1Ahmad A Saadat Saeed Abdel Muhdi,1Noon Mohamed Mahgoub Elawad,
1Dubai Health Authority
Pulmonary sequestration (PS) is a rare congenital pulmonary condition. It accounts for 0.15% to 6.4% of all congenital pulmonary malformations. It is characterized by the presence of non-functional pulmonary tissue lacking a normal connection with the tracheobronchial tree or pulmonary arteries receiving its arterial supply from systemic circulation. It has two main types: intra-lobar (ILPS) and extra-lobar (ELPS). It involves the lower lobe in most cases, and it results in recurrent infections and bronchial obstruction.
Material(s) and Method(s)
A 25-year-old male patient presented to the emergency department with fever, cough, and multiple episodes of hemoptysis. CT demonstrated a large systemic anomalous arterial branch emerging from the thoracic aorta. The aberrant artery was surrounded by a large left lower lobe consolidation with bronchiectasis and cystic changes, as well as a prominent vein draining into the left pulmonary vein. A diagnosis of ILPS was made. After an initial attempt of symptomatic management, the patient’s hemoptysis continued to worsen so a plan of interventional management was decided. Selective embolization using gelfoam and coils successfully achieved the complete de-vascularization of the large anomalous artery and its multiple branches. After 4 days, a repeat endovascular embolization was done involving two bronchial arteries on the ipsilateral side of the sequestration.
Technical success of the procedure was confirmed by a repeat CT scan on the 6th day after the procedure.
The patient showed drastic improvement in clinical and biochemical markers during follow-up.
Although surgical resection is considered the gold standard for treatment of PS, it is still associated with complications and morbidity. On the other hand, endovascular embolization provides an improved clinical outcome and reduces the risk of intra-operative bleeding in the case of surgical resection.
Technical success was achieved with a combination of embolic materials as well as using the distal-proximal technique of coiling. Around 1 cm segment of the feeding arterial trunk was kept without coils for the purpose of ligation in case of future surgical plans.
Another advantage of using an endovascular method for treatment of ILPS is being able to not only embolize the main aberrant vessels but also the bronchial arteries for a better clinical outcome.
PS is a rare condition with a non-specific clinical presentation that is difficult to diagnose. Noninvasive imaging modalities, such CT Angiography is an effective way for diagnosis of PS. Present case report describes the successful outcome of endovascular embolization which can be used as a definite or preoperative treatment of ILPS in adults.