Thoracoscopic Resection of Bronchopulmonary Foregut Malformation

The patient was a 2 month old girl who presented with 3 days of significant stridor.

The condition was presumptively diagnosed as croup and the patient was placed on intravenous steroids.

The patient developed an upper gastrointestinal bleed and was intubated for upper endoscopy.

Upper endoscopy diagnosed steroid induced stress gastritis.

The endoscopist noted unusual angulation and some extrinsic compression of the esophagus.

Chest x-ray with the endoscope in place showed significant deviation of the scope and endotracheal tube to the right.

CT scan showed a posterior mediastinal cystic mass causing significant tracheal compression.

The endotracheal tube was advanced into the right main stem bronchus to isolate the left lung and facilitate a left thoracoscopic approach.

A bougie was introduced into the esophagus to clearly delineate it during the dissection.

The cyst was intentionally punctured and decompressed of its mucinous contents to significantly aid in the resection, particularly during its separation from the esophageal wall.

Traction on the cyst revealed its close relationship to the esophagus and the common wall shared by the two structures, confirming an esophageal duplication.

The esophageal muscle fibers investing the cyst were carefully divided very close to the cyst wall to avoid esophageal perforation.

The integrity of the esophagus was examined throughout the dissection.

The patient was extubated on the first postoperative day and had an uneventful recovery.