Ellis John, Brahmbhatt Sumir, Desmond Daniel, Ching Brian, Hostler Jordanna
Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI, 96859, USA.
J Med Case Rep. 2018 Dec 21;12(1):375. doi: 10.1186/s13256-018-1915-5.
Pulmonary sequestration is a congenital lung disease characterized by nonfunctioning pulmonary tissue that lacks normal communication with the bronchial tree and is supplied by a nonpulmonary systemic artery. Symptomatic bronchopulmonary sequestration is uncommon, seen more frequently in the pediatric population than in adults. It has traditionally been treated with surgical resection; however, a limited but growing number of cases have been treated with angiographic embolization. Given the inherent risks of cardiothoracic surgery, embolization of the anomalous vessel is an enticing alternative treatment. We present a case of a 56-year-old woman with known, symptomatic, intralobar pulmonary sequestration that was successfully treated with coil embolization.
A 56-year-old Pacific Islander woman with a history of chronic myeloid leukemia was admitted to the hospital with an episode of hemoptysis. Computed tomography of the chest demonstrated left lower lobe intralobar pulmonary sequestration fed by a large tortuous vessel branching off of the descending thoracic aorta. Surgical resection of the sequestration is the current standard treatment strategy of symptomatic intralobar pulmonary sequestration. The cardiothoracic surgeon noted that given the size and location of arterial blood supply, intervention would involve thoracotomy and lobectomy. The interventional radiologist offered embolization of the lesion as an alternative to surgery. Multiple coils, 6-13 mm in size, were used to embolize the sequestration. No considerable flow distal to the coils was noted postembolization.
Intralobar pulmonary sequestration is a rare condition that typically requires surgical management. This case demonstrates the efficacy of coil embolization as an alternative management strategy. To date, limited case reports of adults treated with endovascular embolization exist. Treatment of symptomatic pulmonary sequestration with embolization can be considered as an alternative to surgical resection.
肺隔离症是一种先天性肺部疾病，其特征为无功能的肺组织，该组织与支气管树缺乏正常连通，且由非肺系统动脉供血。有症状的支气管肺隔离症并不常见，在儿童中比在成人中更常见。传统上一直采用手术切除治疗；然而，有少数但数量在不断增加的病例采用了血管造影栓塞治疗。鉴于心胸外科手术存在的固有风险，对异常血管进行栓塞是一种诱人的替代治疗方法。我们报告一例56岁女性，患有已知的、有症状的叶内型肺隔离症，通过弹簧圈栓塞成功治疗。
一名56岁的太平洋岛民女性，有慢性髓性白血病病史，因咯血入院。胸部计算机断层扫描显示左下叶叶内型肺隔离症，由一支从胸降主动脉分支出来的粗大迂曲血管供血。对有症状的叶内型肺隔离症，目前的标准治疗策略是手术切除隔离肺组织。心胸外科医生指出，鉴于动脉血供的大小和位置，干预将涉及开胸和肺叶切除术。介入放射科医生提出对该病变进行栓塞作为手术的替代方案。使用多个尺寸为6 - 13毫米的弹簧圈对隔离肺组织进行栓塞。栓塞后未发现弹簧圈远端有明显血流。
叶内型肺隔离症是一种罕见疾病，通常需要手术治疗。本病例证明了弹簧圈栓塞作为一种替代治疗策略的有效性。迄今为止，成人接受血管内栓塞治疗的病例报告有限。对于有症状的肺隔离症，栓塞治疗可被视为手术切除的替代方法。
