He has not received a flu vaccine Medications: Albuterol as needed, Advair, Singulair

    Physical Exam
    WT: 25 kg (25%) HT: 134 cm ( 44%) T: 39.5 HR 141 BP 116/78 R 37 sat 98% on 2 lpm NC

    GEN: WDWN young boy in mild respiratory distress. HEENT: NC/AT. TM clear. OP mildly erythematous. No LAD CV: Tachycardic. Normal S1, S2. No murmur. CRT < 3 secs PULM: Tachypneic. Mild suprasternal retractions. Markedly diminished BS on left compared to right with crackles at bases. No wheezes. ABD: soft, non-distended and non tender. + BS. No HSM EXT: Warm and well perfused. No rash. No clubbing, cyanosis or edema.

    Diagnostic Studies
    CBC W: 26 (56% bands, 30% poly, 7% Lymps)

    CMP: normal
    CRP: 12 ESR: 28

    Blood culture pending


    VRP negative

    Differential Diagnosis?
    ID/Immunology Pneumonia (viral vs bacterial) Tuberculosis Immunodeficiency Fungal infection (cocci, histo, etc) HIV/ immunocompromise Pulmonology CCAM Pulmonary sequestration Broncogenic cyst Congenital lobar emphysema Bronchiectasis Cystic Fibrosis Ciliary dyskinesia Asthma Intersitial lung disease CV Heart failure Undiagnosed congenital heart disease Acquired heart disease Pulmonary hypertension Pulmonary Embolism Rheumatology Sarcoidosis SLE Wegeners granulomatosis Heme/Onc Lymphoma Pulmonary metastases Airway Abnormalities Chronic aspiration Laryngo/tracheomalacia Vascular ring GI - GERD - Chronic aspiration

    Pulmonary Sequestration

    Cystic/Solid mass composed of embryonic tissue that DOES NOT communicate with the tracheobronchial tree AND has anomalous SYSTEMIC blood supply. 15-25% have multiple systemic feeding vessels Thought to be due to an accessory lung bud that develops from the ventral primitive foregut. Does NOT participate in gas exchange or result in a L R shunt.

    Pulmonary Sequestration
    INTRAPULMONARY

    EXTRAPULMONARY

    75% of cases
    Males = Females Does not have its OWN pleura (lies within pleura of lung lobe) Systemic blood supply, but PULM VENOUS DRAINAGE!!! Posterior basal segment of lung (L>R) Often delayed diagnosis with presentation of recurrent infections or hemoptysis.

    25% of cases
    Males: Females = 4:1 Has OWN visceral pleura

    Thoracic/Subdiaphragmatic All left sided.


    Systemic blood supply AND SYSTEMIC venous drainage Presents earlier as abdominal mass, heart failure, respiratory distress. Associated with CDH, colonic duplication, vertebral anomalies, etc

    Pulmonary Sequestration

    Berrocal, Teresa et al. Congenital Anomalies of the Tracheobroncial Tree, Lung, and Mediastinum; Embryology, Radiology, and Pathology. Jan 2004. Radiographics. 24. e17.

    Pulmonary Sequestration Diagnosis

    CXR with recurrent pneumonia that has slow or incomplete resolution. Prental doppler US showing systemic arterial supply to fetal lung lesion

    CT/ MR angiography

    Intrapulmonary Sequestration

    Extrapulmonary Sequestration

    Extrapulmonary Sequestration

    Pulmonary Sequestration Treatment

    Balloon occlusion of systemic arterial supply

    Surgical resection is curative


    Intrapulmonary- often poorly defined margins so often needs lobectomy Prognosis is good.

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