RESUMEN
Pulmonary sequestration (PS) happens when an area of the lung receives its arterial blood supply from systemic circulation, resulting in a non-functional lesion (Intralobar or extralobar). Hydatid cyst results from infection of the tapeworm Echinococcus. We report a case of hydatid cyst existed concurrently with intralobar PS. A 12-year-old girl presented with recurrent hemoptysis of 2 years duration. Serology for Echinococcus granulosus was positive. CT chest suggested intralobar PS in the right middle lobe, which was surgically removed. In conclusion, recurrent localized pulmonary infections should raise the suspicion of intralobar PS which may rarely coexist with hydatid cyst.
Asunto(s)
Secuestro Broncopulmonar , Equinococosis Pulmonar , Hemoptisis , Animales , Secuestro Broncopulmonar/sangre , Secuestro Broncopulmonar/diagnóstico por imagen , Secuestro Broncopulmonar/microbiología , Secuestro Broncopulmonar/cirugía , Niño , Equinococosis Pulmonar/sangre , Equinococosis Pulmonar/diagnóstico por imagen , Equinococosis Pulmonar/microbiología , Equinococosis Pulmonar/cirugía , Echinococcus granulosus/aislamiento & purificación , Femenino , Hemoptisis/sangre , Hemoptisis/diagnóstico por imagen , Hemoptisis/microbiología , Hemoptisis/cirugía , Humanos , Pulmón/diagnóstico por imagen , Pulmón/patología , Tomografía Computarizada por Rayos XRESUMEN
Vascular changes observed in intralobar pulmonary sequestration (PS) have been reported to be similar to those observed in pulmonary hypertension (PH). However, atherosclerosis in the pulmonary artery, which is one of the characteristic arterial changes of PH, has scarcely been reported in PS. Here, we report this unique manifestation in a 66-year-old man, in whom an intralobar PS fed by an aberrant artery branching from the left gastric artery had been identified 10 years earlier, and who was diagnosed with pneumonia after having symptoms of fever and cough. He was treated by lobectomy of the lower lobe of his right lung. Subsequently, a culture test of the fluid from the sequestrated lung was performed, which identified Mycobacterium avium. Subsequent pathological examination of the sequestrated lung demonstrated multiple epithelioid cell granulomas. Furthermore, atherosclerosis of the aberrant artery was also found, which may be associated with his advanced age. This is an extremely rare case of right intralobar PS supplied by aberrant artery with atherosclerosis originating from left gastric artery passing over the diaphragm.
Asunto(s)
Aterosclerosis/patología , Secuestro Broncopulmonar/patología , Infección por Mycobacterium avium-intracellulare/complicaciones , Arteria Pulmonar/patología , Anciano , Aterosclerosis/microbiología , Secuestro Broncopulmonar/microbiología , Células Epitelioides/patología , Granuloma/microbiología , Granuloma/patología , Humanos , MasculinoRESUMEN
HISTORY AND CLINICAL FINDINGS: During a screening examination a pulmonary mass in the left lower lobe was detected in a 39-year-old man. The patient was asymptomatic and had hitherto been healthy. CT pulmonary angiography revealed an intralobar pulmonary sequestration with an afferent arterial branch from the thoracic aorta. DIAGNOSIS, TREATMENT AND COURSE: Thoracotomy with resection of the sequestration was performed. On the first postoperative day hemiparesis of the left side occurred because of an infarction of the arteria cerebri media. After aspiration of the thrombus and intraarterial thrombolysis the patient recovered completely. Histology of the sequestration showed invasive growth of aspergillus and severe inflammation, caused by invasive mycosis. Subsequently the patient received voriconazol for four weeks. CONCLUSION: Diagnosis of pulmonary sequestration in adults is rare. In asymptomatic patients there is still controversy about the treatment. Surgery, arterial embolisation and a "watch and wait" strategy can be taken into account. Because of the risk of infection an operative approach should be favoured.
Asunto(s)
Secuestro Broncopulmonar/diagnóstico , Secuestro Broncopulmonar/cirugía , Aspergilosis Pulmonar/diagnóstico , Aspergilosis Pulmonar/cirugía , Adulto , Secuestro Broncopulmonar/diagnóstico por imagen , Secuestro Broncopulmonar/tratamiento farmacológico , Secuestro Broncopulmonar/microbiología , Humanos , Masculino , Aspergilosis Pulmonar/diagnóstico por imagen , Aspergilosis Pulmonar/tratamiento farmacológico , Pirimidinas/uso terapéutico , Radiografía , Toracotomía , Resultado del Tratamiento , Triazoles/uso terapéutico , VoriconazolRESUMEN
We report on the rare and surgical treatment of a senile patient of infected intralobar pulmonary sequestration. A 56-year-old male who had complained of headache, vomiting, cough, sputum production, and high fever was admitted to our hospital. Chest computed tomography (CT) showed an infected intralobar pulmonary sequestration as an 8x6 cm cystic mass with multiple air-fluid cavities in the left lower basal segment and severe pneumonia in the left upper and lower lobes around the mass. A 3-D CT showed an aberrant artery entering the consolidation from the descending aorta. A standard lower lobectomy was performed with a ligation of the aberrant artery with a diameter of 1 cm supplying the posterior segment of the left lower lobe. A histological examination of the lung revealed acute and chronic broncho-bronchiolitis with cystic dilatation consistent with intralobar pulmonary sequestration. We discuss the characters of senile patients compared with juvenile patients, with reference to a collective review of patients older than 50 reported in the literature.
