Intradiaphragmatic hybrid lesion in an infant: case report Claudio Olivieri a, ⁎ , Lorenzo Nanni a , Gaia Busato a , Guido Rindi b , Riccardo Marano c , Claudio Pintus a a Pediatric Surgery Unit, Policlinico “A. Gemelli,” Largo Agostino Gemelli, 8, 00168 Rome, Italy b Department of Pathology, Policlinico “A. Gemelli,” Rome, Italy c Department of Radiology, Policlinico “A. Gemelli,” Rome, Italy Received 7 November 2011; revised 20 March 2012; accepted 2 April 2012 Key words: Diaphragm; Congenital cystic adenomatoid malformation; Sequestration; Hybrid lesion Abstract Hybrid lesions have elements of both congenital cystic adenomatoid malformation and bronchopulmonary sequestration. We report an unusual case of an infant treated for an intradiaphrag- matic hybrid lesion. Although computed tomography remains the criterion standard imaging examination for planning the operation, the exact localization of such lesions may be discovered only at surgical exploration. © 2012 Published by Elsevier Inc. Congenital cystic adenomatoid malformation (CCAM) and bronchopulmonary sequestration (BPS) belong to the spectrum of congenital pulmonary malformations. Bronch- opulmonary sequestration is defined as a mass of non- functioning lung tissue that receives its vascular supply from a systemic artery and is separated from the tracheobronchial tree. Several cases of supradiaphragmatic or infradiaphrag- matic extralobar sequestrations (ELSs) have been reported in literature, whereas intradiaphragmatic ELS is an extremely rare condition [1]. Congenital cystic adenomatoid malformation is consid- ered a hamartomatous lesion of the bronchial tree; 3 different types had been identified based on histologic characteristics [2]. In contrast to ELS, CCAM is connected to the tracheo- bronchial tree, and its vascular supply comes from the pul- monary circulation. Malformations with both of these components have been recognized and defined as hybrid lesions [3]. We report a case of an infant with an intradiaphragmatic hybrid lesion. To the best of our knowledge, such localization has not been previously reported for hybrid lesions. 1. Case report A 25-year-old prima gravida was referred to our hospital after an ultrasound (US) examination at 24 weeks' gestation, which showed a cystic lesion of the left lower lung. A 3.660- g female infant was delivered vaginally at term, with normal physical findings. At birth, the patient was initially inves- tigated by a plain chest radiograph, which showed neither cystic lesions nor displacement of the mediastinum. During the first months of life, the patient remained asymptomatic; follow-up chest radiographs at 3 and 7 months were con- sidered normal. Chest computed tomography (CT) per- formed at 8 months of age showed a mass in the left lower lobe, measuring 28 × 11 × 32 mm, with an extension at the posterior costophrenic angle. An aberrant arterial supply from the celiac axis was identified. At age 11 months, the patient underwent surgical exploration. After a muscle- ⁎ Corresponding author. Tel.: +39 06 3015 4032; fax: +39 06 3015 4363. E-mail address: claudioolivieri@liberto.it (C. Olivieri). www.elsevier.com/locate/jpedsurg 0022-3468/$ – see front matter © 2012 Published by Elsevier Inc. doi:10.1016/j.jpedsurg.2012.04.010 Journal of Pediatric Surgery (2012) 47, E25–E28