Life after lung sequestration removal. Diagnostics and surgical treatment of lung sequestration in children

Pulmonary sequestration is a pathological area of ​​the lung, localized inside or outside the pulmonary lobe, which does not participate in gas exchange and is supplied with blood from abnormally located vessels extending from the aorta or its main branches. The defect is formed in the early embryonic phase (18-40th day of the intrauterine period).

Pathogenesis

There are two types of sequestration: extralobar (extralobar) and intralobar (intralobar).

With intralobar sequestration, the pathological site is located among normal lung tissue without its pleural delimitation from the parenchyma. Air intake is carried out through peripheral connections. Blood supply occurs due to the supraphrenic or subphrenic aorta or its branches. Venous outflow is carried out through the pulmonary, less often through the unpaired vein. Most often, the defect is located in the posterior-basal segments of the lower lobe, more often on the left.

On macroscopy, the pathological formation is a yellow, non-pigmented, dense area of ​​lung tissue with cysts.

With extralobular sequestration, the pathological site is located in the chest cavity above the diaphragm, sometimes in abdominal cavity. The abnormal lung tissue is separated from the normal lung and covered by its own pleura. In more rare cases, the sequestered area is located extrapulmonary (in the pericardial cavity, in the thickness of the chest wall, in the neck) and fuses with neighboring organs. The arterial blood supply corresponds to that of intralobar sequestration. The outflow of venous blood occurs through the system of the unpaired vein.

Pulmonary sequestration is often combined with other defects.

Clinic, diagnostics

The clinical picture of the disease appears only after infection of the pulmonary sequester. The main symptoms are fatigue, cough, fever, recurrent bronchitis and pneumonia.

On a chest x-ray, homogeneous or inhomogeneous darkening is determined. Most often, the sequestered area is projected in the area of ​​the tenth segment.

According to clinical and radiological data, there are three forms of pulmonary sequestration.

1. Bronchiectasis. In this form, communication develops between the lung sequester and the bronchial tree as a result of inflammation of the surrounding lung tissue.

2. Pseudotumorous form.

3. A form characterized by the occurrence of purulent inflammation of the sequestered area.

Angiography often reveals an additional vessel.

On the tomogram of the chest organs, cystic changes are detected, as well as an additional (abberant) vessel.

Differential Diagnosis

Differential Diagnosis it is necessary to carry out with a bronchogenic cyst, polycystic disease, tuberculosis, neoplasm.

Treatment

Treatment is surgical only. The most commonly performed keeled resection of the sequestered area.

Lung sequestration is a cystic mass of non-functioning lung tissue that has no connection with the bronchi and receives its arterial blood supply only from abnormal vessels. Although the main clinical manifestations of sequestration are associated with the respiratory system, however, severe symptoms also occur on the part of the heart, which may be due not only to concomitant congenital cardiac disease, but also to the presence of powerful shunts.

Pulmonary sequestration can be intralobar, when the abnormal sequestration tissue is within the normal lobe of the lung, and extralobar, when the sequestered tissue is separated from the normal lung and located behind the visceral pleura. A defect defined by the term pseudo-sequestration is also described.

Diagnosis of lung sequestration

Intralobar sequestration of the lung is predominantly found in the lower lobes, most commonly on the left, and in the posterior basal segment. Radiographic findings vary from opacity to cystic lesions of the parenchyma with fluid levels and air bubbles. Abnormal blood supply is usually represented by a vessel extending from the aorta. Often not one, but several vessels approach the sequestered tissue, and the outflow is usually through the pulmonary vein.

The diagnosis is made when a formation is found in one of the lower lobes that does not change in dynamics. CT can provide some help in the diagnosis. However, the most valuable method in such cases is pulmonary or aortic angiography, which allows a clear diagnosis, due to the identification of abnormal vessels. The data of this examination, among other things, are very important for those who need to know the localization of the vessels but avoid their damage in the process. Most of the deaths associated with surgery occur precisely as a result of bleeding from unnoticed abnormal vessels.

