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CC BY 4.0 · European J Pediatr Surg Rep. 2022; 10(01): e141-e144
DOI: 10.1055/s-0042-1757570
Case Report

Arterial Embolization and Methylene Blue Injection into the Aberrant Artery in Two Infants with Intralobar Sequestration

Anna Ayako Accarain 
1   Department of Surgery, Université Libre de Bruxelles, Brussels, Belgium
,
Marc Laureys
2   Department of Radiology, Brugmann University Hospital, Brussels, Belgium
,
Luc Joyeux
3   Department of Pediatric Surgery, Hopital Universitaire des Enfants Reine Fabiola, Bruxelles, Belgium
,
Nasroola Damry
2   Department of Radiology, Brugmann University Hospital, Brussels, Belgium
,
Henri Steyaert
3   Department of Pediatric Surgery, Hopital Universitaire des Enfants Reine Fabiola, Bruxelles, Belgium
,
Helena Reusens
3   Department of Pediatric Surgery, Hopital Universitaire des Enfants Reine Fabiola, Bruxelles, Belgium
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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


Publication History

Received: 18 July 2021

Accepted: 02 March 2022

Article published online:
10 October 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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