Case report
Intradiaphragmatic pulmonary sequestration: advantages of the thoracoscopic approach

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Abstract

Pulmonary sequestrations are accessory foregut lesions that are most commonly located within the thorax and occasionally in the abdominal cavity. Sequestrations arising within the diaphragm are exceedingly rare. We describe 2 patients found to have left peridiaphragmatic lesions on prenatal ultrasound and postnatal computed tomography. In the first patient, an initial laparoscopic approach was abandoned in favor of a thoracoscopic approach after no intraabdominal mass was found. The second patient had an uncomplicated thoracoscopic resection of a similar lesion. To our knowledge, these represent the first intradiaphragmatic pulmonary sequestrations to be resected via a minimally invasive approach. The rarity of these lesions makes definitive diagnosis without operative intervention challenging. Thoracoscopy appears to be a reasonable approach for resection of such intradiaphragmatic lesions.

Section snippets

Case 1

A 7-week-old female infant was referred for evaluation of a left-sided peridiaphragmatic lesion detected on prenatal ultrasound. Pregnancy and delivery were otherwise unremarkable. Postnatal ultrasounds could not definitively localize the mass relative to the diaphragm. A computed tomographic (CT) scan showed a 2.0 × 1.1 × 1.8 cm soft tissue mass separate from the paraspinal region and adrenal gland (Fig. 1A). No feeding or draining vessels could be identified. A review of all the diagnostic

Case 2

A 4-week-old male infant was referred for evaluation of a left lower lobe cystic pulmonary mass detected on prenatal ultrasound. Pregnancy and delivery were unremarkable. A CT scan showed a soft tissue mass in the left posterior costophrenic sulcus measuring 2.3 × 2.0 × 1.7 cm (Fig. 1B). No feeding or draining vessels were identified, and the location of the lesion relative to the diaphragm could not be determined. A subsequent ultrasound showed the mass to be separated from the adrenal gland

Discussion

Pulmonary sequestration is a focus of nonfunctioning lung parenchyma that develops apart from the normal tracheobronchial tree. These anomalies account for up to 6% of congenital pulmonary malformations. Sequestrations are classified as ILS or ELS depending upon whether they are invested in the same visceral pleura as the adjacent normal lung [1]. Approximately 25% of sequestrations are ELS, with up to 15% of these occurring below the diaphragm. Identification of a sequestration is generally

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