LUNG SEQUESTRATION - REPORT OF 7 CASES AND REVIEW OF 540 PUBLISHED CASES

We present an analysis of 400 intralobar and 133 extralobar sequestrations, 6 cases presenting intra- and extralobar sequestration simultaneously, 5 sequestrations of one whole lung, and 2 bilateral intralobar sequestrations. This anomaly comprises 0.15-6.4% of all congenital pulmonary malformations. Usually the posterior basal segment is affected. The aberrant artery in intralobar sequestration originated in 74% of all cases from the thoracic aorta, and in 14.8% there was more than one anomalous artery. The mean diameter of the aberrant arteries was 6.3-6.6 mm. Usually arteries with predominantly elastic fibres were found. Arteriosclerotic changes were common, even in children. The venous return of the intralobar sequestration is, in 95.7% of all cases, via the pulmonary veins. In 13.7% of all cases other congenital malformations were observed. Symptoms arose within the first decade of life in 37.2%. Bronchography and retrograde arteriography are the mainstay of diagnosis. Sequestrations are not supplied by a bronchial artery. Treatment of choice is operation as early as possible. Altogether 7 operative deaths were reported, 5 of which were due to haemorrhage during operation. Of the 133 extralobar sequestrations, 77.4% were located between diaphragm and lower lobe. The arterial supply was provided by branches of the aorta. Some cases were supplied with venous blood by branches of the pulmonary artery. In 6 cases secondary changes, such as tuberculosis or carcinoma were found. In 60% of all the patients symptoms occurred within the first decade of life. Preoperative diagnosis was correct in only 6 cases. There were 4 postoperative deaths.