0:01

So this is, uh, an older infant, a seven month old infant

0:04

who presented, uh, with respiratory distress.

0:08

And you can see this abnormal lucency in the right lower

0:11

lung zone of this, uh, of this infant.

0:15

Um, on our lateral view, uh, we can see

0:18

that it projects over the anterior aspect

0:20

of the right lower lung zone, so potentially in the,

0:22

the right middle lobe of this infant.

0:25

So the next thing we'll do is we'll recommend a CT

0:28

angiography to be able to better delineate the anatomy

0:32

of this lesion and

0:33

to see if it has an arterial vascular supply

0:35

or not to distinguish between CPAM and sequestration.

0:40

So this patient shortly

0:41

after underwent CT to, uh,

0:44

better delineate the preoperative anatomy of this lesion.

0:47

You can see this patient was imaged with general anesthesia.

0:50

This is an endotracheal tube to be able to, uh, make sure

0:53

that this patient stayed still

0:54

to delineate vascular anatomy.

0:56

So as we're coming from superior

0:58

to inferior on this axial ct, we have normal lungs

1:01

until we reach the level of the right middle lobe.

1:04

And here we can see that there are multiple cysts

1:07

of varying size completely replacing the

1:09

parenchyma of this right.

1:11

Um, middle lobe, this is pretty far away from the, uh,

1:16

the, um, abdominal, I'm sorry, the thoracic aorta.

1:20

And so it would be pretty unusual

1:21

to have a systemic vascular supply to

1:24

that right middle lobe,

1:25

but we'll just kind of pay close attention

1:27

that there's no abnormal vessels extending towards

1:29

this right middle lobe region.

1:31

And, and I don't see anything like that.

1:33

Let's look at the coronal plane, um, to make sure

1:37

that we're dealing with the right middle lobe and we are.

1:39

So, um, minor fissure is this structure.

1:42

Major fissure is this structure.

1:43

So we are in the right middle lobe.

1:45

So we can tell our surgeons this is a congenital pulmonary

1:48

airway malformation with, um, varying size cysts,

1:52

and we would measure some of the largest ones.

1:54

This is probably a large cyst type CPM

1:57

in the right middle lobe.

1:58

One more time, we'll just look at the sagittal plane.

2:01

Um, we also wanna pay close attention

2:03

that we don't see any other lesions

2:05

because it's common for, uh, lesions to go together.

2:08

So when you see one lesion, stop

2:10

and look carefully for a second incidental lesion

2:13

or some other, uh, anatomic abnormality in these infants.

2:17

Um, but in this patient, it looks like the, uh,

2:20

congenital pulmonary airway malformation is below it,

2:23

closely approximates the anterior aspect of

2:25

that right minor fissure.

2:26

But this is a CPA mostly combined to the right middle lobe.

2:30

And we'll tell our surgeon, um, that middle lobectomy is,

2:34

is, uh, probably going to get all of this lesion.