Extralobar sequestration of the lung is a lesion located outside the lung lobe. The diagnosis is established in the same way as with intralobar location. If extra-lobar localization is beyond doubt, and there are no manifestations from the side of cardio-vascular system, treatment can be conservative, since infection usually does not occur in such cases. However, extralobar lung sequestration often co-occurs with other anomalies, especially diaphragmatic hernia. An interesting observation was described in three children who had a defect in the diaphragm with a part of the liver protruding through it, which simulated a picture of sequestration radiologically. These cases once again emphasize that with damage to the lower lobe of the lung on the right, it is necessary to perform a radioisotope scan of the liver or peritoneography, which can clearly differentiate these types of pathology.

Lung sequestration is a malformation that is characterized by partial or complete separation (that is, sequestration) from the organ of a part of the lung tissue (usually altered by cystic formations). At the same time, this site ceases to participate in gas exchange, since it also separates from the anatomically normal connections of the lung - the bronchi and blood vessels of the small circle. The blood supply to this separate area is carried out by arteries branching off from the aorta. great circle.

Lung sequestration is a rare malformation of the organ and is approximately 1-6% among them. Among patients of pulmonologists, this anomaly is observed in 0.8-2% of patients with chronic diseases. In most cases, this separated area of ​​the lung is small and is represented by a single bronchogenic cyst or many cystic cavities. Blood circulation in this area is provided by additional vessels that branch off from the thoracic or abdominal aorta or its branches. Venous blood from the separated part of the organ usually enters the superior vena cava, in more rare cases it is excreted by the pulmonary veins. Sometimes the sequestered part of the organ can communicate with the bronchi of the altered lung.

Why does lung sequestration occur? How does this anomaly manifest itself? How is it diagnosed and treated? You can get answers to these questions by reading this article.

The reasons

With sequestration, there is a violation in the development of various structures of the lungs and bronchi. This developmental anomaly respiratory system provoked by teratogenic factors and is formed on early stages embryogenesis, that is, even during intrauterine development. The growth of abnormal tissues begins with an additional protrusion of the primary intestine and a rudiment of the esophageal diverticulum. They separate from the developing lungs and lose contact with them. In some cases, this rudiment of the lung has a connection in the form of broncho-intestinal malformations (stomata-strands) with the esophagus or stomach.

It is assumed that sequestration occurs due to a violation of the reduction of the branches of the aorta and the degeneration of these vessels into abnormal ones. Because of this, fragments of the rudiment of the future lung are separated from the place of normal laying of the organ.

Often in patients with lung sequestration, other developmental anomalies are also detected:

• newborn;
• tracheo- and bronchoesophageal fistulas;
• rhabdomyomatous dysplasia;
• diaphragmatic hernia;
• open mediastinum;
• curvature of the spine;
• defects hip joints;
• renal hypoplasia, etc.

Classification

Depending on the localization, experts distinguish two forms of lung sequestration:

• Intralobar (or intralobar) - the abnormal area is localized on the functioning lung parenchyma and is supplied with blood by one or more vessels. This form of sequestration can be seen as a congenital cyst with abnormal circulation. These cystic cavities are lined with epithelium and contain mucous contents. Over time, suppuration develops in them. Most often, intralobar sequestration is detected in the medial-basal areas of the lower lobe of the left lung.
• Extralobar - the abnormal area has its own (additional) pleural sheet and is completely separated from the normal lung parenchyma. Similar sequesters in most cases come to light in the left lung. In about 20% of patients, they are located in the right lung. In more rare cases, abnormal cystic areas are found in the anterior or posterior mediastinum, under the diaphragm, in the abdominal cavity, or located intrapericardially. The blood supply of the extralobar sequesters is provided by the vessels of the systemic circulation. Microscopic analysis of their tissues reveals multiple underdeveloped acini and bronchioles. Sometimes this kind of lung sequestration is detected during an ultrasound examination of the fetus, but in 2/3 of cases the anomaly makes itself felt in the first three months of a child's life.

