Takei Kensuke, Takanashi Yusuke, Shibata Motohisa, Sekihara Keigo, Funai Kazuhito
First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, JPN.
Cureus. 2024 Nov 4;16(11):e72959. doi: 10.7759/cureus.72959. eCollection 2024 Nov.
Extralobar pulmonary sequestration (EPS) in the mediastinum is rare, and preoperative diagnosis can be challenging. We report a case of EPS in the middle mediastinum, where a congenital pericardial defect became apparent on computed tomography (CT) imaging as pneumopericardium concurrent with spontaneous pneumothorax. The patient presented with a left spontaneous pneumothorax. A chest plain CT revealed bullae in the apical segment of the left upper lobe and the S6 segment of the lower lobe, a 3.2 cm solid mass in the left middle mediastinum, and a pericardial defect with pneumopericardium beside the main left pulmonary artery. We initially considered the mediastinal mass to be a hematoma resulting from the rupture of adhesions between the lung and mediastinum due to the onset of spontaneous pneumothorax. We performed a bullectomy using video-assisted thoracoscopic surgery. Intraoperative findings revealed that the mediastinal mass was not a hematoma but solid tissue, raising suspicion of a mediastinal tumor. We transected the feeding artery and drainage vein using a vessel sealing system and resected the mediastinal mass. Histopathological examination revealed bronchial structures and lung parenchyma, confirming a diagnosis of EPS. The pericardial defect manifesting as pneumopericardium due to concomitant pneumothorax could have provided clues to an accurate preoperative diagnosis of EPS.
纵隔内叶外型肺隔离症（EPS）较为罕见，术前诊断颇具挑战性。我们报告一例中纵隔EPS病例，在计算机断层扫描（CT）成像中，先天性心包缺损表现为与自发性气胸并存的心包积气。患者因左侧自发性气胸就诊。胸部平扫CT显示左上叶尖段和下叶S6段有肺大疱，左中纵隔有一个3.2 cm实性肿块，在左肺动脉主干旁有心包缺损并伴有心包积气。我们最初认为纵隔肿块是由于自发性气胸发作导致肺与纵隔之间粘连破裂形成的血肿。我们采用电视辅助胸腔镜手术进行了肺大疱切除术。术中发现纵隔肿块并非血肿而是实性组织，这引发了对纵隔肿瘤的怀疑。我们使用血管封闭系统切断了供血动脉和引流静脉，并切除了纵隔肿块。组织病理学检查发现支气管结构和肺实质，确诊为EPS。因并发气胸而表现为心包积气的心包缺损可能为EPS的准确术前诊断提供了线索。
