Kanno Chiaki, Kudo Yujin, Amemiya Ryosuke, Matsubayashi Jun, Furumoto Hideyuki, Takahashi Satoshi, Maehara Sachio, Hagiwara Masaru, Kakihana Masatoshi, Nagao Toshitaka, Ohira Tatsuo, Ikeda Norihiko
Department of Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-Ku, Tokyo, 160-0023, Japan.
Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan.
Surg Case Rep. 2023 Oct 7;9(1):176. doi: 10.1186/s40792-023-01758-w.
Pulmonary sequestration is a rare pulmonary malformation, with intralobar pulmonary sequestration being the most common subtype. Lobectomy has generally been performed for its treatment, owing to unclear boundaries of the lesion. However, recent reports have introduced lung resection using intravenous indocyanine green (ICG) as a treatment for pulmonary sequestrations.
A 34-year-old woman presented with chest pain, and enhanced chest computed tomography (CT) displayed a solid mass of 4.5 × 3.1 cm in the right S10 area. An aberrant artery was found running from the celiac artery through the diaphragm to the thoracic cavity. The patient was diagnosed as having pulmonary sequestration Pryce type III, and surgical resection was performed. Intrathoracic findings demonstrated that the precise area of the pulmonary sequestration could not be clearly identified, and a 5-mm aberrant artery was present in the pulmonary ligament. Following the separation of the aberrant artery, intravenous injection of ICG clearly delineated the border between the normal lung tissue and the pulmonary sequestration. Wedge resection was then performed without any postoperative events, and the pathological diagnosis was also pulmonary sequestration.
We herein reported a case of a patient who underwent sublobar resection for intrapulmonary sequestration using intravenous ICG injection, together with a literature review. Our case suggests that a comprehensive understanding of abnormal vessels and pulmonary vasculature in pulmonary resection for intrapulmonary sequestrations, complemented with the use of ICG, might potentially avoid unnecessary pulmonary resection and enable sublobar surgical resection.
肺隔离症是一种罕见的肺部畸形，叶内型肺隔离症是最常见的亚型。由于病变边界不清，通常采用肺叶切除术进行治疗。然而，最近的报告介绍了使用静脉注射吲哚菁绿（ICG）进行肺切除术来治疗肺隔离症。
一名34岁女性因胸痛就诊，胸部增强计算机断层扫描（CT）显示右肺S10区有一个4.5×3.1厘米的实性肿块。发现一条异常动脉从腹腔动脉穿过膈肌进入胸腔。该患者被诊断为普赖斯III型肺隔离症，并接受了手术切除。胸腔内检查发现无法清晰识别肺隔离症的确切区域，肺韧带中有一条5毫米的异常动脉。分离异常动脉后，静脉注射ICG清晰地勾勒出正常肺组织与肺隔离症之间的边界。随后进行了楔形切除术，术后无任何并发症，病理诊断也是肺隔离症。
我们在此报告了一例使用静脉注射ICG对肺内隔离症进行肺叶下切除的患者病例，并进行了文献综述。我们的病例表明，在肺内隔离症的肺切除术中，全面了解异常血管和肺血管系统，并辅以ICG的使用，可能会避免不必要的肺切除，并实现肺叶下手术切除。
