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Ann Thorac Surg 2009;88:2040. doi:10.1016/j.athoracsur.2009.02.070
© 2009 The Society of Thoracic Surgeons
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Images in Cardiothoracic Surgery

Bilateral Communicating Intralobar Sequestration and Microgastria

Sonali Nagendran, MBBCh, Navroop Johal, MRCS, Pat Set, FRCR, Jeffrey Brain, FRCS, Adil Aslam, FRCS, Madan Samuel, DM*

Department of Pediatric Surgery, Addenbrooke's Hospital, Cambridge, United Kingdom

* Address correspondence to Dr Samuel, Department of Pediatric Surgery, Addenbrooke's Hospital, Hills Rd, Cambridge, CB2 0QQ, United Kingdom (Email: madan.samuel{at}addenbrookes.nhs.uk).

A male infant was born at 39 weeks' gestation. Antenatal scans demonstrated an absent stomach, but no thoracic abnormalities. On day 5, feeding difficulties and respiratory distress developed. A chest roentgenogram demonstrated aspiration pneumonia. A contrast study revealed microgastria and severe gastroesophageal reflux, which was treated with a fundoplication.

The recurrent chest infections continued to develop postoperatively. A computed tomography scan demonstrated bilateral intralobar pulmonary sequestrations, which occupied the medial right lower lobe and the entire left lower lobe and communicated with each other (Fig 1). A large abnormal artery arising from the descending thoracic aorta bifurcated to supply both masses (Figs 2 and 3). Go


Figure 1
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  		Fig 1.
 

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  		Fig 2.
 

Figure 3
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  		Fig 3.
 
At age 15 months, he underwent two lateral thoracotomies. This delineated the bilateral intralobar sequestrations, which communicated with each other within the pleural cavity to form a "saddle-shaped" appearance. A bronchoesophageal fistula communicated with the left-sided sequestration. The fistula was repaired, and a bilateral lower lobe segmentectomy (segments 7, 8 and 9) was performed to completely excise the sequestrations. The patient has since made a good recovery.

This patient presented with a bilateral communicating intralobar sequestration. Although Cerruti and colleagues [1] described a bilateral intralobar sequestration in a horseshoe lung with a suspected bridging tunnel, this was not a true intrapleural communication as was seen in this patient. The association between these two extremely rare anomalies of microgastria and pulmonary sequestration highlights the need for clinicians to have a high index of suspicion for multiple pathologies in children with recurrent respiratory symptoms.


   References
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 References
 

  1. Cerruti MM, Marmolejos F, Cacciarelli T. Bilateral intralobar pulmonary sequestration with horseshoe lung Ann Thorac Surg 1993;55:509-510.[Abstract/Free Full Text]




This Article
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