According to the observations of specialists, intralobar sequestration occurs 3 times more often than extralobar sequestration. In some cases, both types of sequestrations can be detected in one patient at once. Extralobar forms of anomalies are 3-4 times more likely to be detected in boys.

Depending on the clinical manifestations experts distinguish the following forms of lung sequestration:

• - accompanied by the destruction of the lung parenchyma surrounding the sequestrum and the appearance of communication of the abnormal part with the bronchi;
• pseudotumorous - the anomaly is accompanied by meager manifestations or is hidden;
• cystic-abscessing - infection with pyogenic microorganisms of the sequester leads to purulent inflammation of the lung parenchyma.

Symptoms

The timing of the onset and nature of symptoms during lung sequestration depend on the location of the abnormal area, the presence or absence of its connection with the respiratory organs, the severity of hypoplasia and inflammatory changes in the lung parenchyma.

With the intralobar form of sequestration, manifestations of anomalies usually do not occur in newborns or in early childhood, and the malformation makes itself felt already at an older age. As a rule, its manifestation is provoked by infection, inflammation, suppuration and a breakthrough of the sequester. Due to such a complicated course of the anomaly, the patient suddenly has a fever, weakness, moderate pain, sweating and shortness of breath during exercise.

At the beginning of inflammation of the sequester, the patient complains of an unproductive cough, which, after the breakthrough of the abscess, is replaced by a productive one and is accompanied by the separation of large volumes of purulent sputum. After finishing acute stage and in the absence of treatment inflammatory process becomes chronic. In the future, it manifests itself as dim exacerbations and periods of remission. Sometimes the disease manifests itself as recurrent.

Manifestations of extralobar lung sequestrations occur only in adolescence or older, and the risk of infection remains extremely low. Usually they make themselves felt by symptoms of compression of other organs (esophagus, stomach, etc.). With compression, the patient may experience cyanosis, difficulty in swallowing.

Left untreated, lung sequestration can lead to the following complications:

• profuse pulmonary bleeding with hemothorax;
• oncological processes;
• pneumomycosis;

Diagnostics

Early detection lung sequestrations are usually hampered by the nonspecificity of their clinical and radiological manifestations, and pathology can be mistaken for other pulmonary diseases. For an accurate diagnosis, the patient must undergo a comprehensive examination:

• MSCT of the lungs;
• Ultrasound of the abdominal organs;
• aortography.

With intralobar sequestrations, an irregularly shaped blackout focus is visualized on x-rays. The degree of intensity of its shading is different, in its thickness there is an enlightenment or a dense formation without or with a horizontal line indicating the presence of liquid content. With inflammation of the intralobar sequester, the image shows moderate infiltration of the lung parenchyma and a pronounced change in the vascular pattern.

During bronchography, a displacement and change in the shape of the bronchi located in closely spaced segments of the organ is detected. If the sequester communicates with the bronchus, then bronchoscopy reveals signs of catarrhal-purulent endobronchitis. When an abdominal sequester of the lung is detected during ultrasound, a formation limited by clear contours with homogeneous echogenicity is determined, which is supplied with blood by large arteries.

For the final confirmation of the diagnosis, it is necessary to perform MSCT (multispiral computed tomography) and angiopulmonography. These studies allow you to accurately determine the presence and number of blood supply to the formation of abnormal arteries. To differentiate right-sided pulmonary sequestration from pathologies of the digestive tract, peritoneography and radioisotope scanning of the liver are performed. Sometimes sequestration is detected only during a surgical intervention for chronic purulent inflammation of the lung tissues.

To eliminate errors, differential diagnosis lung sequestration with the following pathologies:

• bronchiectasis;
• pulmonary tuberculosis;
• destructive pneumonia;
• or a lung cyst;
• neoplasms of the chest.

