[Pulmonary sequestration. Surgical aspects based on 61 cases]

Between 1955 and 1989, 61 patients (33 men, 28 women; mean age: 20 years) were operated upon for lung sequestration. Sequestration was intralobar in 49 cases and extralobar in 10 cases; both types were present in 2 cases. The abnormality was discovered by chance in 15 patients (24%). The most frequent clinical manifestations were those of recurrent bronchopneumonia (54%). X-ray films of the chest showed an apparently benign, posterobasal image in 88% of the cases. Arteriography was performed in 40 patients and revealed an abnormal systemic artery in 28. An abnormal artery was found by the surgeons and the pathologists in all cases. The intralobar type of sequestration was treated, by preference, by lobectomy, and the extralobar type by sequestrectomy. Problems were encountered in 5 cases: 2 wounds of an unrecognized artery and 3 difficult bleeding controls which required aortic clamping. The operative mortality was nil, and the morbidity rate was 5%. Computerized tomography and magnetic resonance imaging can confirm the diagnosis of pulmonary sequestration, but arteriography seems to be the best method to ascertain the diagnosis and guide the surgical procedure. Surgery is the rule in case of doubtful diagnosis or to treat symptomatic sequestration.