Pulmonary sequestration: is it fraught to operate without the diagnosis?

Year 2016, Volume: 1 Issue: 1, 16 - 20, 29.12.2016

A. Cevat Kutluk , Celalettin Kocatürk , Hasan Akın M. Ali Bedirhan Altan Ceritoğlu Merve Hatipoğlu Kemal Karapınar Özkan Saydam

Abstract

Background: Pulmonary sequestration is defined as nonfunctional lung tissue without a normal tracheobronchial tree that is supplied by an aberrant systemic artery. The awareness of the preoperative diagnosis could be very crucial for the safety of the operation.

Materials and Methods: We retrospectively reviewed the records of 16 patients who underwent resection for pulmonary sequestration between 2006-2016. Nine of 16 cases (56%) were female, and the mean age of the patients was 38.5 ± 9.9 years. Fiberoptic bronchoscopy and standard computed thorax tomography were performed for diagnostic work-up in all cases. The patients were divided into 2 groups based on the presence (Group A) or abscence (Group B) of the preoperative diagnosis.

Results: The most common presenting symptoms were cough and expectoration. Preoperative diagnosis of the sequestration was obtained in only 5 patients (31%). Bronchiectasis was the most common cause of false diagnosis, followed by hydatid disease, malignancy, and aspergillosis. Left-sided and intrapulmonary locations were dominant with 12 (75%) and 13 (81%) cases, respectively. Lobectomy was the most common type of surgical resection (75%) and thoracic aorta was the source of aberrant artery in 87% of the patients. Patients in group A were younger. Though intralobar and extralobar types were equally distributed in both groups, all cases in group B had intralobar type. The mean operation time, blood loss, the amount of drainage, and the hospital stay were all insignificantly longer in group B patients. Five of the 6 morbidities occured in group B patients, but the difference was not statistically significant. No mortality occured.

Conclusions: Surgical resection provides definitive management, and is usually reserved for the patients with symptoms. Facilities for a definitive diagnosis should be performed in every case, because, although insignificant, the rate of morbidity is higher in the patients without a definitive diagnosis. Further studies concerning of more patients are required to obtain more comprehensive results.

Keywords

Pulmonary sequestration, lobectomy, diagnosis, bronchiectasis

References

• Gezer S, Taştepe I, Sirmali M, Fındık G, Türüt H, Kaya S, et al. Pulmonary sequestration: a single-institutional series composed of 27 cases. J Thorac Cardiovasc Surg 2007; 133: 955-9.
• Corbett HJ, Humphrey GM. Pulmonary sequestration. Paediatr Respir Rev 2004; 5: 59-68.
• Wei Y, Li F. Pulmonary sequestration: a retrospective analysis of 2625 cases in China. Eur J Cardiothorac Surg 2011; 40: e39-e42.
• Genc O, Gurkok S, Dakak M, Gozubuyuk A, Ozkan M, Caylak H. Pulmonary sequestration and surgical treatment. Asian Cardiovasc Thorac Ann 2006; 14: 3-6.
• Pryce DM. Lower lobe accessory pulmonary artery with intralobar sequestration of lung: report of 7 cases. J Pathol 1946; 58: 457-67.
• Savic B, Birtel FJ, Tholen W, Funke HD, Knoche R. Lung sequestration: report of seven cases and review of 540 published cases. Thorax 1979; 34: 96-101.
• Franco J, Aliaga R, Domingo ML, Plaza P. Diagnosis of pulmonary sequestration by spiral CT angiography. Thorax 1998; 53: 1089-92.
• Yue SW, Guo H, Zhang YG, Gao JB, Ma XX, Ding PX. The clinical value of computer tomographic angiography for the diagnosis and therapeutic planning of patients with pulmonary sequestration. Eur J Cardiothorac Surg 2013; 43: 946-51.
• Sun X, Xiao Y. Pulmonary sequestration in adult patients: a retrospective study. Eur J Cardiothorac Surg 2015; 48: 279-82.
• Osaki T, Kodate M, Takagishi T, Nomi M, Murakami J, Yamamoto H. Unique extralobar sequestration with atypical location and aberrant vessels. Ann Thorac Surg 2010; 90: 1711–2.
• Gonca C, Hamzayev E, Atasoy C, Enon S. Anomalous systemic arterial supply to normal basal segments of the left lung without sequestration. Eur J Cardiothorac Surg 2015; 47: 578.
• Shyam S, Sagar A, Sureka J, Jakkani RK. An unusual case of a giant aneurysm of an aberrant systemic artery supplying a pulmonary sequestration. Eur J Cardiothorac Surg 2012; 42: 592.
• Fabre D, Rohnean A, Fadel E, Dartevelle PG. Giant aneurysmal dilation of an intralobar pulmonary sequestration artery. Eur J Cardiothorac Surg 2009; 36: 413-4.
• Hofman FN, Pasker HG, Speekenbrink RGH. Hemoptysis and massive hemothorax as presentation of intralobar sequestration. Ann Thorac Surg 2005; 80: 2343-4.
• Arslan E. Pulmonary sequestration with different clinical and radiological findings. Turk Gogus Kalp Dama 2013; 21: 110-3.
• Kestenholz PB, Schneiter D, Hillinger S, Lardinois D, Weder W. Thoracoscopic treatment of pulmonary sequestration. Eur J Cardiothorac Surg 2006; 29: 815-8.
• Halkic N, Cuenoud PF, Corthesy ME, Ksontini R, Boumghar M. Pulmonary sequestration: a review of 26 cases. Eur J Cardiothorac Surg 1998; 14: 127-33.
• Aydin Y, Ogul H, Altuntas B, Eroglu A. Pulmonary sequestration mimicking a hydatid cyst. Eur J Cardiothorac Surg 2015; 48: 514.
• Sippel JM, Ravichandran PS, Antonovic R, Holden WE. Extralobar Pulmonary Sequestration Presenting as a Mediastinal Malignancy. Ann Thorac Surg 1997; 63: 1169-71.
• Simoglou C, Lawal LA. Adenocarcinoma in pulmonary sequestration: a case report and literature review. Asian Cardiovasc Thorac Ann 2015; 23: 1119-20.
• Saxxena P, Marshall M, Ng L, Sinha A, Edwards M. Preoperative embolization of aberrant systemic artery in sequestration of lung. Asian Cardiovasc Thorac Ann 2011; 19: 357-9.