Abstract

Objective: This study was designed to reassess value of medical imaging and results of surgery for pulmonary sequestration in a single center.

Methods: From 1975 to 1997, 20 patients (11 males and 9 females; median age 35 years) underwent resection for pulmonary sequestration. Fourteen patients (70%) complained of symptoms: relapsing infection occurred in 9, intermittent fever in 6, chronic cough in 6, chest pain in 6, bronchorrhea in 2, and hemoptysis in 1 patient. Most cases occurred on the right side (13 versus 7 on the left), and in the lower lobes (16 cases, versus 1 in the middle lobe and 3 in the upper lobes). Preoperative angiography was performed in 14 patients.

Results: Preoperative diagnosis was established in 14 cases; systemic arterial supply originated from the thoracic aorta in 10, and from the abdominal aorta in 4 patients. Resection included 16 lobectomies (1 VATS), I anatomic segmentectomy, and 3 wedge excisions (1 VATS). Dense pleural adhesions were encountered in 14 patients; 2 had retracted lobar hila, and 1 had venous drainage into the azygos vein. There was no case of injury to the systemic artery. Post-operative mortality (30 days) was nil. Morbidity included 5 prolonged air leaks (beyond 7 days), one of which was due to a bronchopleural fistula healing spontaneously, and 1 episode of atelectasis requiring bronchoscopy. Pathology obviated 17 intralobar and 3 extralobar sequestrations.

Conclusion: Bronchial angiogram confirms the diagnosis of sequestration, but does not seem essential for subsequent surgery. Complications are those commonly observed after lung resection for chronic infectious disease.