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In unprecedented surgery in Brazil, a 29-week-old baby underwent a procedure to burn off a tumor in the chest region of the mother’s uterus. The rare diagnosis, called pulmonary sequestration, occurs when a mass looks like a lung, being supplied by blood vessels, but with no specific function.
“Although not malignant, the tumor was growing and compressing the baby’s organs, in addition to ‘stealing’ some blood from the body and causing water to deposit in the lung region,” said surgeon Danielle Brasil, who performed the rare procedure at the hospital. Santa Lúcia, in Brasília, in an interview with the BBC Brasil portal.
Specializing in high-risk fetal surgery at King’s College London, the doctor explained that descriptions in the medical literature indicated that for such a case, the action to be taken would be to burn one of the vessels that supplied the tumor with blood.
According to Danielle Brasil, using a large needle containing a laser fiber, it is possible to burn this vessel to “kill” the mass which will later be absorbed by the body of the fetus. The idea was also to remove fluid from the chest to help the lungs expand.
“We were able to perfectly burn the vessel, but after ten days we discovered that the circulation of the tumor was taking another path, causing the mass to grow again and increasing the fluid in the chest,” said the doctor.
It was only then that the medical team decided to perform this unprecedented operation in the country.
better understand the case
In the sixth month of pregnancy, the baby was diagnosed with severe hydrops and pulmonary sequestration. If there was no surgery, the fetus would die.
A total of two surgeries were performed. In the first, the vessel that fed the tumor was burned. However, after a week, the tumor grew back. The medical team therefore decided to perform another surgery, this time to burn off the entire tumour.
Journalist Polyana Resende, mother of the baby named Ragnar, asked for other opinions, but after listening to different experts, agreed to continue the procedure.
It took nearly four hours of operation, without anesthesia, over an eight-month gestation. “The proof of the miracle is that my baby has no scars. He has a warrior name, no wonder. Even before he was born, he faced two battles and won them both,” celebrated Polyana.
Little Ragnar, born on May 18, experienced his first pulmonary radiographywho showed no signs of the tumor.
“In three months, we will have a chest tomography, a more complete examination. Our expectation is to find areas of fibrosis by healing of the tumor that has been destroyed. And of course, confirm that this baby will no longer need surgery,” said Danielle Brasil.
The next step for the medical team is to collect all the materials from the procedures to send a case report to some scientific journals so that the successful and rare experience can be reported to the global medical community.
Learn more about pulmonary sequestration
Pulmonary sequestration is a rare congenital anomaly characterized by non-functioning embryonic lung tissue, involving lung parenchyma and vasculature, classified as intralobar or extralobar.
In the investigation of a case with suspected pulmonary sequestration, the request for imaging examinations must have two specific objectives: to exclude the presence of other pathologies and to characterize the presence of an abnormal arterial supply.
Generally, during the prenatal examination, the pulmonary sequestration can be identified thanks to the realization of the Doppler, being more easily observed in the third trimester.
Sometimes it is also possible to observe the association of pulmonary sequestration with pleural effusion. Its main differential diagnosis is cystic adenomatoid malformation of the lung.
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