Intralobar Pulmonary Sequestration

Abstract

Pulmonary displacement associated with an anomalous artery has been frequently described since the advent of much chest surgery. The earliest adequate report of such a case is generally attributed to Tissler in his D#{252}sseldorf thesis, unpublished but quoted by Muller.’ Earlier classical descriptions by Rektorzek2 (1861), and Humphrey3 (1884) and later Simpson4 (1908) are quoted by McCotter.5 These cases reviewed by McCotter were all autopsy cases in children under two years of age. In over 6,000 post-mortems at the Hospital for Sick Children in the past 25 years, there was no case. It would therefore appear a rare pathological finding after death and not a killing disease of the young, albeit it may be a severely crippling one. Extralobar sequestration on the other hand is usually an autopsy diagnosis, and rather likely to remain one. Forty-two cases of intralobar sequestration have been reported in recent years, up to November 1951 (Cole6). Since then Kergin7 has published the record of five cases and Bruzzoni8 of one. In this paper six further cases are described. They were all seen at the Sick Children’s Hospital, and were diagnosed in part clinically preoperatively and the others by examination of the specimen after excision and by the finding of an aberrant artery when the portion of lung was removed. The first of these cases diagnosed at the time of operation was in 1948. The resected lung was being discussed at a pathological conference as something of a problem. The surgeon, Dr. F. R. Wilkinson, arrived late, but having read Pryce’s9 paper the night before, was able to distinguish himself as a diagnostician. Some of the cases reported in this paper were seen prior to this time, but diagnosed in retrospect. The surgeon had however, noted the systemic artery when he removed the mass. Pryce’#{176} had reported the condition earlier but little attention appeared paid to the first paper until the second one was published. Brief mention of two cases was made by Haight1’ in 1941. The term intralobar sequestration has been applied to these cases since Pryce’s paper in 1948. The purpose in reporting the following cases is to add to the list of published cases, and perhaps make some suggestions whereby clinical diagnoses can be made. Awareness of the anomaly and its clinical course make preoperative diagnosis easy. It has been made in all those seen since 1948. Cases with pulmonary agenesis seen at the hospital have not been Included in this paper despite the fact that most observers now consider them to be due to the same embryonic accident produced earlier. Brief mention should be made of three cases in which pneumonectomies were done. We would not subscribe to a theory attributing all kinds and degrees