Special Feature: Surgical pediatric surgery cases as seen from imaging
The usefulness of preoperative imaging studies for thoracoscopic pulmonary lobectomy in children
2019 Volume 35 Issue 2 Pages 78-83
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2019 Volume 35 Issue 2 Pages 78-83
Thoracoscopic pulmonary lobectomy (TPL) is widely used as the treatment of choice for congenital cystic lung diseases, such as congenital pulmonary airway malformation (CPAM) and intralobar pulmonary sequestration (ILPS). However, TPL in children is technically challenging, because the thoracic cavity is small, and cystic lesions may further obstruct the operative field. Thus, thorough understanding of anatomic relations preoperatively is vital for successful outcome.
Here, we introduce our preoperative imaging protocol that uses thin-slice computed tomography (CT) for investigating CPAM/ILPS cases, by introducing a case of prenatally diagnosed left-lower lobe CPAM who was asymptomatic after delivery and had elective TPL when 2 years old. Preoperative CT identified a 35 mm cystic lesion in the left-lower lobe, and a rare anomalous A6 pulmonary artery that divided into two branches. Because of the CT study, the second branch of A6 could be identified safely at surgery. An intraoperative video highlighting the value of our protocol is presented.
Thin-slice contrast CT is mandatory for assessing the anatomic relations of cystic lesions in relation to pulmonary vasculature, the bronchial tree, as well as for confirming the status of fissures between lobes, to ensure TPL is performed safely and effectively.
