eMedicine Specialties > Radiology > Pediatrics

Pulmonary Sequestration: Follow-up

Author: Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP, Chairman of Medical Imaging, Professor of Radiology, NGHA, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Coauthor(s): Margaret Aird, MBChB, FRCR, Consulting Staff, Department of Radiology, Wythenshawe Hospital; Apam Chiphang, MBBS, Staff Physician, Department of Radiology, North Manchester General Hospital; Lalam Radhesh Krishna, MBBS, MRCS, Specialist Registrar, Department of Radiology, North Manchester General Hospital; Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute; Tufail Ahmed Patankar, MBBS, FRCR, PhD, DMRD, DMRE, DNBE, Consulting Neuroradiologist and Interventional Neuroradiologist, Department of Neuroradiology, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust; Nigel Thomas, MBBS, Vice-Chair, Manchester (North) Research Ethics Committee; Honorary Lecturer, Visiting Professor, University of Salford, UK
Contributor Information and Disclosures

Updated: May 26, 2008

Intervention

Transarterial embolization of the aberrant arterial supply to an ILS may be used as a definitive procedure or as a preoperative procedure to minimize the risk of vascular complications during resection.28,38,39 In a series of 16 children with pulmonary sequestrations treated with endovascular embolization of the feeding systemic artery, embolization alone cured the sequestration in 10 children. Some patients may have significant arteriovenous shunting through the lesion, which can benefit from a transarterial coil-spring or particulate embolization.

Laparoscopic approaches have been used in the resection of an abdominal ELS.6 Advances in imaging have made the distinction of sequestrations from other suprarenal masses, including neuroblastomas, possible in most cases. However, resection provides absolute tissue diagnosis and remains the treatment of choice.1,7 Laparoscopic resection offers the benefit of minimally invasive therapy in addition to providing tissue for confirmation. If resection is performed before the onset of infection, the mortality and morbidity rates are exceedingly low, and the prognosis is good.

Fetal hydrops is a common complication in patients with ELS and is associated with a high perinatal mortality rate and severe respiratory problems at birth.23,33 In a 27-week-old fetus with this condition, an injection of 1 mL of pure alcohol and pleuroamniotic shunting achieved resolution of the hydrops.23 The pregnancy reached maturation, and a full-term healthy neonate was delivered who did not require postnatal intervention.

Medicolegal Pitfalls

  • Failure to achieve a diagnosis in the appropriate clinical setting may deny patients surgery, resulting in recurrent pneumonia.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthor Dr. David Iain Hodgson in development and writing of this article.



More on Pulmonary Sequestration

Overview: Pulmonary Sequestration
Imaging: Pulmonary Sequestration
Follow-up: Pulmonary Sequestration
Multimedia: Pulmonary Sequestration
References
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Further Reading

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Keywords

lung sequestration, bronchopulmonary sequestration, extrapulmonary sequestration, intrapulmonary sequestration, lung bud, lung sequestrum, bronchopulmonary-foregut malformation, scimitar syndrome, horseshoe lung, cystic arteriovenous fistula, cystic arteriovenous malformation, extralobar sequestration, ELS, intralobar sequestration, ILS, acute respiratory distress syndrome, ARDS

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Contributor Information and Disclosures

Author

Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP, Chairman of Medical Imaging, Professor of Radiology, NGHA, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP is a member of the following medical societies: American Institute of Ultrasound in Medicine, Radiological Society of North America, Royal College of Physicians, Royal College of Physicians and Surgeons of the United States, Royal College of Radiologists, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

Coauthor(s)

Margaret Aird, MBChB, FRCR, Consulting Staff, Department of Radiology, Wythenshawe Hospital
Margaret Aird, MBChB, FRCR is a member of the following medical societies: British Institute of Radiology, British Medical Association, and Royal College of Radiologists
Disclosure: Nothing to disclose.

Apam Chiphang, MBBS, Staff Physician, Department of Radiology, North Manchester General Hospital
Disclosure: Nothing to disclose.

Lalam Radhesh Krishna, MBBS, MRCS, Specialist Registrar, Department of Radiology, North Manchester General Hospital
Disclosure: Nothing to disclose.

Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute
Sumaira MacDonald, MBChB, PhD, MRCP, FRCR is a member of the following medical societies: British Medical Association, Royal College of Physicians, and Royal College of Radiologists
Disclosure: Nothing to disclose.

Tufail Ahmed Patankar, MBBS, FRCR, PhD, DMRD, DMRE, DNBE, Consulting Neuroradiologist and Interventional Neuroradiologist, Department of Neuroradiology, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust
Tufail Ahmed Patankar, MBBS, FRCR, PhD, DMRD, DMRE, DNBE is a member of the following medical societies: British Society of Neuroradiologists and Royal College of Radiologists
Disclosure: Nothing to disclose.

Nigel Thomas, MBBS, Vice-Chair, Manchester (North) Research Ethics Committee; Honorary Lecturer, Visiting Professor, University of Salford, UK
Disclosure: Nothing to disclose.

Medical Editor

S Bruce Greenberg, MD, Professor of Radiology, University of Arkansas for Medical Sciences; Consulting Staff, Department of Radiology, Arkansas Children's Hospital
S Bruce Greenberg, MD is a member of the following medical societies: Radiological Society of North America
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD, Consulting Radiologist, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine
Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, and Society of Nuclear Medicine
Disclosure: Nothing to disclose.

 
 
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