Extralobar pulmonary sequestration presenting with torsion in an elderly patient: A case report

Extralobar pulmonary sequestration with torsion is an exceptionally rare condition, especially in adults, and can present with nonspecific symptoms such as abdominal pain, making diagnosis challenging. Timely recognition is critical, as delayed treatment may lead to infarction and serious complications. This report describes the case of a patient with extralobar pulmonary sequestration who presented with abdominal pain.

An 83-year-old healthy female presented with increasing severe abdominal pain and mild fever that had developed for the past three weeks. Chest and abdominal computed tomography revealed a non-enhancing mass in the right posterior paravertebral area, with mild pleural effusion. Video-assisted thoracoscopic surgery to establish a definitive diagnosis revealed a yellow-whitish ovoid mass with congestion and necrosis, accompanied by bloody pleural effusion. The mass was connected to the mediastinum via a twisted feeding vessel. The final diagnosis was consistent with extralobar pulmonary sequestration with torsion and infarction. The patient's symptoms were relieved immediately after surgery.

Extralobar pulmonary sequestration with torsion is rare in adults. Abdominal pain is the hallmark symptom of this condition. The lack of contrast enhancement in the lesion with no visible feeding vascular pedicle or pleural effusion is imaging signs of pulmonary sequestration torsion, and surgical resection is the standard treatment.

This case highlights the importance of considering pulmonary sequestration in the differential diagnosis of unexplained abdominal pain with posterior mediastinal masses, underscoring the value of surgical exploration for diagnosis and treatment.