Pulmonary sequestration: a retrospective analysis of 2625 cases in China

Abstract

Objective: Pulmonary sequestration is a congenital lung malformation, which is often misdiagnosed as lung cancer, pulmonary cysts, mediastinal tumors, etc. Therefore, more research on the clinical characteristics of pulmonary sequestration should be carried out to improve the preoperative diagnosis rate.

Methods: The study used was a retrospective analysis of 2625 cases of pulmonary sequestration well documented in the Chinese National Knowledge Infrastructure from 1998 to 2008. Analysis was performed on the patients' age, gender, symptom, chest computed tomography (CT) scan, chest radiograph, lesion localization, arterial supply, venous drainage, and incorrect preoperative diagnosis.

Results: A total of 2625 cases of pulmonary sequestration was reported in the Chinese National Knowledge Infrastructure from 1998 to 2008, and the male:female ratio was 1.58:1. The symptoms of pulmonary sequestration were cough, sputum, fever, hemoptysis, and chest pain, with 13.36% of patients being asymptomatic. Chest CT scan showed mass lesions (49.01%), cystic lesions (28.57%), cavitary lesions (11.57%), and pneumonic lesions (7.96%). The sequestration was mainly located in the lower lobe, primarily in the left posterior basal segment (66.43%) and in the right posterior basal segment (20.16%). Pulmonary sequestrations were divided into two types, intralobar sequestration (83.95%) and extralobar sequestration (16.05%). Bilateral sequestrations were rare--only three cases had been reported. The arterial supply was mainly provided by branches of thoracic aorta (76.55%) and abdominal aorta (18.47%). The mean incorrect preoperative diagnosis rate was as high as 58.63%. A comparison between pediatric and adult patients indicated that the subtype ratio (intralobar/extralobar) was higher in the adult group than that in the pediatric group (P < 0.001).

Conclusions: Clinical manifestations of pulmonary sequestration varied and preoperative diagnosis was often incorrect. To improve the preoperative diagnosis rate, we should take full advantage of symptoms, image performance, and localization characteristics. A certain early-onset age, recurrent pneumonias, mass or cyst lesion located in the lower lobe, and aberrant arterial supply are indicators for the diagnosis.