Thoracoscopic pneumonectomy for communicating bronchopulmonary foregut malformation in a 4-month-old child

Thoracoscopic total pneumonectomy has recently been described in the pediatric literature for the first time (Anselmo D, Perez I, Shaul D. Thoracoscopic Pneumonectomy for Severe Bronchiectasis in a 9-Year-Old Female. J Laparoendosc Adv Surg Tech 2008;18:775-777). In this article, we describe the use of thoracoscopic pneumonectomy in a 4-month-old boy with a complete (entire left lung) communicating bronchopulmonary foregut malformation. The patient is a 4-month-old boy who presented with persistent cough and low-grade fever. Chest radiograph was performed and showed a diffuse infiltrative pattern in the left lung. Computed tomography was then performed and revealed a poorly aerated abnormal left lung with absence of the left main stem bronchus. Subsequently, the patient underwent an upper gastrointestinal (UGI) series, which demonstrated that the left main stem bronchus arose from the distal esophagus and had no communication with the trachea. The patient tolerated a left thoracoscopic pneumonectomy very well. On postoperative day 5, a UGI demonstrated a question of a small contained leak. Therefore, a repeat study was performed 1 week later and did not demonstrate a leak. He was discharged in good health. Communicating bronchopulmonary foregut malformations are rare anomalies that require resection of the anomalous lung segment. This can be safely performed with a thoracoscopic technique even if it requires a pneumonectomy.