0:00

So this was a newborn infant who prenatally was diagnosed

0:04

with a known congenital lung lesion.

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So the first study that we have is an x-ray of the chest,

0:11

abdomen, and pelvis on day of life zero

0:13

to make sure there's no crazy mass effect

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or something that they need to do urgently

0:18

to care for this infant.

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This patient has symmetrically low lung volumes,

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but basically a normal chest x-ray.

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Otherwise we have some central atelectasis,

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but I don't really see any abnormal opacities,

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no abnormal lucency.

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This is just normal appearance

0:33

of thymus in the right paraspinal region

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and normal emus in the left paraspinal region.

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This bowel gas pattern is also totally normal.

0:41

Um, don't forget that the umbilical stump clamp often will

0:45

pro, will project over the upper abdomen.

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So don't confuse that for pathology.

0:49

So in a patient with a known congenital lung abnormality on

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prenatal imaging, they will wait until about six months

0:55

of age to, uh, go undergo preoperative planning CT

0:59

and geography to, uh, delineate anatomy

1:02

and help plan their surgical approach.

1:05

So this patient, uh, about four months later, underwent, uh,

1:09

CT and geography to, uh, better delineate that lesion.

1:11

They let her grow a little bit.

1:13

Um, so as we're going from superior to inferior,

1:15

you can see a nice correlate to

1:17

that prominent right-sided thymus that we saw on

1:20

that test radiograph, even though it's several months later.

1:23

As we're continuing to, uh, scroll inferiorly, uh,

1:26

we'll come back to this finding here in a moment.

1:28

But there is an abnormal, uh,

1:31

lesion in this posterior

1:34

and medial aspect of this right lower lobe.

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So the question is always,

1:38

is this congenital pulmonary airway malformation

1:41

or is this a sequestration?

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And this big huge feeding systemic artery arising from the

1:48

aorta is gonna give us the answer

1:49

that this is a sequestration.

1:51

So once you see this feeding vessel from the abdominal aorta

1:55

supplying a lung lesion, you can be very confident

1:58

that it is a sequestration.

2:00

Now let's go back to that other finding

2:02

that we saw on the lateral view.

2:04

'cause the surgeon is gonna have two jobs to do at once.

2:07

Number one, he or she is going to need to resect that, uh,

2:11

medial right lower lobe lesion in the, uh,

2:15

posterior aspect of the right lower lobe.

2:17

But number two, they're gonna have

2:18

to fix this more gagny hernia.

2:20

So this more gagny hernia contains part of transverse colon.

2:24

Um, so good news, they can, they can do two things at once.

2:28

This incidental more gagny hernia we saw on this

2:31

preoperative planning CTA when we were trying

2:34

to distinguish CPAM versus sequestration, um,

2:37

and delineate the vascular supply of that, um,

2:41

right lower lobe lesion

2:42

so they can take just a thoracic only approach

2:45

and then repair the liga hernia while they're in there.