PULMONARY SEQUESTRATION - A REVIEW OF 26 CASES

Objectives: Pulmonary sequestration is a continuum of lung anomalies f or which no single embryonic hypothesis is yet available. The aim of t his study was to assess the diagnostic tools and treatment for the rar e condition, pulmonary sequestration, in an unspecialised centre. Meth ods: We performed an analysis of 26 cases of pulmonary sequestration ( paediatric and adult) operated at the Centre Hospitalier Universitaire Vaudois between May 1959 and May 1997. A review of the extralobar and intralobar types of sequestrations is discussed. Angiography is compa red to other diagnostic tools in this condition, and treatment is disc ussed. Results: Twenty-six cases of pulmonary sequestrations, a rare c ongenital pulmonary malformation, were operated on in the defined time period. Seventy-three percent (19) of the cases were intralobar and 2 7% (seven) extralobar. Extralobar localisation was basal in 71% and si tuated between the upper and the lower lobe in 29%. In six cases, the diagnosis was made by exploratory thoracotomy. In the other 20 cases, diagnosis was evoked on chest X-ray and confirmed by angiography. Lobe ctomy (46%) was the most common treatment procedure. Segmental resecti on was performed in 30% of the cases and bilobectomy in 4%. Post-opera tive morbidity was low. The most significant complications were pleura l empyema, haemothorax and haemopneumoperitoneum in case of extralobar sequestration. There was no evidence of metaplasia or pre-neoplastic changes. Conclusions: Despite its rarity, some radiological features a re sufficiently suggestive of diagnosis of pulmonary sequestration. In vestigations are necessary in order to avoid unexpected pathology at t he time of operation. Resection of the involved lung leads to excellen t results and the long-term outcome is highly favourable. (C) 1998 Els evier Science B.V. All rights reserved.