Intralobar pulmonary sequestration expanding toward the contralateral thorax: two case reports

Area of Science:

• Pediatric Surgery
• Thoracic Surgery
• Medical Imaging

Background:

• Intralobar pulmonary sequestration (ILS) is a congenital lung malformation characterized by lung parenchyma within the visceral pleura, lacking normal tracheobronchial connection and supplied by systemic arteries.
• While typically confined within the lung lobe, ILS can exceptionally extend into the mediastinum, posing diagnostic and surgical challenges.

Observation:

• Two infant cases presented with intralobar pulmonary sequestration extending into the posterior mediastinum and contralateral thorax.
• Chest computed tomography (CT) revealed cystic masses in the lower lung lobes with mediastinal and contralateral thoracic extension.
• Both cases involved aberrant systemic arteries supplying the sequestered lung tissue.

Findings:

• Surgical resection via a unilateral thoracoscopic approach was successfully performed in both infants.
• The sequestered lung segments, including the mediastinal and contralateral components, were completely excised.
• Histopathological diagnosis confirmed intralobar pulmonary sequestration in both patients.

Implications:

• These cases highlight the rare but possible extension of ILS into the mediastinum and contralateral thorax through the pulmonary ligament.
• Unilateral thoracoscopic surgery is an effective treatment modality for these complex ILS presentations.
• Pre-operative contrast-enhanced CT is crucial for accurate diagnosis and surgical planning of mediastinal masses, including atypical ILS.