Asunto(s)
Secuestro Broncopulmonar/cirugía , Secuestro Broncopulmonar/diagnóstico , Secuestro Broncopulmonar/microbiología , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
A 22-year-old female was referred to the hospital suffering from a persistent, non-productive cough and repeated exacerbations of a right lower zone infiltrate suggestive of pulmonary sequestration. Angiography revealed an aberrant artery that originated from the left side of the descending aorta, crossed the aorta anteriorly, flowed through the right lower lobe and drained into the right inferior pulmonary vein. Right lower lobectomy was conducted by open thoracotomy. Gross examination revealed mucoid impaction of bronchi in the sequestration. Microscopy demonstrated a clear boundary between sequestrated and normal lung, as well as caseating epitheloid granulomas confined to the sequestration. As the aberrant artery fed both sequestrated and adjacent normal lung and the boundary did not involve the pleura, the lesion was classified as a Pryce's type II intralobar sequestration. No acid-fast bacilli were observed, but homogenates of the sequestration were positive for Mycobacterium tuberculosis by polymerase chain reaction. The patient was treated with isoniazid and rifampicin daily for 9 months, and 6 years later her clinical status remained excellent. Tuberculosis confined to a sequestration is extremely rare and characteristics of the aberrant artery suggested this intralobar sequestration was likely to be congenital in origin.
Asunto(s)
Secuestro Broncopulmonar/complicaciones , Tuberculosis Pulmonar/complicaciones , Adulto , Secuestro Broncopulmonar/diagnóstico , Secuestro Broncopulmonar/microbiología , Femenino , Humanos , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/tratamiento farmacológicoRESUMEN
We addressed the in vivo role of phosphatidylinositol 3-kinase-gamma (PI3K-gamma) in signaling the sequestration of polymorphonuclear leukocytes (PMNs) in lungs and in the mechanism of inflammatory lung vascular injury. We studied mice with deletion of the p110 catalytic subunit of PI3K-gamma (PI3K-gamma(-/-) mice). We measured lung tissue PMN sequestration, microvascular permeability, and edema formation after bacteremia induced by intraperitoneal Escherichia coli challenge. PMN infiltration into the lung interstitium in PI3K-gamma(-/-) mice as assessed morphometrically was increased 100% over that in control mice within 1 h after bacterial challenge. PI3K-gamma(-/-) mice also developed a greater increase in lung microvascular permeability after E. coli challenge, resulting in edema formation. The augmented lung tissue PMN sequestration in PI3K-gamma(-/-) mice was associated with increased expression of the PMN adhesive proteins CD47 and beta(3)-integrins. We observed increased association of CD47 and beta(3)-integrins with the extracellular matrix protein vitronectin in lungs of PI3K-gamma(-/-) mice after E. coli challenge. PMNs from these mice also showed increased beta(3)-integrin expression and augmented beta(3)-integrin-dependent PMN adhesion to vitronectin. These results point to a key role of PMN PI3K-gamma in negatively regulating CD47 and beta(3)-integrin expression in gram-negative sepsis. PI3K-gamma activation in PMNs induced by E. coli may modulate the extent of lung tissue PMN sequestration secondary to CD47 and beta(3)-integrin expression. Therefore, the level of PI3K-gamma activation may be an important determinant of PMN-dependent lung vascular injury.
