Wang Dehua, Wheeler William B
Department of Pathology and Laboratory Medicine, Children's Minnesota, Minneapolis, MN 55404, The United States of America; Department of Pathology and Laboratory Medicine, Rady Children's Hospital UCSD, San Diego, CA 92123, The United States of America.
Respiratory & Critical Care Specialists, Children's Minnesota, Minneapolis, MN 55404, The United States of America.
Int J Surg Case Rep. 2022 Jun 22;96:107336. doi: 10.1016/j.ijscr.2022.107336. eCollection 2022 Jul.
Hybrid lesions of intralobar sequestration (ILS) associated with congenital pulmonary airway malformation (CPAM) is rare and could be undetected by prenatal ultrasound. Some of the cases are discovered incidentally or following lung infection in late childhood or adulthood.
17-year-old female developed chest pain, non-productive cough, low grade fever, and sore throat several weeks following SARS-CoV-2 infection. CT angiogram revealed a large lobulated cystic mass with celiac arterial supply in the posterior right lower lobe that was diagnostic for pulmonary sequestration. Gradually she recovered from all respiratory symptoms after a course of multiple antibiotic treatment for symptom relief. In order to prevent recurrent infection and malignancy, she underwent right lower lung mass resection approximately 3 months later.
Pathological examination confirmed a hybrid lesion of ILS with mixed features of CPAM type I and type II. The hallmark morphological features of SARS-CoV-2 infection were not identified except for those of superimposed acute and chronic bronchopneumonia, abscesses formation and fibrosis within the lesion. This is the first case report of a hybrid lesion of ILS associated with CPAM type I and type II, unmasked following SARS-CoV-2 infection. By using the term of hybrid lesion to report this case is to efficiently correlate the terminology and nomenclature applied in the literature currently for multidisciplinary communication between radiology, pulmonary, surgery and pathology.
叶内型肺隔离症(ILS)与先天性肺气道畸形(CPAM)相关的混合性病变罕见,产前超声可能无法检测到。部分病例在儿童晚期或成人期因肺部感染偶然发现或在之后被发现。
一名17岁女性在感染新型冠状病毒2(SARS-CoV-2)数周后出现胸痛、干咳、低热和咽痛。CT血管造影显示右肺下叶后部有一个大的分叶状囊性肿块,由腹腔动脉供血,诊断为肺隔离症。在接受了一个疗程的多种抗生素治疗以缓解症状后,她逐渐从所有呼吸道症状中康复。为防止反复感染和恶变,大约3个月后她接受了右下肺肿块切除术。
病理检查证实为ILS的混合性病变,具有I型和II型CPAM的混合特征。除了病变内叠加的急性和慢性支气管肺炎、脓肿形成和纤维化外,未发现新型冠状病毒2感染的标志性形态学特征。这是首例关于与I型和II型CPAM相关的ILS混合性病变在新型冠状病毒2感染后被发现的病例报告。使用混合性病变这一术语来报告该病例是为了有效地关联目前文献中用于放射学、肺病学、外科学和病理学之间多学科交流的术语和命名法。