TYK374
You are called from the ER about a 4 week-old infant, born full term to a 26 year-old G1P0 via spontaneous vaginal delivery, who presented in respiratory distress. The parents deny fevers or sick contacts, but there is poor weight gain and diaphoresis during feeding. A chest radiograph shows a left lower lobe opacification. An ultrasound is performed, which demonstrates a pulmonary sequestration. The anesthesia resident is unfamiliar with the this diagnosis and you note that:
a) Pulmonary sequestrations are most commonly extrapulmonary in nature
b) The CXR findings likely represents a pneumonia that developed as a consequence of the sequestration
c) The blood supply of pulmonary sequestrations is from systemic arteries
d) Pulmonary sequestration is often associated with significant dead space ventilation
e) There are three histologic subtypes of sequestration, with variable prognoses depending on subtype
Answer
Answer c. Pulmonary sequestration is most commonly (75%) intrapulmonary, not connected to the airways, and derive blood supply from the systemic circulation. While infection is possible, in this infant with no fever or other infectious signs it is unlikely. However, this infant is presenting with neonatal heart failure symptoms (diaphoresis and failure to thrive) secondary to large leftto- right shunt, and may benefit from diuretic therapy.
Notes
- This question originally printed in the Pediatric Anesthesiology Review Topics kindle book series, and appears courtesy of Naerthwyn Press, LLC.