[When pulmonary sequestration is hidden behind arteriovenous pulmonary malformation]

A 33-year-old patient was stabbed, causing a perforating thoracic wound complicated by cardiorespiratory arrest due to hemorrhagic shock. Emergency surgery was performed with hemostatic and resuscitative bithoracotomy, revealing an incidental lesion suspected of being a pulmonary arteriovenous malformation (PAVM). This lesion being organized, and following embolization of the abnormal arteries arising from the descending thoracic aorta which were causing a systemic-pulmonary shunt, left lower lobectomy was performed. After anatomopathological study, a diagnosis of intralobar pulmonary sequestration was established. Pulmonary sequestration is not included in the international classification of vascular abnormalities. It is defined as a condition in which parts of pulmonary tissue are irrigated by an abnormal systemic artery. There exist two forms of pulmonary sequestration: intralobar and extralobar. Contrarily to most arteriovenous malformations, surgical excision is generally recommended, even though transcatheter embolization could be considered as an option in specific situations. Differential diagnosis of PAVM is difficult and raises questions on risks of progression, which differ between the two pathologies. While transcatheter embolization is a key component of PAVM treatment, radical surgery is usually required for pulmonary sequestration.