Treatment

Treatment of lung sequestrations can only be surgical. To prevent possible intraoperative massive bleeding, the risk of which is observed due to the presence of large abnormally located vessels, a thorough analysis of diagnostic data and detailed preparation for the upcoming intervention are performed. This approach reduces the risk of developing this dangerous and life threatening patient complications.

The purpose of the operation is to remove abnormal lung tissue. If the sequester does not manifest itself in any way and is intralobar, then the removal of the formation can be achieved using a segmentectomy. In other cases, to get rid of the anomaly, the entire affected lobe of the organ is removed - a lobectomy. For non-lobe sequestration, sequestrectomy is performed.

Forecast

The prognosis for the success of lung sequestration treatment depends on many factors. With uncomplicated purulent processes of intralobar formation, the outcome of the disease in most cases is satisfactory. With celiac extralobar sequestrations, the prognosis is more favorable than with their intrathoracic localization. The success of the operation is largely determined by the experience of the surgeon and the accuracy of diagnostic studies.

- a defect in the formation of the lungs, which consists in the isolation from the main organ of a rudimentary area of ​​\u200b\u200bthe lung tissue with an autonomous blood flow, which is not involved in the process of gas exchange. The clinic for lung sequestration can be scarce; with an exacerbation of infectious inflammation, it includes fever, weakness, shortness of breath, cough with mucopurulent sputum, hemoptysis; with compression of the esophagus and stomach - a violation of the passage of food. The diagnosis is based on X-ray data and CT scan of the lungs, bronchography, bronchoscopy, angiopulmonography. With sequestration lung treatment only operational - sequestrectomy, segmentectomy or lobectomy.

ICD-10

Q33.2

General information

Sequestration (from Latin "sequestratio" - separation, separation) of the lung - congenital pathology with partial or complete separation and independent development of a viciously altered part of the lung tissue (independent blood supply, isolation from normal bronchopulmonary structures). Lung sequestration is one of the rare anomalies in the development of the lungs (1-6%), and among chronic non-specific pulmonary diseases, its frequency in pulmonology is 0.8-2%.

Lung tissue sequestration is not involved in respiratory function, has a small size and is usually represented by a cystic formation (a single bronchogenic cyst or an accumulation of small cysts). The site of sequestration is not associated with the vessels of the pulmonary circulation (pulmonary artery), but has an abnormal blood supply through additional vessels coming from the descending arch of the thoracic or abdominal aorta or its branches (subclavian and splenic arteries). The main venous outflow from the vicious area is realized through the system of the superior vena cava, less often through pulmonary veins. Occasionally, the sequestered tissue may communicate with the bronchi of the affected lung.

Causes of lung sequestration

Lung sequestration is a complex defect caused by a combined violation of the formation of various bronchopulmonary structures. The anomaly develops as a result of teratogenic influences in the early prenatal phase. The source of the development of pulmonary sequestrum is additional protrusions of the primary intestine, rudiments of the esophageal diverticulum, separated from the organizing lungs and then losing contact with the primary intestine and bronchial tree. Sometimes there may be a connection between the rudiment of the lung and the esophagus or stomach with the help of an anastomosis-strand (bronchopulmonary-intestinal malformation).

According to the theory of traction, the development of lung sequestration is promoted by a violation of the reduction of the branches of the primary aorta with their transformation into abnormal vessels. Through these vascular branches, the rudimentary fragments of the lung are separated from the normal pulmonary anlage.

Lung sequestration is often combined with other malformations: ELS - with non-immune dropsy of the fetus, anasarca, hydrothorax of the newborn; ILS - with congenital adenomatoid lung malformation type 2, rhabdomyomatous dysplasia, tracheo- and bronchoesophageal fistulas, funnel chest deformity, open mediastinum, diaphragmatic hernia, kidney hypoplasia, defects of the spine and hip joints.

