Pulmonary sequestration: a comparison between pediatric and adult patients

Objective: Modern large single institutional reports on pulmonary sequestra tion (PS) are extremely rare. We were interested in comparing patients with PS referred by our pediatric versus adult pulmonologists. Methods: Hospita l notes of all patients operated on between 1978 and 1997 for a congenital broncho-pulmonary malformation were reviewed. In 28 patients, the parenchym al lesion was vascularized by a systemic artery and was separated from the bronchial tree, thus matching the strict definition of PS. Patient characte ristics and outcome were analyzed comparing the pediatric group (less than or equal to 16 years: n = 13; mean age, 3 +/- 5 years) versus the adult gro up (>16 years: n = 15; mean age, 33 +/- 13 years). Results: No significant differences between both groups were observed in sex, side, type of sequest ration, pulmonary venous drainage, associated anomalies, hospital and late outcome, and patient's overall score. Patient's (n = 21) with the intraloba r type of sequestration presented significantly more often with an infectio n when compared with patients (n = 7) with the extralobar type (91 versus 1 4%; P = 0.0033). When compared with the pediatric group, patients in the ad ult group had significantly more respiratory infections (87 versus 38%; P = 0.016), and also required a lobectomy more often (67 versus 31%; P = 0.056 ). Conclusions: The extralobar type of sequestration often remains asymptom atic, and is usually an incidental finding during infancy. The intralobar t ype mostly presents with recurrent infections in adulthood resulting in mor e lobectomies. We believe these findings support our current policy to remo ve any pulmonary malformation whenever diagnosed in order to: (1), prevent infection and other potentially serious late complications which may compro mise the surgical outcome; and (2), enhance the chance of a parenchymal-spa ring resection. (C) 2001 Elsevier Science B.V. All rights reserved.