INTERESTING CASE

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INTERESTING CASE ROUND

• ????????????????????????? ??????????

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• ???????? ??. ?????????????????? repeated
  episodes of fever, cough ??? respiratory distress
  ?????????? 6 ?????
• ??????????? ????????????????????????
  ?.?.??????????????????? ??? pulmonary
  tuberculosis
• ?????????????????????????? ?.?. ?????????
  ?????????????????? agenesis of left lung

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??????????? Wt 6,300 gm Ht 69 cm,
T 37.2oC , HR 120/min, RR 58/min Pectus
excavatum, slight suprasternal retraction, mild
cyanosis, trachea deviate to the left
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??????? 3 ?????????????? 10 ?????
Rt hemithorax hyper-tympanic with diminished
breath sound Fine crepitations over the left
hemithorax Liver palpable 2 cm below RCM Few
cervical LN, sized 0.2-0.5 cm were palpable
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??????? 3 ?????????????? 10 ?????
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Chest roentgenogram hyper aeration and cystic
lesion of the right lung Heart shifted to the
left Lungs Pulm. infiltration in Rt lung,
posteriorly What is your next approach ?
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??????? 3 ?????????????? 10 ?????
Tomogram compression of the right upper lobe
bronchus and multiple cystic shadows in the right
lower lobe.
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(No Transcript)
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Pulmonary angiography and thoracic aortography
with selective angiogram revealed an anomalous
artery arising from descending aorta just above
the diaphragm to supply the cystic lesion in
the posterior part of the right lower lobe.
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Pathological examination showed a feeding artery
entering the nodular and cystic lower lobe which
was larger than normal. Bronchographic study of
the excised lung failed to reveal communication
between the normal bronchial tree and the right
lower lobe lesion.
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Pulmonary Sequestration
Pulmonary tissue that is embryonic and cystic,
does not function, is isolated from normal
functioning lung, and is nourished by systemic
arteries.
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Pulmonary Sequestration
The intralobar sequestration is encircled by
visceral pleura and has no pleural separation
from the rest of the lobe it usually occurs in
the lower lobes. The systemic arteries are likely
to be large, and the veins drain into the
pulmonary system.
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Pulmonary Sequestration
Extralobar sequestration can occur from the
thoracic inlet to the upper part of the abdomen
but characteristically is a left- sided (gt 90
percent), ball-like, pliable mass between the
diaphragm and the lower lobe and outside the
visceral pleura.
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Pulmonary Sequestration
The systemic arteries are small, the venous
drainage is likewise systemic through the azygos
system and other anomalies, principally
congenital pleuroperitoneal hernias, are
frequently concurrent.
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??????? 4 ??????????? 1 ?? Admit
???????????? ?? ??? ???????????? pneumonia
Chest X-ray ?? nodular density ??? Lt. hilar
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??????? 4 ??????? ???? 1 ??
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What is your diagnosis and next approach ?
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??????? 4 ??????????? 1 ?? ??? tomogram
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What is your diagnosis and next approach?
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???????? bronchogenic cyst