Pulmonary Sequestration

Normal Anatomy
 

• Trachea: Delivers air from the throat to the lungs.
• Lungs: Conduct gas exchange, inhaling oxygen and exhaling carbon dioxide.
• Heart: Pumps blood, including to and from the lungs.
• Diaphragm: Moves up and down during breathing to help the lungs expand and contract.

Intralobar Sequestration

The sequestered tissue lies within a normal lobe, without a separate pleural covering (more common).

• Location: Within a normal lung lobe, shares the pleura with surrounding normal lung tissue.
• Blood Supply: From systemic arteries (e.g., branches of the aorta).
• Venous Drainage: Drains into pulmonary veins.
• Typical Age of Discovery: Often found in adolescents or adults.
• Clinical Presentation: Recurrent lung infections, cough, sputum production, sometimes chest pain.
• Imaging: Cystic or solid lung mass with systemic arterial supply.

Extralobar Sequestration

The sequestered tissue is completely separate from normal lung and has its own pleura.

• Location: Outside the normal lung lobes, with its own separate pleural covering.
• Blood Supply: Also from systemic arteries.
• Venous Drainage: Into systemic veins (e.g., azygos vein, inferior vena cava).
• Typical Age of Discovery: Usually diagnosed during newborn or infancy, often asymptomatic.
• Appearance: Appears as a separate lung-like mass, disconnected from the normal lung.

Surgery

• Intralobar sequestration: Surgery is recommended to remove the abnormal segment and prevent infection.
   
• Extralobar sequestration: May be monitored if asymptomatic, but resection is often preferred to avoid future complications.
   
• Video-Assisted Thoracoscopic Surgery (VATS) is the minimally-invasive approach of first choice. Its advantages include: Small incisions, shorter recovery time, less postoperative pain

Interventional Embolization

For patients who are unfit for surgery, embolization of the feeding artery can cause the abnormal tissue to shrink.