Bilateral intralobar and extralobar pulmonary sequestration: A case report

Abstract

Background

Bilateral pulmonary sequestration is a rare condition, with the coexistence of intralobar (ILS) and extralobar sequestration (ELS) being particularly uncommon. Antenatal diagnosis of such bilateral presentations remains exceedingly rare.

Case presentation

A 26-week of gestational age fetus was diagnosed by prenatal ultrasound with an echogenic lesion in the right hemithorax and an echogenic lesion in the left hemithorax. Fetal MRI at 36 weeks confirmed bilateral pulmonary lesions. A male infant was delivered at 39 weeks with no respiratory symptoms. Postnatal angiothoracic computed tomography (CT) with 3D vascular reconstruction confirmed left extralobar and right intralobar sequestrations. Although the child remained asymptomatic, elective surgery was scheduled at 9 months to prevent potential complications while allowing for continued growth and lung development. The ELS was successfully excised via a thoracoscopic approach, with an uneventful postoperative course. At 12 months, a right lower lobectomy was performed, through thoracotomy, to remove the ILS. The postoperative period was marked by a transient pulmonary infection, which resolved with antibiotic therapy. Histopathological examination confirmed the diagnosis of pulmonary sequestration. At 18 months of follow-up, the child exhibited normal growth and development without any complications.

Conclusion

In cases of bilateral, intrapulmonary and extrapulmonary sequestrations, a sequential resection before the age of 1 year seems to be a safe and effective management option.