• Journal of Chest Surgery
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• v.28 no.8
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• pp.792-796
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• 1995

The pulmonary sequestration is a rare congenital malformation of the lung, concerning about the abnormal feeding systemic artery, may happen a serious complication of bleeding during operation if not recognized before operation. We experienced a case of bilateral intralobar pulmonary sequestration preoperatively confirmed by aortogram. An Aortogram demonstrated a anomalous systemic artery arising from thoracic aorta just above the diaphragm. The artery bifurcated and supplied areas of both right and left lower lobes. On the operative field, left lower lobectomy was done with devision and ligation of left branch of anomalous artery and triple ligation of remained branch of anomalous artery was done. Postoperative course was uneventful. She was discharged on postoperative seventeenth day.

• Journal of Chest Surgery
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• v.39 no.7 s.264
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• pp.556-560
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• 2006

A 42-year-old female was admitted to our hospital complaining of a dyspnea. Chest X-ray showed left atelectasis. A mass was detected in left main bronchus by computed tomography and bronchoscopy. The mass was diagnosed as a endobronchial leiomyoma by biopsy exam. After open thoracotomy and bronchotomy, mass removal was done and middle lobe was ventilated normally. Aberrant arterial supply from descending aorta to left lower lobe of the lung was detected and left lower lobectomy was done. The lower lobe of the left lung was pathologically diagnosed as intralobar pulmonary sequestration. Herein we report a rare coexistent case of endobronchial leiomyoma and intralobar pulmonary sequestration.

• Journal of Chest Surgery
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• v.31 no.12
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• pp.1206-1211
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• 1998

Background: Pulmonary sequestration is not common and it's diagnosis needs special care such as an aortogram ar tomography. Material and Method: We have experienced 13 patients who had pulmonary sequestration from January 1990 to September 1997. Result: Six men and seven women were treated and their mean age was 25.8±14.3 years. Their chief complaints were coughing, chest pain, and no symptoms in decreasing order. There were nine intralobar(ILS) and three extralobar(ELS) pulmonary sequestrations and one patient had both. There was no preference in location of either left or right. They were mainly diagnosed by aortography and their feeding arteries commonly originated from the lower thoracic aorta. The patients with ILS were treated by lobectomy and those with ELS by sequestrectomy. Conclusion: to treat pulmonary sequestration properhy, aortogram or chest CT is warranted to iidenty the abnormal origin of feeding artery.

• Journal of Chest Surgery
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• v.28 no.8
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• pp.797-800
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• 1995

Pulmonary sequestration is an uncommon congenital pulmonary malformation characterized by presence of nonfunctioning lung tissue which receives its blood supply mostly from the anomalous systemic arteries - descending thoracic aorta or abdominal aorta, subclavian artery, innominated artery and internal mammary artery, etc. In our country, 39 cases were reported previously. The patient was a 40 years old woman and admitted due to productive cough for 1 year. The chest X-ray and chest C-T showed a dense mass containing a large cavity with air-fluid level and multiple radiolucent cysts in the right lower lung field. On the operative field, we could identify an aberrant large artery [ $\phi$7mm which arose directly from the descending thoracic aorta at eighth thoracic spinal level and fed the sequestrated portion of the right lower lobe. The aberrant artery was double ligation after division. Only sequestrated lobe on the superolateral lesion of the right lower lobe was resected because of nonseparated lobes in all the right lobes. An abnormal vein and bronchiole were ligated with black silk. The patient`s postoperative course was unevenful.

• Journal of Chest Surgery
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• v.36 no.5
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• pp.356-362
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• 2003

Background: Intralobar and extralobar pulmonary sequestrations have been considered as congenital lesions that occur at different stages of embryonic life. However, most cases of intralobar pulmonary sequestration (IPS) seem to have an acquired origin, as they are absent in infants and associated anomalies are relatively, uncommon among them. Material and Method: The cases of 25 patients who were diagnosed as IPS after surgical resection from December, 1985 to July, 2002 were included in this study. The medical records wire retrospectively reviewed and the clinical characteristics were age at operation; gender; symptoms at presentation; presence of congenital anomalies; combined diseases; preoperative studies and diagnosis; location of the lesion; method of surgical resection; origin, size and numbers of aberrant artery; histopathological findings; and postoperative complications. Result: There were 17 (68%) female patients and 8 (32%) male patients, their ages ranged from 1 to 57 and mean value was 23 years old. Though 14 patients (56%) complained of respiratory symptoms such as pneumonia and recurrent respiratory infections, a large number of patients (44%) were asymptomatic or had chest pain only when the lesion was discovered. Only 8 patients (32%) were diagnosed as pulmonary sequestration preoperatively and 8 (32%) were suspected as mediastinal or lung tumor, 5 (20%) were congenital or acquired cystic lung disease, and 4 (16%) were lung abscess or bronchiectasis, respectively. The majority of aberrant arteries (86.4%) confirmed during the operation were originated from thoracic aorta and 2 were thoracic and abdominal aorta, 1 was abdominal aorta, respectively. The younger patients (less than 10 years old) had more other congenital anomalies (30% vs 6.7%) but the proportion of congenital IPS was not significantly different (10% vs 6.7%, p>0.05) compared with elder patients. Histopathologically, almost all lesions showed chronic inflammation, cystic changes and similar pleural adhesions regardless of age. Conclusion: The large portion of the patients with IPS (44%) was clinically asymptomatic or presented non-respiratory symptoms at diagnosis and likely to be diagnosed as mediastinal or lung tumor especially in elder patients. Though the younger patients had more other congenital anomalies, most cases of IPS proved to be acquired lesions in terms of the histopathlogical findings and the proportion of congenital evidences.

