Simultaneous unilateral thoracoscopic resection of bilateral pulmonary sequestration

Abstract

Background: Intra-lobar (ILS) and extra-lobar lung (ELS) sequestrations represent rare congenital lung malformations. Despite their benign nature, the lesions pose risks such as recurrent pulmonary infections, hemoptysis, congestive heart failure, and tumor development. Pulmonary sequestration (PS) typically manifests in two forms, ILS and ELS, with bilateral occurrence being exceptionally rare and mostly requiring bilateral thoracic surgery.

Case presentation: A 9-year-old child, who initially presented with bilateral lung lesions without respiratory symptoms, was diagnosed with PS following a chest computed tomography scan. The surgical approach was determined based on the absence of inflammation and the clear demarcation of the lesions from normal lung tissue, highlighted by a unique tissue connection between the ILS and ELS across the chest cavities. We used a novel method wherein the left ELS was successfully pulled into the right chest cavity and both sequestrations were concurrently resected. Postoperative recovery was smooth, with no complications or residual lesions.

Conclusions: Our findings highlight the importance of thorough preoperative planning with enhanced computed tomography. Simultaneous unilateral thoracoscopic surgery can be a viable, less invasive option for treating bilateral PS, offering benefits such as reduced recovery time and better cosmetic outcomes.

Keywords: Bilateral pulmonary sequestration; Case report; Extra-lobar lung sequestration; Intra-lobar pulmonary sequestration; Thoracoscopic resection.

Fig. 1

Preoperative chest CT reveals: (A) Right ILS and left ELS, ELS bigger, distinct boundaries between the lesions and the normal lung tissue. (B) Tissue connection between ILS and ELS. (C) Bilateral branches of abnormal supply arteries and return veins. (D) Common trunks of the abnormal supply arteries and return veins. (◆: Intra-lobar pulmonary sequestration (ILS), ★: Extra-lobar lung sequestration (ELS), ↑: Connection tissue between ILS and ELS, ●: Aorta artery, ▲: Common trunk of the abnormal supply arteries, ▼: Common trunk of the abnormal return veins, ◥: ILS branch of the abnormal supply arteries, ◤: ELS branch of the abnormal supply arteries, ◢: ILS branch of the abnormal return veins, ◣: ELS branch of the abnormal return veins)

Fig. 2

In thoracoscopy: (A) A three-hole method incision; (B) clear boundary between the ILS and the normal lung tissue; (C) gap between ILS and ELS situated between the descending thoracic aorta and the esophagus; and (D) left ELS connected with the right ILS. Free the common trunk of the abnormal supply artery. ( ◆: Intra-lobar pulmonary sequestration (ILS), ★: Extra-lobar lung sequestration (ELS), ●: Aorta artery, ▲: Common trunk of the abnormal supply arteries, ■: Esophagus, ▍: The gap on the mediastinal pleura)

Fig. 3

Pathological macroscopic view, postoperative X ray before the closed thoracic drainage tube removed and postoperative chest CT after one month: (A) Macroscopic view of connected bilateral the ILS and the ELS, which are connected by tissues. (B) Bilateral lung expansion was well, with no pleural effusion or pneumothorax. (C) Absence of residual lesions in both lungs and no residual cavities in both chest cavities. ( ◆: Intra-lobar pulmonary sequestration (ILS), ★: Extra-lobar lung sequestration (ELS))