From the Research
Extralobar pulmonary sequestration is generally easier to treat than intralobar sequestration. This is primarily because extralobar sequestration exists as a separate entity outside the normal lung tissue with its own pleural covering, making surgical resection more straightforward. The distinct boundary between the extralobar sequestration and normal lung tissue allows for a cleaner surgical plane and often permits a less extensive operation. In contrast, intralobar sequestration is embedded within normal lung tissue, sharing the same pleural covering, which typically necessitates a more complex lobectomy procedure rather than simple resection.
Key Considerations
- The treatment for both types is surgical removal, as medical management alone is not curative 1.
- Patients with either type may present with recurrent infections, hemoptysis, or be asymptomatic with the condition discovered incidentally.
- Preoperative imaging with CT angiography is essential to identify the anomalous blood supply, which typically arises from the systemic circulation (often the thoracic or abdominal aorta) 2.
- Understanding the vascular anatomy is crucial for surgical planning to avoid potentially catastrophic bleeding during the procedure.
- While minimally invasive approaches are increasingly used for both types, the technical complexity and extent of resection generally remain greater for intralobar sequestration 3, 4.
Surgical Approach
- The use of video-assisted thoracic surgery (VATS) for pulmonary sequestration has been shown to be feasible and safe, with potential benefits including less postoperative pain and shorter hospital stays 1, 5, 3.
- However, the decision to use VATS or an open thoracotomy approach should be based on the individual patient's anatomy and the surgeon's expertise.
- Recent studies suggest that sublobar resection may be a viable option for intralobar sequestration, potentially reducing the extent of lung tissue removed and preserving more functional lung tissue 4.