Case Report

Incidental Finding of Congenital Thoracic Malformations in Adult Population

Authors: Mehdi Akhavan-Heidari, MD, Devin Edwards, MD, Jessica Besenhaver, MS, Rebecca Wolfer, MD

Abstract

Objective: Evaluation of abnormal adult chest computed tomography (CT) scans.


Study Design: Retrospective series of 3 cases.


Setting: Two University-based hospitals.


Intervention: Three adult patients (age range 56 to 61) underwent chest CT scans. Two were trauma patients and one complained of chest pain with a negative cardiac workup. One CT scan revealed a lung mass that was highly suspicious for malignancy and the other two CT scans were suspicious for diaphragmatic hernia. Two patients underwent elective surgery and the third underwent emergent surgery.


Results: The CT scan of patient 1 was suspicious for malignancy; however, the pathology of the lung mass revealed only inflammation consistent with an intralobular bronchopulmonary sequestration. Patient 2 had a congenital Morgagni hernia with omentum and colon in the mediastinum, and patient 3 had a diaphragmatic defect combined with a bifid sternum and defective pericardium, fulfilling three criteria of pentalogy of Cantrell.


Conclusion: Thoracic congenital malformations may go unnoticed and unsuspected until adulthood. They should be kept in mind when reviewing unusual CT scans of the chest in adults. Their surgical management, however, is similar to their counterparts in infancy.


Key Points


* Congenital abnormalities are uncommon in the adult population due to detection and correction in childhood.


* Missed congential defects can be found incidentally in adulthood with imaging for an unrelated problem.


* Missed congenital abnormalities should be kept in mind when reviewing unusual CT scans of the chest in asymptomatic adults.


* Surgical management of congenital abnormalities is similar in adults and in children.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Pryce DM. Lower accessory pulmonary artery with intralobar sequestration of lung: a report of seven cases. J Pathol 1946;58:457–467.
 
2. Petersen G, Martin U, Singhal A, et al. Pulmonary sequestration in the middle-aged and elderly adult: recognition and radiographic evaluation. J Thorac Cardiovasc Surg 2003;126:2086–2090.
 
3. Shibli M, Connery C, Shapiro JM. Intralobar and extralobar bronchopulmonary sequestration complicated by Nocardia asteroides infection. South Med J 2003;96:78–80.
 
4. Albanese CT. Pediatric surgery. In: Norton JA, Bollinger RR, et al, eds. Surgery: Basic Science and Clinical Evidence. 1st ed. New York, Springer, 2001, pp 2069–2819.
 
5. Kirks DR, Kane PE, Free EA, et al. Systemic arterial supply to normal basilar segments of the left lower lobe. AJR Am J Roentgenol 1976;126:817–821.
 
6. Savic B, Birtel FJ, Tholen W, et al. Lung sequestration: report of seven cases and review of 540 published cases. Thorax 1979;34:96–101.
 
7. Iwai K, Shindo G, Hajikano H, et al. Intralobar pulmonary sequestration, with special reference to developmental pathology. Am Rev Respir Dis 1973;107:911–920.
 
8. Ikezoe J, Murayama S, Godwin JD, et al. Bronchopulmonary sequestration: CT assessment.Radiology 1990;176:375–379.
 
9. O’Mara CS, Baker RR, Jeyasingham K. Pulmonary sequestration. Surg Gynecol Obstet1978;147:609–616.
 
10. Singh S, Bhende MS, Kinnane JM. Delayed presentations of congenital diaphragmatic hernia.Pediatr Emerg Care 2001;17:269–271.
 
11. Tazuke Y, Kawahara H, Soh H, et al. Congenital diaphragmatic hernia in identical twins. Pediatr Surg Int 2000;16:512–514.
 
12. Gerard PS, Wilck E, Senderoff E, et al. Morgagni hernia mimicking a lipomatous tumor. N Y State J Med 1993;93:58–59.
 
13. Harris GJ, Soper RT, Kimura KK. Foramen of Morgagni hernia in identical twins: is this an inheritable defect? J Pediatr Surg 1993;28:177–178.
 
14. LaRosa DV Jr, Esham RH, Morgan SL, et al. Diaphragmatic hernia of Morgagni. South Med J1999;92:409–411.
 
15. Wong NA, Dayan CM, Virjee J, et al. Acute respiratory distress secondary to Morgagni diaphragmatic herniation in an adult. Postrad Med J 1995;71:39–41.
 
16. Sekiguchi Y, Shimura S, Takishima T,. Intrapleural omentum simulating pleural effusion. Chest1994;106:285–287.
 
17. Carmi R, Boughman JA. Pentalogy of Cantrell and associated midline anomalies: a possible ventral midline developmental field. Am J Med Genet 1992;42:90–95.
 
18. Online Mendelian Inheritance in Man, OMIM (TM). Johns Hopkins University, Baltimore, MD. MIM Number: {313850}: {12/10/2002}. Available at: http://www.ncbi.nlm.nih.gov/omim/
 
19. Martin RA, Cunniff C, Erickson L, et al. Pentalogy of Cantrell and ectopia cordis, a familial developmental field complex. Am J Med Genet 1992;42:839–841.