Classification

There are 2 forms of lung sequestration: intralobar(intralobar - ILS) and out-of-share(extralobar - ELS). With intralobar pulmonary sequestration, the cystic area is located among the functioning lung parenchyma within the boundaries of the visceral pleura (most often in the area of ​​the medial-basal segments of the lower lobe of the left lung) and is vascularized by one or more aberrant vessels. ILS can be considered as a congenital cyst with abnormal circulation. Sequestered pulmonary cysts have an epithelial lining and a fluid or mucoid content, often not primarily associated with the bronchial tree. In the cystic-altered area of ​​​​sequestration of the lung, suppuration sooner or later occurs.

In the extralobar form, the pulmonary sequester has a separate pleural sheet and is isolated from the main organ, being a completely ectopic tissue (accessory pulmonary lobe). PE is more often observed in the left half of the chest (in 48% of cases), in the right (20%), in the anterior (8%) or posterior (6%) mediastinum, subphrenic (18%), in the abdominal cavity (10%), intrapericardially (isolated cases). ELSE is provided by blood exclusively through the arteries of the systemic circulation (thoracic or abdominal aorta). Microscopically, the ELS tissue includes many undeveloped identical bronchioles, acini, consisting of alveolar ducts. irregular shape and normal or dilated alveoli. In a quarter of cases, ELS is diagnosed prenatally, in 2/3 cases - in the first 3 months of a child's life.

The incidence of intralobar sequestration of the lung is approximately 3 times higher than extralobar sequestration, sometimes their simultaneous presence in one patient is possible. ELS is 3-4 times more common in boys than in girls.

According to clinical criteria, 3 forms of lung sequestration are distinguished:

• bronchiectasis(with melting of adjacent lung tissue and the appearance of a secondary communication with the bronchial system);
• pseudotumorous(with few or no symptoms)
• cystic abscess(with the development of purulent inflammation of the lung)

Symptoms of lung sequestration

The clinical picture of lung sequestration is determined by the location of the sequester, the presence or absence of its connection with respiratory tract, the degree of development of hypoplasia of the lung tissue and inflammatory changes. Symptoms of intralobar lung sequestration rarely appear in the neonatal stage and early childhood, usually developing at an older age with infection, inflammation, suppuration and a breakthrough of cystic sequestration.

With suppuration of the cyst and abscess of the vicious lobe of the lung, the disease begins acutely with fever, weakness, sweating, moderate pain, shortness of breath on exertion, unproductive cough, and when the abscess ruptures, with the release of a significant amount of purulent sputum. Sometimes hemoptysis and pulmonary hemorrhages are possible, pleural complications are frequent. The course of lung sequestration usually becomes chronic with recurring flaccid exacerbations and remissions. With ILS, a clinic of recurrent pneumonia may occur.

Extralobar sequestration of the lung is often asymptomatic and begins to disturb the patient only in adolescence and later. Extralobar sequesters can provoke compression of the esophagus, stomach and other organs, which can manifest as shortness of breath, cyanosis, and impaired food evacuation. The risk of infection is extremely low.

Lung sequestration can be complicated by pneumomycosis, tuberculosis, profuse pulmonary bleeding and massive hemothorax, tumor formation, development of acute heart failure due to volume overload of the heart due to arteriovenous shunting in a sequestered cyst.

Diagnostics

Early diagnosis of lung sequestration is difficult due to the similarity of its clinical and radiological symptoms with those of other pulmonary pathologies. The diagnosis is established by the totality of data from plain radiography and CT of the lungs, bronchography, bronchoscopy, ultrasound of the abdominal cavity, aortography, angiopulmonography.

X-ray intralobar sequestration of the lungs (in the absence of connection with the bronchus and inflammation) is defined as an irregular shading of varying degrees of intensity with enlightenment in the thickness or as a cavity formation with or without a horizontal level of fluid. With exacerbation around the sequester in the lower lobe of the lung, there is a pronounced deformation of the vascular-bronchial pattern, moderate perifocal infiltration of the lung tissue. Bronchography shows deformation and displacement of the bronchi adjacent to the affected segment of the lung. The bronchoscopic picture of lung sequestration communicating with the respiratory tract corresponds to catarrhal-purulent endobronchitis on the side of the affected lung.

