From the Archives of the AFIP: Intralobar Sequestration

Radiologic-Pathologic Correlation

Abstract Introduction Postulated Pathogenesis Clinical Characteristics

Pathologic Features Histologic Features Radiologic Appearance

Therapy And Prognosis Conclusions Source Information References

Therapy And Prognosis

Treatment of intralobar sequestration is surgical and consists of either segmentectomy or, more commonly, a full lobectomy when chronic infection has obliterated segmental planes (25,31,64). Conservative nonsurgical management has been argued by some authors (19,64), but resection following antibiotic treatment is considered prudent to avoid reinfection and potential bleeding complications (13,25,31,36). Ligation or embolization of the vascular pedicle without resection has been performed to correct a hemodynamically significant shunt, but it is generally thought that simple devascularization predisposes the patient to further infection (14,17,64,65).

Radiologic delineation of the systemic vascular supply and venous drainage of the sequestration assists the surgeon in planning a successful ligation of vessels. Inadvertent transection of the arterial supply is a complication that has resulted in catastrophic hemorrhage (1,25,31,33). The anomalous artery is typically found coursing within the inferior pulmonary ligament. Multiple branches should always be sought, since imaging studies may not reveal smaller feeding vessels (1,11,25,31,38,55). Surgeons have reported that dissection of the vascular supply can be hazardous because of dense pleural adhesions (45). In addition, the wall of the anomalous vessel is composed of elastic elements that resemble the constituents of pulmonary arteries, and the vessel is thought to be more fragile than normal muscular vessels (1,3,30,45). Interestingly, an intralobar sequestration may expand when normal lung is hyperventilated intraoperatively, a finding that indicates either abnormal bronchial communication or collateral ventilation (25,66). Some authors recommend performing a preoperative barium swallow examination or upper gastrointestinal series to exclude the rare but documented presence of a communication to the gastrointestinal tract in bronchopulmonary foregut malformations (7,9,33,66).

Reported postoperative complications are uncommon and include hemothorax, empyema, bronchopleural fistula, and bronchopleurocutaneous fistula (1). The prognosis following surgical excision of intralobar sequestration is excellent, and long-term follow-up suggests that these patients do well (5,25,31,55).

Abstract Introduction Postulated Pathogenesis Clinical Characteristics

Pathologic Features Histologic Features Radiologic Appearance

Therapy And Prognosis Conclusions Source Information References