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2012-10-31-15 Sequestration, infradiaphragmatic ©Fabrice Cuillier

Sequestration, infradiaphragmatic

Fabrice Cuillier*, MD
, Belec S.**, MD.  
* Antenatal diagnosis Center, Félix Guyon’Hospital, 97400 Saint-Denis, Ile de la Réunion, France. 
** Department of Gynecology, Intercommunal’s Hospital, 97400 Mamoudzou, Mayotte, France. 

Case report:

A 30-year-old woman (G3P2) was referred to our antenatal unit at 28 weeks without remarkable family history of congenital disease. The patient did not take any medications. 
At 24 weeks, a left intra-abdominal, hyperechoic, isolated mass was revealed. Amniocentesis was refused by her family. 
We followed the patient during the second trimester.  Ultrasound findings at 28 weeks :
  • Left isolated abdominal hyperechoic mass behind the stomach (Figure 1-3). 
  • Normal cardiac morphology. 
  • The pulmonary artery and aorta seemed normal. There was no sign of cardiac compression.    
  • The two kidneys were normal (Figure 4, 5). The mass seemed independent. 
  • The Doppler of the mass did not reveal ectopic vessel (Figure 6, 7). 
At 36 weeks, the intra-abdominal mass had the same size, and the same location. No diaphragmatic defect or intra-thoracic extension could be seen. The right and the left lung had a normal aspect. 
At 38 weeks, the patient gave birth to a healthy boy. The baby was not intubated. 
The baby was operated one month later. Tumor ablation was performed by laparotomy. The tumor had an intrathoracic prolongation inside the diaphragm pillar.  
The anatomo-pathological analysis confirmed the diagnosis of sequestration, so the final diagnosis was extra-lobar extra-thoracic sequestration.    

Figure 1-3: Left isolated abdominal hyperechoic mass behind the stomach

Figure 4, 5: The two kidneys were normal. The mass seemed independent. 

Figure 6, 7: The Doppler of the mass did not reveal ectopic vessel.

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