• Tuberculosis and Respiratory Diseases
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• v.44 no.2
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• pp.401-408
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• 1997

Background : Pulmonary sequestration is a rare congenital malformation, which is manifested by formation of nonfunctioning lung tissue lacking normal communication with the tracheobronchial tree. The preoperative diagnostic rate has been relatively low, and without consideration of pulmonary sequestration, unexpected bleeding from aberrant vessels may be a serious problem during the operation. The purpose of our study is to describe the clinical features of pulmonary sequestration based on a review of 15 cases treated by operation. Method : Fifteen patients with pulmonary sequestration who had undergone surgical treatment from 1991 through May 1996 at Yongdong Severance Hospital and Severance Hospital were reviewed retrospectively. Results : The mean age of the patients was 22.5 years (range 5~57), and male to female ratio was 9 : 6. Clinical presentations varied from recurrent respiratory infections such as fever, cough, and sputum or chest pain to no symptom. The chest simple X-rays showed multicystic shadow(10/15) and solid mass-like shadow(5/15). The chest CT scans, done in twelve cases, showed multicystic lesion with or without lung infiltration(8/12), solid mass-like lesion(4/12), The chest MRIs, done in three cases, revealed the aberrant arteries originating from descending aorta(2/3). Aortograms, done in four cases, showed the aberrant arteries originating from descending thoracic aorta(2/4), abdominal aorta(I/4), and intercostal artery(1/4). and the venous returns were via the pulmonary veins. Pulmonary sequestration was considered preoperatively in six patients of fifteen. Other preliminary diagnosis were lung tumor(3/15), lung abscess(21/15), bronchiectasis(2/15), and mediastinal tumor(2/15). In the operative findings, twelve cases were of intralobar type and three cases of extralobar type. The left lower lobe was most often affected(9/15) and one extralobar sequestration was in the pericardium. The aberrant arteries originated from descending thoracic aorta(6/15), abdominal aorta(1/15), internal thoracic arteries (2/15), intercostal artery(1/15), pericardiophrenic artery(1/15), but in four cases, the origins could not be defined. There was no mortality or complication postoperatively. Conclusion : In our study, preoperative diagnostic rate was relatively low, and clinical features were similar to previous reports. Preoperative vigorous diagnostic approach including aortography is strongly advocated not only for its diagnostic value, but also for accurate localization of the aberrant vessels, which is major concern to surgical procedure.

• Tuberculosis and Respiratory Diseases
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• v.60 no.6
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• pp.678-683
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• 2006

Both bronchial leiomyoma and pulmonary sequestration are rare conditions, and to the best of our knowledge there are no reports of the two conditions coexisting. We report a female patient with bronchial leiomyoma with acquired pulmonary sequestration who presented with dyspnea, cough and purulent sputum. The patient had been treated for pneumonia at a local medical clinic. but was transferred to our clinic beacausr there was no clinical improvement. A 3-D computed tomography scan revealed a 1.5 cm sized mass near the distal portion of the left main bronchus and an anomalous artery arising from the aorta. The patient showed clinical improvement after a left lower lobectomy and a ligation of the anomalous artery.

• Journal of Chest Surgery
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• v.23 no.4
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• pp.698-706
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• 1990

Congenital Cystic Lung Disease is a spectrum of closed related anomalies that arise during an early stage of embryonic lung bud maturation-namely bronchogenic cyst, congenital lobar emphysema, pulmonary sequestration and congenital cystic adenomatoid malformation. And they show similar surgical strategies. So they are called as the term bronchopulmonary-foregut malformations, firstly proposed by Gerle[1968]. From Aug. 1979 to Aug 1989, 47 patients were operated upon on Dept. of Thoracic & Cardiovascular Surgery at the CUMC. There were 21 females and 26 males ranging in age from age of 21 day to age of 56 year [15 cases under 15 years old]. 30 patients had bronchogenic cysts - 23 of intrapulmonary type, 7 of mediastinal type in location. Affected lobes and locations were as follows: 11 in upper lobe, 3 in middle lobe, 11 in lower lobe and anterosuperior, middle, and posterior mediastinal type were 3, 2, 2 respectively. There were 9 pulmonary sequestrations[all intralobar type] with the distribution of 5 in right lower lobe and 4 in left lower lobe. And associated anomalies were presented with arterial supply originating from thoracic aorta[8 cases], abdominal aorta[1 case] and with venous drainage into azygos vein[1 case]. They all were operated upon lower lobectomy [8 case], pneumonectomy[1 case] in case of pulmonary hypoplasia Congenital lobar emphysema and congenital cystic adenomatoid malformation had 4 cases respectively. Their affected lobes were as follows: the former were 3 in upper lobes, 1 in middle lobe and the latter were 3 in upper lobe, 1 in lower lobe. They were treated with lobectomy and segmentectomy. Diagnosis was aided by chest X - ray, bronchography, aortography, DSA and CT scan, They all were confirmed by pathologic exams. There were no hospital death but few minor morbidities such as, atelectasis-pneumonia[2], wound infection[2], prolonged chest tube placement[2]. We experienced surgical treatments of 47 cases for 10 years and reported them with literature review.