Pulmonary sequestration - prenatal and post natal ultrasound

Case contributed by Dr Maulik S Patel

Presentation

Antenatal ultrasound for anomaly scan. No complaints.

An echogenic lesion is noted in left lower hemithorax posteriorly. Its base is noted abutting spine. Lesion also abutts lower thoracic aorta, part of oesophagus and heart.

Lesion is posterior and close to normal appearing stomach bubble. No defect is noted in adjacent spine.

Lesion appears to extend in upper abdomen posterior to stomach. There seems to be defect in left hemidiaphragm..

Cranio-caudal - 15 mm

Axial              - 10 mm

Antero-posterior - 10 mm.

No cystic spaces are noted in the lesion.

No hydrothroax is noted.

No mass effect is noted on heart or stomach bubble.

 

RIGHT hemidiaphgram is normal.

RIght lung and rest of the left lung are normal.

Lesion receives arterial supply from aorta. One or probably two arterial are seen supplying the lesion.

 

Mild fullness of LEFT renal pelvis is noted.

No other abnormality could be localized in fetus.

Ultrasound

Baby boy. Post natal Day 1 - ultrasound.

An echogenic lesion is noted posterior to gastro-oesophageal junction.It also extends to lower left hemithorax.

Lesion abutts upper abdominal aorta. Lesion is posterior to heart.

Discontinuity is noted in left hemidiaphragm. Left adrenal gland is normal.

Lesion is echogenic without cystic changes. 

NO pleural effusion is noted in either of pleural cavities.

Lesion receives arterial supply from aorta. One artery is seen supplying the lesion.

Hydronephrosis without parenchymal loss is noted in LEFT kidney with distended bladder. No hydroureter is noted..

No other abnormality could be localized in abdomen.

Case Discussion

Other differential for an echogenic lung lesion for antenatal ultrasound includes CCAM ( congenital cystic adenomatoid malformation ), lobar emphysema, bronchial atresia; all supplyed by pulmonary artery.

Antenatal and postnatal Findings of lower chest echogenic mass with extension below diaphram along with blood supply from aorta favours the diagnosis of pulmonary sequestration.

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Case information

rID: 27529
Case created: 6th Feb 2014
Last edited: 18th Dec 2015
Inclusion in quiz mode: Included

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