Asunto(s)
Infecciones por Escherichia coli/enzimología , Escherichia coli , Infiltración Neutrófila , Neutrófilos/enzimología , Fosfatidilinositol 3-Quinasas/metabolismo , Sepsis/enzimología , Animales , Vasos Sanguíneos/enzimología , Vasos Sanguíneos/lesiones , Vasos Sanguíneos/patología , Secuestro Broncopulmonar/enzimología , Secuestro Broncopulmonar/genética , Secuestro Broncopulmonar/microbiología , Secuestro Broncopulmonar/patología , Antígeno CD47/metabolismo , Permeabilidad Capilar/genética , Adhesión Celular/genética , Fosfatidilinositol 3-Quinasa Clase Ib , Infecciones por Escherichia coli/complicaciones , Infecciones por Escherichia coli/genética , Infecciones por Escherichia coli/patología , Regulación de la Expresión Génica/genética , Integrina beta3/metabolismo , Isoenzimas/deficiencia , Isoenzimas/genética , Isoenzimas/metabolismo , Pulmón/enzimología , Pulmón/microbiología , Pulmón/patología , Ratones , Ratones Noqueados , Infiltración Neutrófila/genética , Neutrófilos/patología , Fosfatidilinositol 3-Quinasas/deficiencia , Fosfatidilinositol 3-Quinasas/genética , Sepsis/genética , Sepsis/microbiología , Sepsis/patología , Transducción de Señal/genéticaRESUMEN
Intralobar pulmonary sequestration associated with asymptomatic aspergillosis is a rare case. We describe the case of a 65-year-old woman with intrapulmonary sequestration, anomalous systemic arterial supply to the left lower lobe and aspergillosis who underwent left lower lobectomy and ligation of an anomalous artery by Video-Assisted Thoracoscopic surgery (VATS). Pathological examination showed the parenchymal distortion and chronic inflammation. Aspergillus were found in the cyst. VATS lobectomy for intralobar pulmonary sequestration is a safe and valid procedure.
Asunto(s)
Aspergilosis/complicaciones , Secuestro Broncopulmonar/microbiología , Enfermedades Pulmonares Fúngicas/complicaciones , Anciano , Aspergilosis/diagnóstico , Aspergilosis/cirugía , Secuestro Broncopulmonar/diagnóstico , Secuestro Broncopulmonar/cirugía , Femenino , Humanos , Enfermedades Pulmonares Fúngicas/diagnóstico , Enfermedades Pulmonares Fúngicas/cirugía , Cirugía Torácica Asistida por VideoRESUMEN
We report two cases of intralobar pulmonary sequestration associated with nontuberculous mycobacterial infection. Case 1: A 28-year-old woman was hospitalized because of cough. Chest CT demonstrated multi-cystic lesions with an air-fluid level in the right lower lobe. Case 2: A 25-year-old woman was hospitalized because of fever. Chest CT demonstrated homogeneous consolidation in the right lower lobe. In both cases, aortography showed an anomalous artery supplying the right basal segment, and pulmonary sequestration was diagnosed. Furthermore, Mycobacterium avium was detected in the bronchial lavage, and a right lower lung lobectomy was performed after chemotherapy. Mycobacterium avium was cultured from the fluid in the sequestrated lung, and histological findings of the resected lobe showed epithelioid cell granulomas. We diagnosed these cases as having pulmonary sequestrations associated with nontuberculous mycobacterial infection. We concluded that pulmonary sequestration should be considered an underlying disease of secondary nontuberculous mycobacterial infections in young patients.
Asunto(s)
Secuestro Broncopulmonar/complicaciones , Infección por Mycobacterium avium-intracellulare/etiología , Adulto , Antibacterianos/uso terapéutico , Secuestro Broncopulmonar/microbiología , Femenino , Granuloma de Células Gigantes/etiología , Granuloma de Células Gigantes/patología , Humanos , Pulmón/patología , Enfermedades Pulmonares/etiología , Enfermedades Pulmonares/patología , Complejo Mycobacterium avium/aislamiento & purificación , Infección por Mycobacterium avium-intracellulare/microbiología , Infección por Mycobacterium avium-intracellulare/terapia , NeumonectomíaRESUMEN
Aspergillus is an opportunistic fungus that usually colonizes preexisting lung cavities, especially tuberculous ones. Colonization of a pulmonary sequestration by this germ is exceptional, with just 14 cases reported in the world literature, most of them in Asia. A case is presented of a 48-year-old woman with pleuritic thoracic pain. Simple chest radiology revealed a lower right pulmonary tumor with clear margins and a calcium-type density. CT showed it to correspond to a 6 x 5-cm hypodense mass, which was enhanced at the periphery with intravenous contrast. Aspiration puncture yielded a greenish-yellow pus and the microscopic study strongly suggested Aspergillus, confirmed by culture as Aspergillus fumigatus. Surgery revealed an infected pulmonary sequestration at the lower right lobe, and a lobectomy was performed.
Asunto(s)
Aspergillus fumigatus , Secuestro Broncopulmonar/microbiología , Enfermedades Pulmonares Fúngicas/microbiología , Aspergillus fumigatus/aislamiento & purificación , Secuestro Broncopulmonar/diagnóstico por imagen , Secuestro Broncopulmonar/cirugía , Femenino , Humanos , Enfermedades Pulmonares Fúngicas/diagnóstico por imagen , Enfermedades Pulmonares Fúngicas/cirugía , Persona de Mediana Edad , Intensificación de Imagen Radiográfica , Toracotomía , Tomografía Computarizada por Rayos XRESUMEN
A rare example of an intralobar sequestration (ILS) containing a fungal mycetoma is reported. This finding indicates the presence of a communication between the ILS and the airways, thus supporting the theory that ILSs are acquired lesions, rather than congenital malformations.