21 Cases Of Clinical Diagnosis And Analysis Of Pulmonary Sequestration

?Objective?:Pulmonary sequestration(PS)is a rare congenital malformation of the lung.The current clinical misdiagnosis rate is high.This article intends to discuss and summarize the incidence,clinical features,auxiliary examination,treatment methods and misdiagnosis reasons of pulmonary sequestration,aiming to explore the common occurrence of pulmonary sequestration,in order to change the clinician's understanding of pulmonary sequestration and improve the diagnostic rate.Reduce misdiagnosis and mistreatment.?Methods?:Clinical data of 21 patients with pulmonary sequestration treated at the Affiliated Hospital of Guangzhou Medical University from July 2003 to May 2018 were collected.Based on the combination of literature reports,the gender of 21 patients was retrospectively analyzed.The proportion,age distribution,clinical features,tumor markers,imaging findings,abnormal nourishing artery sources,bronchoscopy findings,treatment methods,and prognosis were included.?result?:1.A total of 21 patients were observed in this group,including 8 females and 13 males.The ages ranged from 13 to 80 years and the disease duration ranged from 1 week to 20 years.Length of stay 5-24 days.2.In this group of patients,cough(14 cases)and cough(13 cases)were the most common manifestations of pulmonary sequestration,including 8 cases of hemoptysis/filamentary sputum,5 cases of fever,2 cases of shortness of breath,1 case of chest tightness,and 4 cases of asymptomatic symptoms.Physical examination: 61.9% of the observed subjects did not have any positive signs,23.8% had wet rales,and 14.3% had respiratory sounds weakened.3.The type of lesions was predominantly intrafoliar,accounting for 57.1%;the predominant site was mostly left lower lobe(61.9%),33.3% of lesions were located in the right lower lobe,rare in the upper lobe,accounting for only 4.8%.4.In this group of observational subjects,there were 15 cases of complete detection of tumor markers,of which mainly CYFPRA-211,Ca125,Ca199 and other indicators increased.5.In 21 patients,chest X-ray and chest-enhanced CT+CTA/MPR were both improved: 12 cases of X-rays showed masses in the lung field or high-density oval-shaped shadows,some of the edges were unclear,and the other 9 cases showed only lungs with X-rays.Increased texture/lobar cords;14 chest-enhanced CT+CTA/MPR suggesting increased mass or lump density,some with air cavity/air-liquid level;and another 7 chest-enhanced CT+CTA/MPR Only a small amount of flocculent,ground glass-like high density shadows were observed in the lower lobes of the lungs,and the edges were blurred.6.66.7% of the observational abnormal blood vessels originate from the abdominal aorta,the number of abnormal blood vessels is one;28.6% are from the thoracic aorta,the number of abnormal blood vessels is one,and 4.7% are from the abdominal aorta and thoracic aorta.Joint blood supply,abnormal blood vessel count was 2.7.Six patients had perfect bronchoscopy,and all had no specific signs.8.Seven patients underwent surgical treatment.Inflammatory lesions were the main manifestations of postoperative pathology.No fungal,atypical hyperplasia,precancerous or cancerous lesions were present.9.(1)?Fourteen patients were selected for conservative treatment of the drug,and penicillin/cephalosporin antibiotics were routinely given for anti-infective therapy,supplemented with symptomatic treatment of hemostasis,phlegm,cough,oxygen and nutritional support.?(2)?Seven patients underwent surgical treatment without serious postoperative complications and no perioperative death.Postoperatively,penicillin/cephalosporin antibiotics were used to prevent infection,supplemented with oxygen inhalation,nebulization,hemostasis,phlegm,and other symptomatic treatments?10.After treatment,all patients had less cough and sputum,fever,hemoptysis,hemoptysis and other symptoms disappeared,and the symptoms improved and then discharged.?conclusion?:1.Pulmonary sequestration is a rare congenital pulmonary dysplasia.It occurs in the left lower lobe of the lung.It often presents with repeated respiratory tract infections.The clinical symptoms are lack of specificity,and are easily associated with pneumonia,pulmonary cysts,and bronchiectasis.As well as the confusion of lung malignant diseases,the rate of missed diagnosis and misdiagnosis is high.Imaging findings revealed that the abnormal blood supply artery is the key to the diagnosis of pulmonary sequestration.Chest radiographs can be used as routine screening.Chest-enhanced CT and three-dimensional vascular reconstruction are the first choice for diagnosis.Magnetic resonance imaging is an important supplement to CT in the diagnosis of location.In some patients with pulmonary sequestration.2.Surgery is the preferred treatment plan and can completely remove the lesion.Surgical methods include traditional thoracotomy,video-assisted thoracic assistive surgery,interventional embolization,and the newly emerged Da Vinci robot-assisted resection.Routine intraoperative rapid frozen pathological examination,such as benign lesions,direct surgical resection can be,if the biopsy results suggest that malignant,you need to be treated according to the principle of radical lung cancer surgery.Because pulmonary sequestration is malignant or associated with other malignant lung tumors,regular follow-up is still required for patients who have been cured.