Pediatric Pulmonary Sequestration Workup
- Author: Bruce M Schnapf, DO; Chief Editor: Michael R Bye, MD more...
No laboratory studies are needed in pulmonary sequestration.
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- Chest radiography is indicated.
- Chest radiography findings vary depending on the size of the sequestered lung tissue and whether infection is present. If no communication between sequestration and normal lung tissue is present, radiography usually reveals a dense opacity in the posterior basal segment of the lower lobe. A cystic appearance may also be observed.
- Lesion density often increases with secondary infection and appears as a uniform consolidation. When this area fails to clear after a course of appropriate medical therapy, the presence of a malformation, such as sequestration, should be considered, particularly if the lesion is localized to the posterior basal segment of the left lower lobe.
- Distinguishing an intrapulmonary sequestration from extrapulmonary sequestration is difficult using plain radiography.
- Intrapulmonary lesions tend to be heterogeneous and are not well defined.
- Extrapulmonary masses are usually observed as solid, well defined, and retrocardiac.
- Bronchography and arteriography are unnecessary because of current noninvasive imaging available.
- Presence of systemic arteries revealed by chest imaging is the major diagnostic feature of pulmonary sequestration. CT scanning with contrast or magnetic resonance angiography (MRA) have been very useful. The arterial supply and venous drainage both should be outlined because of the unpredictability of vascular connections. CT angiography is helpful in identifying aberrant systemic arterial supply, and the 3-dimensional rendering of multidetector row CT scanning can reveal venous drainage.[20, 21]
- Real-time ultrasonography and Doppler imaging are reliable methods of demonstrating systemic origin or blood supply, as well. On prenatal ultrasonography, a sequestration usually appears as well-defined echodense, homogeneous mass. Detection by color flow Doppler of a systemic artery from the aorta to the fetal lung lesion is a pathognomonic feature.
Upper GI contrast examination may be useful if communication with the GI tract is considered.
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- Bronchoscopy: Bronchoscopy is not necessary unless an alternative cause of the radiographic abnormalities, such as an inhaled foreign body, is suspected.
- Balloon occlusion
- Consider balloon occlusion or embolization of the aberrant systemic arteries at the time of catheterization.
- Some patients may have a considerable shunt through this anomalous circuit to the extent that, once the segment has been removed, the improvement in cardiovascular status may be striking.
- If surgical resection is necessary, risk of vascular complications is greatly reduced with this procedure.
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- Because no communication with the bronchial tree occurs, sequestration appears to have loose, spongy tissue with numerous small cystic spaces containing clear, mucoid fluid.
- Structures that may resemble bronchi are present near the center.
- Dilated subpleural lymphatics may also be present.
Flye MW, Conley M, Silver D. Spectrum of pulmonary sequestration. Ann Thorac Surg. 1976 Nov. 22(5):478-82. [Medline].
Corbett HJ, Humphrey GM. Pulmonary sequestration. Paediatr Respir Rev. 2004 Mar. 5(1):59-68. [Medline].
Abel RM, Bush A, Chitty LS, Harcourt J, Nicholson AG. Congenital lung disease. Kendig's Disorders of the Respiratory Tract in Children. 7th ed. Philadelphia, Pa: WB Saunders; 2006. 301.
Alivizatos P, Cheatle T, de Leval M, Stark J. Pulmonary sequestration complicated by anomalies of pulmonary venous return. J Pediatr Surg. 1985 Feb. 20(1):76-9. [Medline].
DeParedes CG, Pierce WS, Johnson DG, Waldhausen JA. Pulmonary sequestration in infants and children: a 20-year experience and review of the literature. J Pediatr Surg. 1970 Apr. 5(2):136-47. [Medline].
Gustafson RA, Murray GF, Warden HE, et al. Intralobar sequestration. A missed diagnosis. Ann Thorac Surg. 1989 Jun. 47(6):841-7. [Medline].
Wilson RL, Lettieri CJ, Fitzpatrick TM, Shorr AF. Intralobular bronchopulmonary sequestrations associated with bronchogenic cysts. Respir Med. 2005 Apr. 99(4):508-10. [Medline].
