pulmonary sequestration in children
Introduction
Introduction to Pediatric Lung Isolation Pulmonary sequestration (pulmonary sequestration) is a congenital dysplasia of lung tissue characterized by a portion of lung tissue that is isolated from normal lung tissue and that is not connected to the bronchial and pulmonary arteries of normal lung tissue, and whose blood supply is from the aorta. An abnormal branch can be divided into two types, an intra-leaf type and an extra-leaf type. basic knowledge The proportion of illness: 0.0021% Susceptible people: children Mode of infection: non-infectious Complications: multiple lung infections
Cause
Causes of pulmonary isolation in children
(1) Causes of the disease
Pulmonary sequestration is a congenital malformation, which refers to non-functional embryonic and cystic lung tissue. The cause of this disease is unknown. Some people think that isolated lung tissue may originate from an abnormal bronchus in the embryonic stage, the early embryo of the embryo and There are many capillaries around the lung bud that are connected to the renal aorta. Because the capillaries connected to the isolated lung tissue are not absorbed, they can serve as a branch of the aorta and become an abnormal artery for supplying isolated lungs. It was found to be related to genetic factors, and in some cases, the mother had an abnormal pregnancy history during pregnancy.
(two) pathogenesis
1. Intra-leaf type: more common, there is a common visceral pleura in the lobe, 60% in the left lower lobe, blood supply from the large branch of the aorta, venous return to the pulmonary vein, even with the gastrointestinal tract, but rare, There is a small amount of traffic between the isolated lung and the nearby lung tissue. The intralobular type is mostly containing balloon swelling. There are many symptoms in the neonatal and infancy. About half of the cases can be diagnosed after puberty. X-ray examination shows a thin wall cyst. It is connected to the adjacent bronchus, and there are one or several cavities, and there are air and liquid planes in the cavity.
2. Leaf appearance: less common, located in the visceral pleura, can also be regarded as the secondary lung lobe, isolated lung tissue can communicate with the trachea, bronchus, esophagus, stomach, small intestine, but rare, blood supply from the small branch of the aorta, Intravenous inflow into the azygous vein, 90% in the left lower lobe and transverse diaphragm, showing no balloon-shaped mass, often combined with other congenital malformations such as transverse sputum, X-ray showed a tumor-like or lobulated dense shadow, neat edges Sometimes it is semi-circular by the shadow of the heart and the shadow of the cross (more than half of the diagnosis within 1 year).
Prevention
Pediatric lung isolation prevention
1, a reasonable diet, increase nutrition.
2, open the window every day to keep the indoor air fresh, especially the bedroom, computer room, study and so on.
3. Go to places with dense population and air pollution, such as dance halls, theaters, and video halls.
4. Wash your hands frequently and wash them thoroughly with running water, including rubbing your hands with dirty towels.
5, it is best to wear a mask when going to the hospital, wash your hands after going home, to avoid cross-infection.
6, be careful not to fatigue, prevent colds, so as not to reduce disease resistance.
Complication
Pediatric pulmonary isolation complications Complications multiple lung infections
There are many recurrent or persistent progressive lung infections.
Symptom
Symptoms of pulmonary isolation in children Common symptoms Fever with cough, slightly... Chest pain secondary infection hemoptysis chills weight loss
Symptoms usually occur after secondary infection, especially in the intra-leaf type. Repeated or persistent progressive pulmonary infection, like pneumonia or lung abscess, chills, fever, chest pain, cough, cough and hemoptysis, weight Relieve, the leaf type infection is less common, more asymptomatic, only the chest cavity mass was found during X-ray examination. Although the X-ray examination showed abnormal shadow before surgery, it was difficult to distinguish it from pulmonary cyst and other lung diseases.
Examine
Pediatric lung isolation test
Routine laboratory tests are not special. When there is infection, blood routine examination is the diagnosis of infectious blood picture. The diagnosis mainly relies on imaging examination. Chest X-ray can provide the initial clue to diagnose PS. B-ultrasound and color Doppler ultrasonography have become Common methods for screening PS, chest CT can be an important means of detecting PS because it can display abnormal blood supply arteries and substantial changes, and can be divided into the following three types:
1 cyst or soft tissue mass containing gas and liquid.
2 changes around the emphysema around the cyst or mass.
3 localized multi-vessel signs, most cases can be diagnosed by B-ultrasound and CT examination, retrograde aortic angiography, because of the ability to determine the source of blood vessels, it is decisive for the diagnosis of PS, to find out the number of parts of the blood supply artery, The path is essential for the development of a surgical plan. The chest MRI can be multi-planar and has a vascular flow effect. The PS donor artery and the reflux vein can be displayed without a contrast agent.
Diagnosis
Diagnosis and diagnosis of pulmonary isolation in children
The diagnosis of this disease should be based on X-ray examination and bronchography. Chest X-ray examination often shows large dense shadows in the lesion area. Single or multiple cystic light-transparent areas can be seen in between. The thickness of the capsule wall varies, and there are often inflammatory infiltration around. If there is liquid level in the capsule, it indicates that the cystic cavity and the bronchus are in communication. The X-ray lateral image or layered radiograph can more clearly show the exact location and extent of the lesion, and the relationship with adjacent tissues and organs, thus eliminating In other lung diseases such as focal chronic empyema, bronchography can show that the contrast agent can not enter the lesion area, and the adjacent normal bronchial shadow is displaced due to the extrusion, which can be differentiated from bronchiectasis and local inflammation. Retrograde aortic angiography can further show the blood supply and vascular walking direction of the lesion. This point is helpful for judging the location of abnormal blood vessels during surgery to avoid accidental injury to the artery and causing major bleeding. It is helpful in the differential diagnosis of congenital cysts. It is also important because the pulmonary cyst does not have this abnormal supply of arteries.
The intralobular type should be differentiated from congenital pulmonary cysts and similar diseases; the leaf type should be differentiated from the lung tumor, and bronchography is helpful for differential diagnosis. Because there is no contrast agent filling in the isolated lung, but the surrounding is full of contrast The bronchial image of the agent shows a clear outline. When bronchoscopy, no purulent secretions flow out from the main bronchus, even in the presence of infection. Retrograde aortic angiography can develop the branch of the artery that supplies the isolated lung to be diagnosed. .
