Bronchopulmonary Sequestration
Everything in the library about bronchopulmonary sequestration — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Medical Management
1 item
Prenatal Management of CPAMs: Lung Lesions
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Dr. Alan Flake discusses prenatal management of congenital pulmonary airway malformations (CPAMs). It includes two videos of examples of fetal surgery.
video18:16 · Jan 2019
Surgical Management
2 items
Postnatal Management of Lung Lesions Part II: Pediatric Thoracic Surgery...
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Course directors Drs Alan Flake, Steve Rothenberg and Todd Ponsky, along with additional faculty including Drs Jean Martin Laberge, Ramesh Santhanakrishnan, Giovanna Riccipetitoni, Mark Wulkan, Alexander Razumovskiy, Starla Martinez, Marcel
video25:07 · Sep 2018
Fetal Interventions Part II: Lung Lesions
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Dr. Alan Flake leads a discussion in fetal interventions for prenatally-diagnosed lung lesions.
video16:30 · Jan 2019
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Postnatal Management of Lung Lesions Part II: Pediatric Thoracic Surgery...
Infra-diaphragmatic and sub-diaphragmatic sequestrations are frequently misdiagnosed as intrathoracic lesions
clinicalSteve0:22 ↗
A new class of sequestrations exists within the leaves of the diaphragm muscle, requiring diaphragm opening for resection
clinicalSteve0:39 ↗
Sequestrations at the esophageal hiatus can cause esophageal obstructive symptomatology
clinicalAlan0:51 ↗
The majority of infra-diaphragmatic sequestrations approached abdominally extend up through the esophageal hiatus, even when not apparent on CT
clinicalSteve4:45 ↗
Intra-diaphragmatic sequestrations (between diaphragm leaves) are frequently associated with the esophageal hiatus
clinicalAlan6:21 ↗
Bronchogenic cysts can be associated with bronchial obstruction and cause hyperplastic growth of the distal lobe
clinicalAlan7:24 ↗
In cases of fetal bronchial atresia causing hydrops not responsive to steroids, fetal lobe resection may be required
clinicalAlan7:37 ↗
When bronchogenic cysts obstruct lobar bronchi, the bronchus is typically destroyed enough that lobectomy is required rather than cyst resection alone
clinicalAlan8:32 ↗
Energy-based vessel sealers are operator-dependent because they seal as the knife advances; advancing too fast will divide the vessel before sealing
clinicalSteve9:49 ↗
Modern energy sealers now have a tone frequency that indicates when the vessel is sealed and safe to advance the blade
clinicalAlan10:07 ↗
The risk with clips on vessels is inadvertent dislodgement during dissection because they protrude past the vessel and are relatively large in small spaces
clinicalSteve11:50 ↗
Clips are safer when used as the last maneuver, such as on sequestration feeding vessels, and can be reinforced with distal ligature
clinicalAlan12:17 ↗
Thoracoscopic resection specimens provide adequate histology for diagnosis, comparable to open procedures, despite pathologist complaints about specimen quality
clinicalAlan14:15 ↗
A recent JPS study comparing early (approximately 3 months) versus later (approximately 18 months) CCAM resection found increased risk of complications like infection with delayed resection but no difference in long-term pulmonary function outcomes
host_summaryAlan15:33 ↗
Compensatory lung growth and alveolarization continues until age 4-6 years, so resection timing within the first few years likely does not significantly impact lung development
clinicalAlan16:22 ↗
CO2 insufflation pressure of 7 cm H2O is typically used for pediatric thoracoscopy and is well tolerated
clinicalAlan19:12 ↗
Starting CO2 pressure at 4 cm H2O is adequate if single-lung ventilation is good; pressure may need to increase to 7-8 cm H2O for lung collapse then can be reduced
clinicalSteve19:27 ↗
Main-stem intubation of the contralateral bronchus provides adequate single-lung ventilation with some overflow ventilation that is well tolerated
clinicalSteve19:35 ↗
The smallest thoracoscopic lobectomy performed was approximately 2400g, which was not significantly different technically from a term infant
clinicalAlan20:25 ↗
PDA ligations are now routinely performed thoracoscopically down to 800g, and 1000g now seems like a large space compared to a few years ago
clinicalSteve20:49 ↗
Current technology limits thoracoscopic lobectomy in small infants because 5mm clips and sealers occupy two-thirds of the chest space, making effective work difficult
clinicalSteve21:20 ↗
Thoracoscopic lobectomy under 2kg is difficult with current technology
clinicalSteve21:50 ↗
Premature infants requiring CCAM resection typically have large masses impacting ventilation, which cannot be done thoracoscopically and have contralateral lung issues preventing single-lung ventilation
clinicalAlan21:57 ↗
A healthy, stable baby with a healthy contralateral lung is required for thoracoscopic lobectomy
clinicalAlan22:12 ↗
Infants with small, stable CCAM lesions can be sent home for 1-2 months to grow before returning for elective resection, making the operation easier and less stressful for parents
clinicalSteve22:44 ↗
Most CCAM lesions are removed before 3 months of age; the operation is technically easier in small infants despite the smaller working space, and children recover more quickly with shorter hospitalization
clinicalSteve17:38 ↗
Trocar setup is critical in neonatal thoracoscopy; incorrect trocar positioning will make the operation very difficult, especially in small neonates
clinicalSteve18:15 ↗
True bilobar CPAM involvement is relatively rare; most cases involve abnormal lobulation or fissure formation rather than actual involvement of two lobes
clinicalAlan24:07 ↗
When fissures are abnormal, the approach is to create a fissure in an appropriate position that preserves maximal lung parenchyma while avoiding leaving devascularized lung or lung without an airway
clinicalAlan24:25 ↗
Following anatomic boundaries properly makes residual cystic lesions requiring re-resection rare; speaker has had only one case requiring return for further resection
clinicalAlan24:50 ↗
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