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Two adult cases of extralobar pulmonary sequestration: A non-complicated case and a necrotic case with torsion.

Takeuchi K, Ono A, Yamada A, Toyooka M, Takahashi T, Shigematsu Y, Ohta M, Sagoh T - Pol J Radiol (2014)

Bottom Line: On magnetic resonance imaging, the masses in both cases showed inhomogeneous low signal and branching high signal on T2-weighted images.That was characteristic for a stroma without dilated alveoli as a solid part and dilated alveoli as fluid regions.By comparing those two cases, we came to a conclusion that only T2-weighted imaging reflects the native structure, even after infarction.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Fukui Red Cross Hospital, Fukui, Japan.

ABSTRACT

Background: This case report describes two cases of extralobar pulmonary sequestration in adults with and without torsion/necrosis.

Case reports: Non-complicated extralobar pulmonary sequestration was found incidentally in a 50-year-old asymptomatic woman (Case 1), diagnosed with the presence of a branching structure in a mass lesion and blood supply from the right inferior phrenic artery. Another case of a 38-year-old woman presented with a sudden onset of back pain caused by extralobar pulmonary sequestration with torsion/necrosis (Case 2). A 4-cm fusiform mass in the paravertebral region showed enhancement in the peripheral rim only, and no feeding artery. These were the same as it had been reported typical findings in extralobar pulmonary sequestration with necrosis. On magnetic resonance imaging, the masses in both cases showed inhomogeneous low signal and branching high signal on T2-weighted images. That was characteristic for a stroma without dilated alveoli as a solid part and dilated alveoli as fluid regions.

Conclusions: By comparing those two cases, we came to a conclusion that only T2-weighted imaging reflects the native structure, even after infarction. Although differentiation from a cystic tumor with hemorrhage or infection can be problematic, inhomogeneous low signal and branching high signal on T2-weighted images may help us distinguish extralobar pulmonary sequestration from other cystic lesions.

No MeSH data available.


Related in: MedlinePlus

Case 2. Contrast-enhanced chest CT. A mass is present in the azygo-esophageal recess, and only the periphery is enhanced. A small amount of pleural effusion is seen on the right side.
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f4-poljradiol-79-145: Case 2. Contrast-enhanced chest CT. A mass is present in the azygo-esophageal recess, and only the periphery is enhanced. A small amount of pleural effusion is seen on the right side.

Mentions: A 38-year-old healthy woman presented after a sudden onset of back pain that disappeared the next day, then reappeared the day after. Laboratory tests showed slight elevations in C-reactive protein (CRP) (1.91 mg/dL), creatine phosphokinase (221 IU/L), and lactate dehydrogenase (219 IU/L), and other values including white blood cell count were within normal range. Electrocardiography, abdominal ultrasonography, gastrointestinal endoscopy and chest radiography were normal. Contrast-enhanced CT of the chest and abdomen revealed a 4-cm fusiform mass in the azygo-esophageal recess (Figure 4). That mass demonstrated iso-density with muscles, and only the peripheral rim was enhanced. It was abutting the lung, esophagus, vertebrae, and left atrium, but those surrounding structures did not show any abnormalities. A small amount of pleural effusion was seen on the right side, i.e. at the location of the mass. No other lesions that might have caused the symptoms were evident. On magnetic resonance imaging, the mass showed inhomogeneous low signal with branching signal hyperintensity on T2-weighted images, slight hyperintensity on T1-weighted images, and contrast enhancement only at the periphery (Figures 5 and 6). Four days after onset, pleural effusion increased and CRP was elevated to 5.52 mg/dL. A mass was suspected – an acute necrotic solid tumor or complicated (hemorrhagic or infectious) cystic lesion, such as solitary fibrous tumor, neurogenic, foregut cyst or cystic teratoma. Although we could not establish the diagnosis, the mass was considered the cause of the symptoms, and video-assisted thoracoscopic surgery was attempted. Intraoperatively, a dark red-brown mass and small amounts of hemorrhagic pleural effusion were identified in the pleural cavity. Parietal pleura near the mass appeared red, which suggested spreading inflammation. The mass was easily separated from the surrounding tissue, and was connected to the mediastinum by a twisted pedicle. The pedicle passed around the esophagus, but connection to the aorta could not be recognized. The mass was resected at the pedicle. Microscopically, the mass contained circular lining cartilage and fat, and received its blood supply from an artery in the pedicle (Figure 7). That vessel was an elastic artery, with a large diameter compared to the size of the mass. The mass displayed total hemorrhagic necrosis of the remaining native structures without granulation tissue, indicating a pattern of necrosis arising within the past several weeks. We diagnosed necrotic extralobar pulmonary sequestration with torsion based on the clinical course and surgical and pathological findings. Symptom completely resolved following resection.


