Case Reports

Pulmonary cystic disease associated with pectus excavatum : Two case

Yoshikiyo Nakagawa, Sadashige Uemura, Tsunehiro Yano, Tatsuo Nakaoka
Terutaka Tanimoto, Shigeki Imai 1）,Shigeru Watanabe 1）
Department of Pediatric Surgery, Diagnostic Radiology 1）, Kawasaki Medical School

Abstract

　　We report two cases of pulmonary cystic disease which were accidentally found in preoperative images of pectus excavatum (PE).
Case 1 : A seven-year-old girl presented with moderate chest depression without a history of respiratory symptoms. Preoperative CT scan demonstrated an emphysematous lesion in the upper lobe of the right lung. We removed it surgically under thoracoscopic assistance. Although bronchial obstruction and stenosis were not clear from the images and pathological findings, it was diagnosed as lobar emphysema. The postoperative course was favorable and she underwent the Nuss procedure a half year later.
Case 2 : A six-year-old girl presented with moderate chest depression without other symptom. CT scan demonstrated an emphysematous lesion in the right lower lobe. As an abnormal vessel was pointed out in the area, we performed MR angiography. An aberrant vessel which flowed into the right lower lobe from the aorta was clearly depicted. Accordingly, we diagnosed it as pulmonary sequestration. We performed thoracoscopic right lower lobectomy. She underwent the Nuss procedure a year later.
As congenital pulmonary cystic disease and PE occasionally coexist, preoperative CT scan of PE should be performed. When lung resection was required for a patient with PE, two-stage surgery was performed, as earlier lung resection would be more favorable in preventing bar-related infection and acute expansion of the lung.

Keywords：Pulmonary cystic disease, Pectus excavatum (funnel chest), Lober emphysema, Pulmonary sequestration, Nuss procedure