Neonatal Med.  2019 Nov;26(4):223-228. 10.5385/nm.2019.26.4.223.

Communicating Bronchopulmonary Foregut Malformation Type III with Pulmonary Sequestration Diagnosed in a Newborn: A Case Report

• Kim SK
• Choi JW
• Kim HK
• Sung SI
• Chang YS
• Park WS

• KMID: 2466643
• DOI: http://doi.org/10.5385/nm.2019.26.4.223

Abstract

Communicating bronchopulmonary foregut malformation (CBPFM) is a communication between the respiratory and gastrointestinal tracts that can be difficult to differentiate from pulmonary sequestration or H-type tracheoesophageal fistula (TEF) because of the similarities in clinical features. A female neonate born at full term had been experiencing respiratory difficulty during feeding from the third day of life. The esophagography performed to rule out H-type TEF revealed that the esophageal bronchus directly communicated with the left lower lobe (LLL) of the lung. Lobectomy of the LLL, fistulectomy of the esophagobronchial fistula, and primary repair of the esophagus were performed. Finally, CBPFM type III with pulmonary sequestration was confirmed on the basis of the postoperative histopathological finding. We report the first newborn case of CBPFM type III with pulmonary sequestration in Korea.

Keyword

Bronchial fistula; Bronchopulmonary sequestration; Tracheoesophageal fistula

MeSH Terms

Bronchi
Bronchial Fistula
Bronchopulmonary Sequestration*
Esophagus
Female
Fistula
Gastrointestinal Tract
Humans
Infant, Newborn*
Korea
Lung
Tracheoesophageal Fistula

Figure

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  Figure 1. Chest radiograph after gastric tube insertion (at birth). Increased opacity is found involving the left lower lung field (solid arrow). The cardiac size is borderline. A feeding tube is placed with its tip on the stomach, which is located more medial than usual and associated with visible small bowel gases in the right abdomen, suspected to be gastrointestinal malrotation.

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  Figure 2. (A) Esophagogram. The esophagus is directly communicating with the bronchus from the left lower lobe of the lung (solid arrow), combined with a suspected right gastric diverticulum (dotted arrow). (B) Chest computed tomography scans (coronal view). The left lower lobe, which contains atelectasis and consolidation, is supplied by the aberrant artery arising from the celiac trunk. A lesion suspected to be a fistula (solid arrow) is found between the esophagus and the bronchus.

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  Figure 3. (A) Intraoperative demonstration of the anatomy. The feeding artery (solid arrow) from the celiac trunk is depicted. (B) Intraoperative demonstration of the anatomy. The fistula (solid arrow) connecting the esophagus to the bronchus is shown.

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  Figure 4. Gross surgical specimen of the resected left lower lobe. The left lower lobe tissue measures 8×5×3 cm. The gross finding shows bronchiectasis or a dilatated cystic area.

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