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Abstract Background Extralobar pulmonary sequestration–a congenital lung malformation characterized by nonfunctional lung tissue with its own visceral pleura and without a connection to the normal tracheobronchial tree–is often surgically resected given the potential for infectious complications. We report a case of a child with extralobar pulmonary sequestration in a rare and challenging intradiaphragmatic location, which made preoperative identification and planning difficult. Case presentation A 2-year-old boy presented for follow-up of a large left extralobar pulmonary sequestration initially diagnosed on an antenatal ultrasound. Follow-up imaging, including prenatal MRI and postnatal CT angiography, was inconclusive on the precise location of the extralobar pulmonary sequestration in relation to the diaphragm but did reveal a subdiaphragmatic arterial supply from a branch off the celiac trunk. Planned resection with diagnostic thoracoscopy revealed the mass to seemingly be below the diaphragm; however, subsequent abdominal laparoscopy identified it to be within the diaphragm. Once the supplying vessel off the celiac trunk was controlled and divided, the mass was circumferentially excised from the edges of the diaphragmatic muscle. The remaining diaphragmatic defect was then closed, and the patient did well postoperatively. Conclusions This case demonstrates the difficulty of making a definitive diagnosis of intradiaphragmatic extralobar pulmonary sequestration without operative intervention. CT angiography and identification of the sequestration’s arterial supply may not be conclusive in determining the precise location if in close proximity to the diaphragm.

Background: Extralobar pulmonary sequestration–a congenital lung malformation characterized by nonfunctional lung tissue with its own visceral pleura and without a connection to the normal tracheobronchial tree–is often surgically resected given the potential for infectious complications. We report a case of a child with extralobar pulmonary sequestration in a rare and challenging intradiaphragmatic location, which made preoperative identification and planning difficult. Case presentation: A 2-year-old boy presented for follow-up of a large left extralobar pulmonary sequestration initially diagnosed on an antenatal ultrasound. Follow-up imaging, including prenatal MRI and postnatal CT angiography, was inconclusive on the precise location of the extralobar pulmonary sequestration in relation to the diaphragm but did reveal a subdiaphragmatic arterial supply from a branch off the celiac trunk. Planned resection with diagnostic thoracoscopy revealed the mass to seemingly be below the diaphragm; however, subsequent abdominal laparoscopy identified it to be within the diaphragm. Once the supplying vessel off the celiac trunk was controlled and divided, the mass was circumferentially excised from the edges of the diaphragmatic muscle. The remaining diaphragmatic defect was then closed, and the patient did well postoperatively. Conclusions: This case demonstrates the difficulty of making a definitive diagnosis of intradiaphragmatic extralobar pulmonary sequestration without operative intervention. CT angiography and identification of the sequestration's arterial supply may not be conclusive in determining the precise location if in close proximity to the diaphragm. [ABSTRACT FROM AUTHOR]

We present a case of intradiaphragmatic extralobar pulmonary sequestration (IDEPS) prenatally diagnosed via ultrasound and MRI. Originally seen in the second trimester, the lesion was followed with serial imaging pre and postnatally until being resected thorascopically at 2 years of age.

Abstract We present the case of a giant bronchogenic cyst (BC) that appeared just within the right diaphragm. A 51‐year‐old man was referred to our hospital with a chief complaint of pain from the lumbar area to the right shoulder. Computed tomography images showed a cystic mass measuring 18.0 × 17.5 × 12.8 cm in the right thoracic cavity. Right posterolateral thoracotomy from the eighth intercostal space was performed, and the cyst wall and diaphragm were resected together. The defect of the diaphragm was repaired using a 2‐mm‐thick Gore‐Tex™ expanded polytetrafluoroethylene patch. It is embryologically rare for a giant BC to develop within the right diaphragm. As BCs may be associated with malignant tumours or infection, complete resection of the cyst wall is required. Literature review revealed no consensus on the best surgical procedure. Therefore, it is important to consider the appropriate surgical procedure for each case.

Bronchogenic cysts are congenital anomalies arising from the abnormal budding of foregut during gestation. They are usually found in the mediastinum or lung parenchyma. Intradiaphragmatic location of bronchogenic cysts is very rare. We present the computed tomography findings, surgical specimen and pathologic features in a male patient who underwent thoracoscopic excision of an intradiaphragmatic bronchogenic cyst, which was then confirmed by pathology. [Arch Clin Exp Surg 2018; 7(3.000): 125-127]

We present the case of a giant bronchogenic cyst (BC) that appeared just within the right diaphragm. A 51‐year‐old man was referred to our hospital with a chief complaint of pain from the lumbar area to the right shoulder. Computed tomography images showed a cystic mass measuring 18.0 × 17.5 × 12.8 cm in the right thoracic cavity. Right posterolateral thoracotomy from the eighth intercostal space was performed, and the cyst wall and diaphragm were resected together. The defect of the diaphragm was repaired using a 2‐mm‐thick Gore‐Tex™ expanded polytetrafluoroethylene patch. It is embryologically rare for a giant BC to develop within the right diaphragm. As BCs may be associated with malignant tumours or infection, complete resection of the cyst wall is required. Literature review revealed no consensus on the best surgical procedure. Therefore, it is important to consider the appropriate surgical procedure for each case. [ABSTRACT FROM AUTHOR]

El secuestro broncopulmonar es una malformación congénita rara, consistente en una masa de tejido pulmonar no funcionante sin conexión al árbol traqueobronquial. Esta puede clasificarse en intra y extralobar. El extralobar corresponde al 25% de los secuestros broncopulmonares y sólo el 1% es intradiafragmático. Existe escasa literatura internacional sobre secuestro broncopulmonar intradiafragmático, por lo que su diagnóstico y tratamiento es un desafío para el cirujano. Nuestro caso es un recién nacido con diagnóstico antenatal de una masa abdominal por ecografía y resonancia magnética nuclear, las cuales mostraron un tumor adrenal que impresiona ser un neuroblastoma. Se realizó tomografía axial computarizada postnatal donde el secuestro broncopulmonar intradiafragmático apareció como más probable. No se pudo excluir el neuroblastoma. Se realizó laparoscopía abdominal en la que se observó un bulto en el hemidiafragma izquierdo. Se decidió un abordaje toracoscópico combinado, el cual mostró que el defecto se encontraba entre ambas cavidades. Este es el primer caso reportado de secuestro broncopulmonar intradiafragmático en Chile.

