A focal consolidation patch with emphysematous bordering was found in the medial inferior aspect of the right lower lung, and was supplied possibly by 2 aberrant arteries from the right side of the celiac trunk. Pulmonary sequestration of the posteromedial basal lung was suspected, due to the imaging findings.此病灶
Thoracoscopic wedge resection of the right lower lung pulmonary sequestration was carried out following the chest CT.
During the operation, right basal lung consolidation with an obstructed bronchial lumen and frank pus accumulation was noted. A feeding artery that originated from the paraesophageal side of the celiac artery was ligated. Pathology reported a whitish fibrotic pulmonary tissue, measuring 9.8× 5.5 × 3.2 cm, and the microscopic evaluation was compatible with pulmonary sequestration.
No malignant cells or evidence of congenital pulmonary airway malformation (CPAM) could be seen in the specimen. The operative findings and pathology report were compatible with ILS.
There was no recurrence of hemoptysis during the 2-month postoperative follow-up, and the patient did not experience copious sputum production as before. Medical control with hemostatics and antibiotics was no longer required.
Pulmonary sequestration is traditionally classified as ILS or extralobar pulmonary sequestration (ELS), based on its pleural investment. By definition, ILS is located within a normal lobe and lacks its own visceral pleura, and ELS is found outside the normal lung and has its own pleura. Some experts have proposed bronchopulmonary-foregut malformation as another variant when the sequestered lung is connected to the gastrointestinal tract [2].
Of the various congenital anomalies of the lung, BPS accounts for 0.15-6.4% of all malformations [3]. ILS is more common by far and comprises 75-90% of all BPS [3-4]. ILS affects males and females equally, but there is a significant male predominance in ELS [1-2].