Yue Yang, Xin Hua, Xu Bao-Cen, Zhang Le-Ning, Zhao Wei
Department of Thoracic Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin.
Department of Thoracic Surgery, People's Hospital of Xing'an League, Ulanhot City, Inner Mongolia autonomous region, China.
Medicine (Baltimore). 2019 Jul;98(30):e16582. doi: 10.1097/MD.0000000000016582.
The presence of a mediastinal neurilemmoma accompanied by intrapulmonary sequestration is a rare occurrence. The clinical symptoms of a neurilemmoma depend on the site of the tumor. Diagnosis of pulmonary sequestration mainly depends on the presence of aberrant feeding arteries.
A 78-year-old woman was admitted to our hospital with a mediastinal space-occupying lesion of 50 years. Computed tomography and magnetic resonance imaging showed 2 roundish low-density shadows in the left posterior mediastinum.
The pathological findings of the upper cystic mass support the diagnosis of neurilemmoma. A branch of aorta was found supplying blood to the lower mass; it was considered a pulmonary sequestration.
Left-sided thoracotomy was planned to remove the chest space-occupying lesions. Two masses were completely removed. Severe adhesion between the left lower lobe and the diaphragm was successfully separated, the aberrant feeding vessel was properly managed, and the lower lobe was resected completely.
The patient experienced remission of symptoms, had no significant postoperative complications, and was discharged from the hospital.
Special attention should be paid to neurological involvement of the neurilemmoma and the fragile feeding arteries of the intrapulmonary sequestration. Early diagnosis and treatment are important in such cases.
纵隔神经鞘瘤合并肺内隔离症较为罕见。神经鞘瘤的临床症状取决于肿瘤的位置。肺隔离症的诊断主要依靠异常供血动脉的存在。
一名78岁女性因纵隔占位性病变50年入院。计算机断层扫描和磁共振成像显示左后纵隔有两个圆形低密度阴影。
上部囊性肿块的病理结果支持神经鞘瘤的诊断。发现一条主动脉分支向下部肿块供血，考虑为肺隔离症。
计划行左侧开胸手术切除胸部占位性病变。两个肿块被完全切除。成功分离左下叶与膈肌之间的严重粘连，妥善处理异常供血血管，完整切除下叶。
患者症状缓解，术后无明显并发症，出院。
应特别注意神经鞘瘤的神经受累情况以及肺内隔离症脆弱的供血动脉。在此类病例中，早期诊断和治疗很重要。