Celiac PE is detected on ultrasound as a clearly demarcated formation of homogeneous echogenicity with blood supply through the branches of large arteries. The diagnosis is finally confirmed by MSCT of the lungs and angiopulmonography with the presence, number and topography of abnormal vessels supplying the area of ​​sequestration. Radioisotope scanning of the liver and peritoneography help to distinguish right-sided sequestration of the lungs from the pathology of the gastrointestinal tract. Lung sequestration is often detected during surgery for chronic purulent process in the lung. A differential diagnosis for lung sequestration is carried out with destructive pneumonia, a tuberculous process, a cyst or abscess of the lung, bronchiectasis, a tumor of the chest cavity.

Treatment of lung sequestration

With lung sequestration, surgical intervention is required - the removal of an abnormal area of ​​\u200b\u200bthe lung tissue. If asymptomatic intralobar lung sequestration is detected, a segmentectomy is possible, but most often, removal of the entire affected lung lobe (usually lower) is required - lobectomy. The tactics of surgical treatment of the extralobar form is to remove the sequestered area (sequestrectomy). The presence of abnormal large arterial vessels of atypical localization during sequestration of the lungs makes it important to carefully preliminary diagnosis to avoid their intraoperative damage and the development of severe life-threatening bleeding.

The prognosis for intralobar form in the absence of purulent-septic processes is satisfactory, with extralobar lung sequestration of abdominal localization, as a rule, it is better than with its intrathoracic location.

As part of congenital malformations of the lungs, a combination of pulmonary and cardiovascular changes often occurs. With pulmonary sequestration, we are talking about a section of the lung that is located inside or outside the pulmonary lobe and is not involved in gas exchange. The blood supply to this site is provided by an abnormal vessel from the thoracic or abdominal aorta or intercostal artery. For the first time Huber in 1777 reported on two year old who had a vascular anomaly - message thoracic aorta with vessels of the lower lobe of the right lung. At present, this definition is traditionally adhered to, although this is not entirely true, since in this case we are not talking about sequestration, but about separation. Numerous, partly conflicting, theories have been presented regarding pathogenesis.
Lung sequestration is a malformation characterized by the fact that part of the lung tissue, usually abnormally developed and representing a cyst or a group of cysts, is separated from normal anatomical and physiological connections (bronchi, pulmonary arteries) and is vascularized by the arteries of the systemic circulation extending from the aorta. A mass of non-functioning embryonic or cystic tissue that has no connection with a functioning airway and is supplied with blood from the systemic circulation is called a sequester. Although in most cases sequesters do not communicate with a functioning airway, this is not the rule. Both inside and outside the lobar sequesters are formed according to the same pathoembryological mechanism as the rudiments of the esophageal diverticulum. Inside the sequester, tissue of the stomach or pancreas may be found. The teratogenic period of this complex defect refers to the early embryonic phase. Preferential recognition has a theory according to which the malformation of the vessel is preceded by the appearance of an aberrant artery. Through this vessel, single or multiple embryos of the developing bronchial tree are laced and fixed. The frequency of lung sequestration among chronic nonspecific lung diseases (XNLD), according to various authors, varies from 0.8 to 2%.
According to the anatomical structure, the following forms of pulmonary sequestration are distinguished:

1. intralobar sequestration (cyst or cysts of the lung with abnormal blood supply);
2. cystic hypoplasia with aortic circulation, in which the abnormally developed area is located inside the functioning lobe of the lung;
3. extralobar sequestration (an accessory lung, or lobe, with abnormal blood supply) with the formation of an additional underdeveloped organ (cyst or group of cysts) outside a normally functioning lung and vascularization of the first by an artery or arteries of the great circle.

