Pulmonary sequestration: is it fraught to operate without the diagnosis?

Abstract

Background: Pulmonary sequestration is defined as nonfunctional lung tissue without a normal tracheobronchial tree that is supplied by an aberrant systemic artery. The awareness of the preoperative diagnosis could be very crucial for the safety of the operation. Materials and Methods: We retrospectively reviewed the records of 16 patients who underwent resection for pulmonary sequestration between 2006-2016. Nine of 16 cases (56%) were female, and the mean age of the patients was 38.5 ± 9.9 years. Fiberoptic bronchoscopy and standard computed thorax tomography were performed for diagnostic work-up in all cases. The patients were divided into 2 groups based on the presence (Group A) or abscence (Group B) of the preoperative diagnosis. Results: The most common presenting symptoms were cough and expectoration. Preoperative diagnosis of the sequestration was obtained in only 5 patients (31%). Bronchiectasis was the most common cause of false diagnosis, followed by hydatid disease, malignancy, and aspergillosis. Left-sided and intrapulmonary locations were dominant with 12 (75%) and 13 (81%) cases, respectively. Lobectomy was the most common type of surgical resection (75%) and thoracic aorta was the source of aberrant artery in 87% of the patients. Patients in group A were younger. Though intralobar and extralobar types were equally distributed in both groups, all cases in group B had intralobar type. The mean operation time, blood loss, the amount of drainage, and the hospital stay were all insignificantly longer in group B patients. Five of the 6 morbidities occured in group B patients, but the difference was not statistically significant. No mortality occured. Conclusions: Surgical resection provides definitive management, and is usually reserved for the patients with symptoms. Facilities for a definitive diagnosis should be performed in every case, because, although insignificant, the rate of morbidity is higher in the patients without a definitive diagnosis. Further studies concerning of more patients are required to obtain more comprehensive results.