Bronchogenic cysts (BC) are congenital abnormalities that occur most commonly within the mediastinum, and rarely occur within the diaphragm. We present the 21st case of an intradiaphragmatic bronchogenic cyst in the English literature, and review all previous published cases. Analysis includes presenting clinical symptoms, relevant radiologic studies, surgical approaches to resection, and management of the diaphragm, among other relevant data. These lesions should remain on the differential diagnosis in cases of unusual masses in the region of the diaphragm. [ABSTRACT FROM AUTHOR]

We present a case of intradiaphragmatic extralobar pulmonary sequestration (IDEPS) prenatally diagnosed via ultrasound and MRI. Originally seen in the second trimester, the lesion was followed with serial imaging pre and postnatally until being resected thorascopically at 2 years of age. [ABSTRACT FROM AUTHOR]

Abstract: Pulmonary sequestrations are accessory foregut lesions that are most commonly located within the thorax and occasionally in the abdominal cavity. Sequestrations arising within the diaphragm are exceedingly rare. We describe 2 patients found to have left peridiaphragmatic lesions on prenatal ultrasound and postnatal computed tomography. In the first patient, an initial laparoscopic approach was abandoned in favor of a thoracoscopic approach after no intraabdominal mass was found. The second patient had an uncomplicated thoracoscopic resection of a similar lesion. To our knowledge, these represent the first intradiaphragmatic pulmonary sequestrations to be resected via a minimally invasive approach. The rarity of these lesions makes definitive diagnosis without operative intervention challenging. Thoracoscopy appears to be a reasonable approach for resection of such intradiaphragmatic lesions. [Copyright &y& Elsevier]

Abstract: Background/Purpose: Intradiaphragmatic extralobar pulmonary sequestrations (IDEPSs) are a rare subset of bronchopulmonary sequestrations (BPS). We report the largest series of patients with IDEPS and describe the diagnostic and operative challenges associated with this condition. Methods: We retrospectively reviewed our experience with fetal and pediatric BPS from 1995 to 2010 to identify patients with IDEPS. Results: We identified 27 patients with BPS and 4 patients in whom the masses were within the diaphragm. In 1 patient, the prenatal ultrasound correctly identified the mass as being within the diaphragm itself, whereas the remaining cases were thought to be intraabdominal or had discordant preoperative imaging findings. The diagnosis of an IDEPS proved challenging to make prospectively using prenatal ultrasound, computed tomography, or magnetic resonance imaging. All patients underwent attempted resection. Two cases required a combined laparoscopic and thoracoscopic approach to accurately localize the mass. The postoperative recovery of these patients was uneventful. Conclusions: We present the largest reported experience of IDEPS. Because preoperative imaging studies cannot always determine whether a sequestration is intraabdominal, intrathoracic, or intradiaphragmatic, operative planning may pose a challenge. However, the use of minimally invasive approaches can allow exploration of both the thoracic and abdominal cavities with low morbidity. [Copyright &y& Elsevier]

Abstract: Background: Extralobar pulmonary sequestrations (EPS) are a rare benign congenital bronchopulmonary foregut malformation. Complete resection is necessary to confirm the diagnosis with histopathologic examination. The aim of this study was to describe the laparoscopic minimally invasive surgery (MIS) for a small series of ectopic EPS in small children and to show its feasibility and safety. Methods: From January 2001 to December 2008, 12 cases of EPS were prenatally diagnosed and retrospectively reviewed. From this group, we isolated 6 children with ectopic EPS. Ages ranged from 15 days to 14 months. Three infants were symptomatic, and the others showed persistence of the lesion with parental anxiety. All prenatal diagnoses were confirmed by postnatal Doppler ultrasound and intravascular contrast computed tomography scan with 3-dimensional reconstructions. Postnatally, all were ectopic lesions: 3 were hiatal and intradiaphragmatic, 3 infradiaphragmatic and left paramedian. Laparoscopic MIS consisted of 4 small trocars and low-pressure pneumoperitoneum. We carried out a retroesophageal dissection in 4 cases, an elective control of systemic vessels, and a removal of the EPS with histologic study. Results: We performed 5 procedures laparoscopically and 1 thoracoscopically. There were 2 abdominal conversions. Nevertheless, no intraoperative or immediate postoperative complications occurred. Hospital stay ranged from 1 to 5 days (mean, 2.7 days). The diagnosis of pure pulmonary sequestration with feeding vessels in 5 cases was confirmed by histopathology. Follow-up ranged from 13 to 84 months (mean, 43 months). Late complications were benign. Conclusions: Laparoscopic MIS for ectopic EPS in small children is a feasible and safe technique. The great magnification provided by the endoscopic procedure allows for the search of associated congenital anomalies, meticulous retroesophageal dissection, and control of the systemic vessels. Resection provides definitive diagnosis and treatment, and confers the benefits of a minimal access technique. [Copyright &y& Elsevier]