Imaging Diagnosis for Intradiaphragmatic Pulmonary Sequestration: A Pilot Study.

Area of Science:

• Radiology
• Pediatric Surgery
• Thoracic Imaging

Background:

• Extrapulmonary sequestration (EPS) is a rare congenital malformation.
• Intradiaphragmatic EPS (ID-EPS) is particularly uncommon and poses diagnostic challenges due to its location within the diaphragm.
• Conventional diagnosis often necessitates invasive procedures like diaphragm incision or detachment.

Purpose of the Study:

• To describe the characteristic imaging findings of ID-EPS.
• To evaluate the diagnostic accuracy of ultrasonography and computed tomography (CT) in identifying ID-EPS.
• To differentiate ID-EPS from above-diaphragm EPS (AD-EPS) using imaging features.

Main Methods:

• Retrospective analysis of imaging findings in patients with ID-EPS and AD-EPS.
• Comparison of specific ultrasonography and CT features: split diaphragm sign, lesion edge shape, intra-abdominal drainage vein, and lesion characteristics.
• Statistical analysis using Fisher's exact test to determine significant differences between groups.

Main Results:

• Significant differences were found in the split diaphragm sign on ultrasound (P=.046), lesion edge shape on ultrasound/CT (P=.005), and presence of cystic areas within the lesion on ultrasound (P=.046) between ID-EPS and AD-EPS.
• Drainage into the abdomen was more frequent on CT in ID-EPS (P=.046).
• No significant differences were observed for the split diaphragm sign on CT.

Conclusions:

• A combination of postnatal ultrasonography and CT provides valuable imaging clues for predicting EPS located within the diaphragm.
• Specific imaging features can help differentiate ID-EPS from AD-EPS, potentially avoiding invasive diagnostic procedures.
• These imaging modalities enhance the diagnostic accuracy for rare cases of intradiaphragmatic lung malformations.