Intralobar sequestration - changes are most often localized in the posteromedial region of the lower lobe of the left (rarely right) lung, they are a cyst or a group of cysts of the bronchogenic type, lined from the inside with a cylindrical or multi-row squamous epithelium, initially do not communicate with the bronchial tree and are filled with mucous fluid. An arterial vessel approaches them, starting most often on the lateral surface of the descending thoracic aorta and passing through the thickness of the pulmonary ligament. Venous outflow from the abnormally developed zone is carried out through the pulmonary veins. In the cyst (or cysts), sooner or later suppuration begins. There is no difference in the frequency of this pathology in both lungs.

Clinical manifestations. Occurs only after the development of a suppurative process in the cystic cavity (cavities). It begins with a moderate fever, and after a breakthrough of the contents of the cyst in the bronchus, abundant mucopurulent sputum appears, sometimes hemoptysis.
It proceeds with periodic sluggish exacerbations and remissions of the infectious process.
According to clinical and radiological signs There are 3 forms of pulmonary sequestration:

1. 1. bronchiectasis, in which, after repeated inflammation and melting of the borderline lung tissue, communication with the bronchial tree occurs again;
   2. pseudotumorous, characterized by poor symptoms;
   3. a form that takes on the character of an abscess or empyema, in which, due to infection in the area of ​​​​the sequester, a purulent inflammation of the lung or pleural empyema.

In principle, sequestration can be assumed with etiologically insufficient clear lung infiltration especially the lower lobes. Bronchography data are important for making a diagnosis. The separated segment is not filled.

physical picture. Physical examination is usually uninformative. Sometimes it is possible to determine wet rales of various sizes in the posterior lower sections of one of the lungs.

X-ray examination. In the medial-basal part of one of the lower lobes, a cyst or a group of cysts with or without a horizontal fluid level is determined. In the circumference of cysts during the period of exacerbation, moderate infiltration of the lung tissue can be detected. Sometimes, in this section of the lung, an irregularly shaped shading is determined, against which a cavity can be detected during a tomographic examination.

Rice. Lung sequestration. The sequestered lung is highlighted in blue on a CT scan.

Bronchography. Slightly altered bronchi of the lower lobe of the corresponding lung are found, pushed aside and brought together by the existing volumetric formation. The cyst cavity is rarely filled with a contrast agent. The discovery of a cyst or group of cysts in the inferomedial region of one of the lungs should always be a reason to suspect intralobar sequestration. An abnormal arterial vessel in some cases can be detected on well-executed tomograms in the posterior projection. The diagnosis is definitively confirmed by Seldinger autography or selective opacification of the abnormal artery.

Treatment . The most important results of angiographic examination, especially in preparation for lung surgery. Fatal bleeding has been described as an operative complication. Pulmonary sequestration requires surgical treatment. Surgical intervention held in early dates, often reduced to wedge resection of the sequestered area. It is also indicated in asymptomatic cases, since recurrent inflammation develops in the sequestration with known complications.
In extralobar sequestration, an abnormal area of ​​lung tissue appears outside a normally developed organ and may be located in the pleural cavity, in the abdominal cavity, or on the neck. The vestigial lung (lobe) is small and has an abnormal arterial blood supply due to a vessel originating from the aorta or from another large artery of the great circle. Its structure is also more often cystic, usually not communicating with the airways.
Extra-lobar sequestration does not manifest itself in any way and is detected by chance during operations or during post-mortem examination. Rarely there is an infectious process. Diagnostics is developed insufficiently. When the cavities of an underdeveloped lung communicate with the airways, bronchological examination contributes to recognition. Aortography, searches and selective contrasting of the abnormal artery are also shown.
The simultaneous existence of intra- and extralobular sequestration is described. Intralobar sequestration is rarely seen in childhood. Pulmonary sequestration can be combined with other malformations. Kidney hypoplasia, open mediastinum, funnel-shaped rib cage, pulmonary cysts, congenital anomalies of the heart, esophageal-bronchial fistulas, diaphragmatic hernia, anomalies of the spine and hip joint.

Literature:
Reference book of a pulmonologist / V.V. Kosarev, S.A. Babanov. - Rostov n / a: Phoenix, 2011. - 445, p.