Hadley GP, Egner J. Gastric duplication with extralobar pulmonary sequestration: an uncommon cause of "colic". Clin Pediatr (Phila). 2001 Jun. 40(6):364. [Medline].
Collin PP, Desjardins JG, Khan AH. Pulmonary sequestration. J Pediatr Surg. 1987 Aug. 22(8):750-3. [Medline].
Clement BS. Congenital malformations of the lungs and airways. Pediatric Respiratory Medicine. St Louis, Mo: Mosby; 1999. 1124-5.
Gezer S, Tastepe I, Sirmali M, et al. Pulmonary sequestration: a single-institutional series composed of 27 cases. J Thorac Cardiovasc Surg. 2007 Apr. 133(4):955-9. [Medline].
Telander RL, Lennox C, Sieber W. Sequestration of the lung in children. Mayo Clin Proc. 1976 Sep. 51(9):578-84. [Medline].
Abbey P, Das CJ, Pangtey GS, Seith A, Dutta R, Kumar A. Imaging in bronchopulmonary sequestration. J Med Imaging Radiat Oncol. 2009 Feb. 53(1):22-31. [Medline].
Torreggiani WC, Logan PM, McElvaney NG. Persistant right lower lobe consolidation. Chest. 2000 Feb. 117(2):588-90. [Medline].
Ko SF, Ng SH, Lee TY, et al. Noninvasive imaging of bronchopulmonary sequestration. AJR Am J Roentgenol. 2000 Oct. 175(4):1005-12. [Medline].
Paterson A. Imaging evaluation of congenital lung abnormalities in infants and children. Radiol Clin North Am. 2005 Mar. 43(2):303-23. [Medline].
Ikezoe J, Murayama S, Godwin JD, et al. Bronchopulmonary sequestration: CT assessment. Radiology. 1990 Aug. 176(2):375-9. [Medline].
Deguchi E, Furukawa T, Ono S, et al. Intralobar pulmonary sequestration diagnosed by MR angiography. Pediatr Surg Int. 2005 Jul. 21(7):576-7. [Medline].
Kang M, Khandelwal N, Ojili V, Rao KL, Rana SS. Multidetector CT angiography in pulmonary sequestration. J Comput Assist Tomogr. 2006 Nov-Dec. 30(6):926-32. [Medline].
Lee EY, Siegel MJ, Sierra LM, Foglia RP. Evaluation of angioarchitecture of pulmonary sequestration in pediatric patients using 3D MDCT angiography. AJR Am J Roentgenol. 2004 Jul. 183(1):183-8. [Medline].
Adzick NS, Harrison MR, Crombleholme TM, et al. Fetal lung lesions: management and outcome. Am J Obstet Gynecol. 1998 Oct. 179(4):884-9. [Medline].
Laberge JM, Bratu I, Flageole H. The management of asymptomatic congenital lung malformations. Paediatr Respir Rev. 2004. 5 Suppl A:S305-12. [Medline].
Albanese CT, Rothenberg SS. Experience with 144 consecutive pediatric thoracoscopic lobectomies. J Laparoendosc Adv Surg Tech A. 2007 Jun. 17(3):339-41. [Medline].
Ko SC, Chang YC, Liaw YS, et al. Diagnosis of pulmonary sequestration by magnetic resonance imaging. J Formos Med Assoc. 1998 Mar. 97(3):220-3. [Medline].
Levine MM, Nudel DB, Gootman N, et al. Pulmonary sequestration causing congestive heart failure in infancy: a report of two cases and review of the literature. Ann Thorac Surg. 1982 Nov. 34(5):581-5. [Medline].
Sersar Sameh I, El Diasty M, Ibrahim Hammad R, et al. Lower lobe segments and pulmonary sequestrations. J Thorac Cardiovasc Surg. 2004 Mar. 127(3):898-9. [Medline].
Spinella PC, Strieper MJ, Callahan CW. Congestive heart failure in a neonate secondary to bilateral intralobar and extralobar pulmonary sequestrations. Pediatrics. 1998 Jan. 101(1 Pt 1):120-4. [Medline].