Abstract
Bronchopulmonary sequestration is a rare congenital lung dysplasia. An intralobar
sequestration (ILS) is a nonfunctional mass within the lung parenchyma without bronchial
communication and with aberrant systemic arterial blood supply. Surgical resection
or close observation can be proposed in the management of asymptomatic and low-risk
ILS, but there is a lack of consensus. Endovascular embolization before thoracoscopic
resection of ILS has been described to limit perioperative bleeding. Another technique
previously reported is the injection of methylene blue in the feeding artery to macroscopically
mark the sequestration from the healthy lung. In that way, a nonanatomical resection
can be performed instead of a lobectomy without the risk of leaving abnormal lung
tissue in place. We describe the first two cases of these two techniques combined:
a 3-year-old girl with an ILS in the right lower lobe with an artery originating from
the abdominal aorta, and a 14-month-old girl with an ILS in the right lower lobe with
an artery coming from the celiac trunk.
The combination of embolization and injection of methylene blue in the aberrant artery
leads to a clear macroscopic demarcation of the blue-colored ILS from the healthy
lung parenchyma and allowed safe nonanatomical resection of the ILS without risk of
bleeding or compromising normal lung tissue.
Keywords
VATS - hybrid management - intralobar sequestration
