Management of Pulmonary Sequestration : Review of 12 Cases

Abstract

Controversies exist regarding indications for diagnostic angiography, and the optimal surgical management of pulmonary sequestration. This paper summarizes our diagnostic procedures employed and operations undertaken for 12 patients experienced in the last 18 years. During the period between April 1970 and March 1988, 12 patients with pulmonary sequestration were treated at the Kobe Children's Hospital. The patients' age ranged from 4 days to 7 years. They were 7 males and 5 females. Eight patients had intralobar sequestration (ILS) and 4 patients had extralobar sequestration (ELS). Angiography was done in all patients in whom ILS was suspected. This provided the definitive diagnosis with precise informations of arterial blood supply and venous drainage of the sequestered lobe. On the other hand, most of the patients with ELS were not examined by angiography, and were operated on with preoperative diagnosis of mediastinal tumor or diaphragmatic eventration. Surgical procedures undertaken in ILS include lobectomy in 4, partial or segmental resection of the sequestered lobe in 3, pneumonectomy necessitated with bilobate ILS in one. Surgical procedures in ELS include resection of the sequestered lobe in 3 and pneumonectomy in one which was unavoidable due to a progressive pulmonary tension emphysema after resection. Two patients died of respiratory failure following pneumonectomy, but others were free of any complications. In conclusion, angiography is recommended for ILS, but can be omitted for ELS when it is suspected because ELS has no vascular communication to pulmonary vein. Regarding operation, partial resection should be attempted in case of ILS in order to preserve the normal lung as much as possible in children.