Retrospective review of the diagnosis and treatment of pulmonary sequestration in 28 patients: surgery or endovascular techniques?

Abstract

Background: Pulmonary sequestration (PS) is a rare congenital pulmonary malformation. In this study, we aimed to retrospect and evaluate the diagnosis, treatment, and outcomes of PS in 28 patients at our institute.

Methods: The files of 28 patients with PS who were treated with surgery (21 cases) or endovascular intervention (7 cases) between May 2005 and June 2016 from a single institute were retrospectively reviewed. The following data of all patients were analyzed: age, sex, clinical symptoms, diagnostic methods, operative techniques, and treatment outcomes.

Results: Twenty-eight patients, 15 male and 13 female, with a median age of 42.5 underwent operative intervention for PS. Twenty-one patients showed preoperative symptoms including cough, expectoration, hemoptysis, chest and/or back pain, and fever. General chest computed tomography (CT) scanning; percutaneous needle biopsy, bronchoscopy, enhanced CT scanning, and CT angiography (CTA) were used as diagnostic methods. Twenty-one patients were diagnosed preoperatively by enhanced CT scanning and CTA; seven patients were confirmed by surgery. Twenty-one patients underwent surgery (15 cases via thoracotomy and 6 cases via video-assisted thoracic surgery), seven patients underwent interventional therapy (three cases via endovascular embolization and four cases via thoracic aortic endovascular stent-graft exclusion). Three patients had a complication in surgery group (intraoperative hemorrhage in two patients and postoperative hydropneumothorax in one patient) and two patients had post-embolization syndrome in interventional group (fever and pain at embolism site). During the follow-up period ranging from 6 to 84 months, no recurrences or further complications were observed in two groups.

Conclusions: Enhanced CT or CTA may be a potential approach for the diagnosis of PS. Surgical resection for PS is the major treatment approach. Endovascular embolization of PS could be considered when pulmonary lesion is small-sized. Endovascular exclusion could be used to treat combined arterial aneurysm and dissection of PS.

Keywords: Pulmonary sequestration (PS); intervention therapy; surgery.

Figure 1

Enhanced CT scanning (A) and 3-dimensional reconstruction (B) demonstrates aberrant artery (white arrow) originating from the thoracic aorta. CT, computed tomography.

Figure 2

DSA shows the changes of feeding artery before and after embolization. (A) Pre-embolization DSA shows single large feeding artery later dividing into multiple branches to supply the sequestered LLL (white arrow); (B) mid-embolization DSA reveals marked reduction of the abnormal vascular blush and occlusion of the feeding artery (white arrow). LLL, left lower lobe; DSA, digital subtraction angiography.

Figure 3

Enhanced CT scanning shows aortic dissection on the initial part of feeding artery (A) combined extensive effusion of LLL (B) (white arrow). At 3th month of follow up, the aortic dissection and feeding artery are isolated (C) and LLL effusion has been absorbed (D) (white arrow). CT, computed tomography; LLL, left lower lobe.