Two adult cases of extralobar pulmonary sequestration: A non-complicated case and a necrotic case with torsion.

Takeuchi K, Ono A, Yamada A, Toyooka M, Takahashi T, Shigematsu Y, Ohta M, Sagoh T - Pol J Radiol (2014)

Case 2. Contrast-enhanced chest CT. A mass is present in the azygo-esophageal recess, and only the periphery is enhanced. A small amount of pleural effusion is seen on the right side.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4061149&req=5

f4-poljradiol-79-145: Case 2. Contrast-enhanced chest CT. A mass is present in the azygo-esophageal recess, and only the periphery is enhanced. A small amount of pleural effusion is seen on the right side.
Mentions: A 38-year-old healthy woman presented after a sudden onset of back pain that disappeared the next day, then reappeared the day after. Laboratory tests showed slight elevations in C-reactive protein (CRP) (1.91 mg/dL), creatine phosphokinase (221 IU/L), and lactate dehydrogenase (219 IU/L), and other values including white blood cell count were within normal range. Electrocardiography, abdominal ultrasonography, gastrointestinal endoscopy and chest radiography were normal. Contrast-enhanced CT of the chest and abdomen revealed a 4-cm fusiform mass in the azygo-esophageal recess (Figure 4). That mass demonstrated iso-density with muscles, and only the peripheral rim was enhanced. It was abutting the lung, esophagus, vertebrae, and left atrium, but those surrounding structures did not show any abnormalities. A small amount of pleural effusion was seen on the right side, i.e. at the location of the mass. No other lesions that might have caused the symptoms were evident. On magnetic resonance imaging, the mass showed inhomogeneous low signal with branching signal hyperintensity on T2-weighted images, slight hyperintensity on T1-weighted images, and contrast enhancement only at the periphery (Figures 5 and 6). Four days after onset, pleural effusion increased and CRP was elevated to 5.52 mg/dL. A mass was suspected – an acute necrotic solid tumor or complicated (hemorrhagic or infectious) cystic lesion, such as solitary fibrous tumor, neurogenic, foregut cyst or cystic teratoma. Although we could not establish the diagnosis, the mass was considered the cause of the symptoms, and video-assisted thoracoscopic surgery was attempted. Intraoperatively, a dark red-brown mass and small amounts of hemorrhagic pleural effusion were identified in the pleural cavity. Parietal pleura near the mass appeared red, which suggested spreading inflammation. The mass was easily separated from the surrounding tissue, and was connected to the mediastinum by a twisted pedicle. The pedicle passed around the esophagus, but connection to the aorta could not be recognized. The mass was resected at the pedicle. Microscopically, the mass contained circular lining cartilage and fat, and received its blood supply from an artery in the pedicle (Figure 7). That vessel was an elastic artery, with a large diameter compared to the size of the mass. The mass displayed total hemorrhagic necrosis of the remaining native structures without granulation tissue, indicating a pattern of necrosis arising within the past several weeks. We diagnosed necrotic extralobar pulmonary sequestration with torsion based on the clinical course and surgical and pathological findings. Symptom completely resolved following resection.

Bottom Line: On magnetic resonance imaging, the masses in both cases showed inhomogeneous low signal and branching high signal on T2-weighted images.That was characteristic for a stroma without dilated alveoli as a solid part and dilated alveoli as fluid regions.By comparing those two cases, we came to a conclusion that only T2-weighted imaging reflects the native structure, even after infarction.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Fukui Red Cross Hospital, Fukui, Japan.

ABSTRACT

Background: This case report describes two cases of extralobar pulmonary sequestration in adults with and without torsion/necrosis.

Case reports: Non-complicated extralobar pulmonary sequestration was found incidentally in a 50-year-old asymptomatic woman (Case 1), diagnosed with the presence of a branching structure in a mass lesion and blood supply from the right inferior phrenic artery. Another case of a 38-year-old woman presented with a sudden onset of back pain caused by extralobar pulmonary sequestration with torsion/necrosis (Case 2). A 4-cm fusiform mass in the paravertebral region showed enhancement in the peripheral rim only, and no feeding artery. These were the same as it had been reported typical findings in extralobar pulmonary sequestration with necrosis. On magnetic resonance imaging, the masses in both cases showed inhomogeneous low signal and branching high signal on T2-weighted images. That was characteristic for a stroma without dilated alveoli as a solid part and dilated alveoli as fluid regions.

Conclusions: By comparing those two cases, we came to a conclusion that only T2-weighted imaging reflects the native structure, even after infarction. Although differentiation from a cystic tumor with hemorrhage or infection can be problematic, inhomogeneous low signal and branching high signal on T2-weighted images may help us distinguish extralobar pulmonary sequestration from other cystic lesions.

No MeSH data available.


Related in: MedlinePlus