From the Research
Surgical resection is the recommended treatment for pulmonary sequestration, especially for symptomatic patients, to prevent complications such as recurrent infections, hemoptysis, or heart failure due to left-to-right shunting. Pulmonary sequestration is a rare congenital lung malformation where a segment of lung tissue develops abnormally, receiving its blood supply from the systemic circulation rather than the pulmonary circulation. There are two main types: intralobar sequestration, which is contained within the normal lung tissue and shares the same pleural covering, and extralobar sequestration, which has its own pleural covering separate from the normal lung. Patients may present with recurrent respiratory infections, hemoptysis, or be asymptomatic with the condition discovered incidentally on imaging. Diagnosis typically involves CT angiography or MR angiography to identify the abnormal blood supply.
The most recent and highest quality study, 1, published in 2024, supports the recommendation for surgical resection, with a case series of 8 consecutive adult patients undergoing surgical management for pulmonary sequestration. The study found that surgical resection can be performed safely and effectively, with no intra-operative or post-operative complications reported within hospital. Another study, 2, published in 2016, also recommends surgical resection, with a retrospective analysis of 14 patients with intralobar sequestrations, and found that preoperative embolization can be performed in selected cases.
Some studies, such as 3, published in 2021, suggest that embolization of the feeding artery can be a promising alternative to surgery, especially for patients with hemoptysis. However, this approach is not recommended as the first line of treatment, and surgical resection remains the gold standard.
Key points to consider in the management of pulmonary sequestration include:
- Surgical resection is the recommended treatment for symptomatic patients
- Embolization of the feeding artery can be considered in high-risk surgical candidates or as an alternative to surgery in selected cases
- Asymptomatic patients may be monitored, but many specialists still recommend elective surgery to prevent future complications
- Preoperative evaluation of the arterial supply is essential to plan the resection
- Minimally-invasive surgical approaches, such as video-assisted thoracoscopic surgery (VATS), can be considered in selected cases.