Total unilateral pulmonary sequestration.

A case is described of a baby boy aged 7 months who was found to have total sequestration of the right lung, the right main bronchus communicating with the lower end of the oesophagus. This was discovered during investigation for supposed asthma, as the child had wheezed since birth. No episodes of cyanosis or difficulties with feeding had occurred. The embryological considerations are discussed and reasons are given to account for this abnormality which must have occurred at the 5-mm. stage of development. This child is probably the first reported case of total pulmonary sequestration which has survived childbirth and subsequent pneumonectomy and now, when 6 years old, appears to have a reasonable life ahead. A baby boy aged 7 months was admitted to hospital on 20 October 1961 with a history of wheezing since the day of birth. He had never had any feeding difficulties or attacks of cyanosis. There was an unusual shape to the back of his head and webbing of the neck was present. The apex beat was found to be near the right nipple. The chest radiograph (Fig. 1) showed a marked mediastinal shift to the right. On broncho-scopy the instrument could only be passed just through the cords and then, due to acute angulation backwards of the trachea, could be passed no further. A bronchogram was carried out and this confirmed the posterior angulation of the trachea (Fig. 2) and also showed the total absence of a right bronchial tree and the presence of a normal left bronchial tree (Fig. 3). A penetrating chest radiograph was taken and, as a result of the air spaces seen in the right lung field, the child was given propyliodone (Dionosil) to swallow and this showed the presence of a large broncho-oesophageal fistula leading upwards from the oesophagus about 1 cm. above the diaphragm (Fig. 4). As no other serious congenital abnormality could be found it was decided that this sequestrated lung should be removed before a severe infection developed. A right thoracotomy was performed on 7 November, when a free pleural space was found without evidence of effusion or infection. The lung was of normal size but was grey in colour, pneumonic FIG. 1. Plain radiograph of chest showing collapse of right lung. 311