Introduction: Complications by lung sequestration may include massive pleural effusions that can
become evident already during pregnancy and require immediate therapy.
Case presentation: We report the case of a pregnant 34-year-old female, who was admitted in her 30th
week of pregnancy for severe left-sided hydrothorax of the fetus. A lung sequestration
was suspected by ultrasound. An intrauterine double pigtail was implanted as a pleuro-amniotic
shunt. The further course of the pregnancy was uneventful. The fetus was born spontaneously
in the 38th week.
Ultrasound and computed chest tomography of the newborn confirmed the presence of
a sequestration of the left lower lobe. Massive left-sided effusion caused complete
atelectasis of the left lung und a marked rightward mediastinal shift. The double
pigtail (pleuro-amniotic shunt) was dislocated into the left hemi-thorax and had to
be removed surgically. A new pigtail catheter was inserted. However, under conservative
therapy recurrent and progressive pleural effusions with respiratory insufficiency
were evident. Therefore, surgical resection of the lung sequestration was required
on the 20th day postpartum.
Intraoperatively, a single large artery directly from the distal thoracic aorta provided
vascular supply for the large and lobulated sequester, which was adjacent to a normal
left lower lobe. Histopathologic evaluation of the resected sequestration revealed
loss of draining lymphatic vessels, which explains the massive pleural effusions.
Following an uneventful postoperative course the neonate was discharged on postoperative
day 10 with a regular x-ray.
Conclusions: This case demonstrates that severe, pleural effusion may present as a consequence
from sequestration of the lung. Early intervention, interdisciplinary management and
surgical resection allowed for a safe correction of this rare but potentially life-threatening
malformation.
