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You are called from the ER about a 4 week-old infant, born full term to a 26<br />
year-old G1P0 via spontaneous vaginal delivery, who presented in respiratory<br />
distress. The parents deny fevers or sick contacts, but there is poor weight gain<br />
and diaphoresis during feeding. A chest radiograph shows a left lower lobe<br />
opacification. An ultrasound is performed, which demonstrates a pulmonary<br />
sequestration. The anesthesia resident is unfamiliar with the this diagnosis and<br />
you note that:<br />
<br />
a) Pulmonary sequestrations are most commonly extrapulmonary in nature<br />
<br />
b) The CXR findings likely represents a pneumonia that developed as a<br />
consequence of the sequestration<br />
<br />
c) The blood supply of pulmonary sequestrations is from systemic arteries<br />
<br />
d) Pulmonary sequestration is often associated with significant dead space<br />
ventilation<br />
<br />
e) There are three histologic subtypes of sequestration, with variable prognoses<br />
depending on subtype<br />
<div class="mw-customtoggle-TYK_Answer" style="text-align: right; color:#0000ff">Click for Answer</div><br />
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==Answer==<br />
Answer c. Pulmonary sequestration is most commonly (75%) intrapulmonary,<br />
not connected to the airways, and derive blood supply from the systemic<br />
circulation. While infection is possible, in this infant with no fever or other<br />
infectious signs it is unlikely. However, this infant is presenting with neonatal<br />
heart failure symptoms (diaphoresis and failure to thrive) secondary to large leftto-<br />
right shunt, and may benefit from diuretic therapy.<br />
==Notes==<br />
<references /><br />
:This question originally printed in the [http://www.amazon.com/Justin-L.-Lockman/e/B00FLG5AEE/ref=ntt_dp_epwbk_0 Pediatric Anesthesiology Review Topics] kindle book series, and appears courtesy of Naerthwyn Press, LLC.<br />
==Keywords==<br />
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