Diagnosis, treatment and assessment principle of pulmonary sequestration in pilot-2 clinical cases referred

Abstract

Objective To investigate the imaging manifestation and treatment of pulmonary sequestration (PS), and try to put forward its medical assessment principle for pilot. Methods Two cases of pilots' definite PS were retrospectively analyzed on diagnosis process and medical assessment. Also, relevant literatures were reviewed. Results The clinical symptoms of these two PS cases were not typical. One case was diagnosed as extralobar pulmonary sequestration and had no clinical symptom while he was suspected as abnormality during his annually physical examination. The other pilot with intralobar pulmonary sequestration manifested recurrent hemoptysis and was misdiagnosed and treated as pneumonia for a long time. In all diagnostic approaches, imaging played an important role in clinical examination. Plain chest films could be a diagnostic clue to PS, while sliced CT, contrast-enhanced CT and CT angiography were helpful in indicating the abnormal blood supply artery. But Digital subtraction angiography would be the most reliable approach. Active treatment was recommended to definite PS. The intralobar pulmonary sequestration pilot was treated in our department by advanced trainscatheter artery embolization, and at last got fly certification. In another case of extralobar pulmonary sequestration the pilot was recovered flying till his retirement limit. Conclusions The congenital malformation is seldom in clinical diagnosis, especially for pilots. Since misdiagnosis and missed diagnosis are easily happened on PS more care should be paid to the chest X-ray in annually health examination. So far our medical assessment principle for this disease is that non-fighter pilot who without clinical symptom should be individually evaluated. Pilot with symptom is recommended to take interventional therapy which has little influence to pulmonary function and it would be helpful for recovery and getting medical qualification. Also we suggest that flight surgeon should strengthen the awareness of such rare congenital anomaly as PS. Side effects of various therapies on flight abilities should be prudently considered. The advanced and minimal invasive treatments may at last furthest prolong pilot's flight career. Key words: Bronchopulmonary sequestration; Diagnosis, differential; Eligibility determination