Presentation and Management of Pulmonary Sequestration With an Aneurysmal Aberrant Pulmonary Artery

Bronchopulmonary sequestration presents rarely in adults and less frequently with an aneurysmal aberrant feeding artery. Treatment of bronchopulmonary sequestration generally involves lung resection with vascular ligation; however, aneurysmal disease increases the risk of intra- and postoperative hemorrhage and often necessitates more extensive surgery for vascular control. A 39-year-old female patient with a history of prior abdominal surgery presented with sudden onset epigastric and back pain. Computed tomography demonstrated an aneurysmal aberrant pulmonary artery originating from the abdominal aorta, adjacent to the celiac artery, supplying an intralobar pulmonary sequestration in the inferior right lower lung lobe. She also had evidence of cholelithiasis, with confusing symptom correlation. She was treated with a minimally invasive hybrid approach, which involved endovascular arterial embolization prior to delayed thoracoscopic lung resection. This is a safe and effective approach that reduces the risk of intraoperative bleeding while safely achieving vascular control proximal to the aneurysmal disease.