Pulmonary sequestration is a congenital lung malformation involving the systemic arterial blood. Infection is a common complication; however, Nocardia infection is rare. We report the case of a 55-year-old immunocompetent male with recurrent infection of a pulmonary cyst in the left lower lobe. Despite the use of empirical antibiotics, the inflammation recurred. Contrast-enhanced computed tomography confirmed pulmonary sequestration, and bronchoscopy revealed Nocardia cyriacigeorgica. Although trimethoprim-sulfamethoxazole was effective, it was discontinued because of severe drug-induced rash. Surgical resection resolved the infection without the use of long-term antibiotics. Timely consideration of surgical intervention may be important for infection control in pulmonary sequestration complicated by Nocardia, especially when antibiotic management is difficult.

Bronchopulmonary sequestration (BPS) is a congenital anomaly of the lung characterised by non-functioning pulmonary tissue that receives its blood supply from an anomalous systemic artery, most commonly from the aorta. Although typically diagnosed in childhood or adolescence, BPS can present later in life and may mimic more common pulmonary conditions. We present the case of a male patient in his late 60s with a persistent non-productive cough, in whom imaging revealed a sequestered lung segment with a feeding vessel arising directly from the descending aorta. This case emphasises the importance of recognising that congenital pulmonary anomalies such as sequestration can present for the first time in older adults. Early recognition is crucial to avoid misdiagnosis as malignancy or chronic infection and to ensure that patients receive the appropriate, individualised management.

The paper presents a case study of an infant with symptoms of gastroesophageal reflux, recurrent pneumonia, and tracheal narrowing observed during laryngoscopic examination, in whom intralobar sequestration was suspected during the diagnostic process. The article further provides an overview of current knowledge concerning the aetiology, clinical presentation, therapeutic approaches, and complications of pulmonary sequestration. Pulmonary sequestration is a rare congenital anomaly of the respiratory system in which non-functional lung tissue develops during prenatal development without communication with the bronchial tree. It is typically supplied by systemic arteries, most commonly from the descending aorta. Pulmonary sequestration is classified into two types: intralobar and extralobar. Common symptoms include respiratory distress, feeding difficulties, recurrent pneumonia, chronic cough, and haemoptysis. Lobectomy remains the treatment of choice; however, in asymptomatic patients, and in the absence of established guidelines, conservative management with periodic monitoring may be considered as a favourable alternative.

E.J. term newborn born by C-section due to maternal hypertension and obesity.

ABSTRACT. The article presents a comprehensive analysis of contemporary approaches to the diagnosis of congenital lung malformations and anomalies (CLMAs), which account for 5-18 % of all thoracic organ anomalies. Epidemiological aspects, classification, and morphological features of the most common forms are discussed, including congenital pulmonary airway malformation, pulmonary sequestration, congenital lobar emphysema, bronchogenic cysts, as well as rare anatomical variants such as tracheal bronchus or accessory lung. Attention is drawn to the phenomenon of hybrid lesions that combine characteristics of multiple nosologies. The significance of prenatal diagnostics, particularly ultrasound and MRI, is highlighted as essential for timely detection of pathologies and planning the management of newborns. Considerable attention is given to the genetic factors and pathogenesis of CLMAs, including the role of mutations in the FGF10 and TBX4 genes, as well as associations with primary ciliary dyskinesia. It is shown that malformation development has a polyetiological nature, combining genetic, embryological, and exogenous factors. Clinical manifestations range from asymptomatic cases to severe respiratory failure, and pathognomonic features of individual forms are identified. It is summarized that diagnosis of congenital lung malformations relies on a combination of clinical data, the results of instrumental methods (CT, MRI, bronchoscopy), histological studies, and genetic testing. The findings are crucial for timely selection of optimal therapeutic strategies, prevention of infectious complications, and reduction of the risk of malignant transformation.

We report a fetus at 20 + 5 weeks' gestation with an exceptionally rare constellation of congenital anomalies. Prenatal imaging revealed left congenital diaphragmatic hernia, rightward cardiac displacement, possible tracheoesophageal fistula (TEF), transposition of the great vessels, and a large ventricular septal defect. Autopsy confirmed complete absence of tracheoesophageal separation from the larynx to the carina, consistent with Kluth type Xc2, incorporating extralobar pulmonary sequestration with esophageal communication. The findings met criteria for a communicating bronchopulmonary foregut malformation (CBPFM), Srikanth Group III. Additional anomalies included bilateral pulmonary hypoplasia, bilateral unilobar lungs with eparterial bronchi, mirror-image dextrocardia, L-looped ventricles with concordant atrioventricular and ventriculoarterial alignments, right-sided aortic arch, bilateral superior vena cava, cardiac-type total anomalous pulmonary venous connection with drainage into the morphologic right atrium, and anomalous coronary origin from the pulmonary artery. Cytogenetic studies and whole-exome sequencing were normal. To our knowledge, this is the first report of Kluth type Xc2 TEF with Srikanth Group III CBPFM since Stolte's original description in 1952, and the first to combine this unique constellation. This case broadens the recognized spectrum of foregut and cardiopulmonary maldevelopment and underscores the importance of comprehensive evaluation in fetuses with multiple anomalies.

Prenatal diagnosis of echogenic lung lesions can be achieved using high-resolution ultrasound during the second trimester. The most common causative lesions are congenital pulmonary airway malformation (CPAM) and bronchopulmonary pulmonary sequestration. Few studies have described the prognosis, prenatal and postnatal management of these lesions. Here, we report one of the few cases of CPAM managed successfully in Pakistan with favourable outcomes.

Lung-preserving surgery is comparable to lobectomy for intralobar pulmonary sequestration: A retrospective case series

Extralobar pulmonary sequestration with a transdiaphragmatic gastric attachment: a case report

Bilateral intralobar and extralobar pulmonary sequestration in an infant with severe pectus excavatum

Combined embolization with coils, gelatin sponge, and PVA microspheres for pulmonary sequestration: A case report

Pulmonary sequestration (PS) is a rare congenital malformation of the lower respiratory tract characterized by non-functional lung tissue lacking communication with the tracheobronchial tree and supplied by an aberrant systemic artery, most often arising from the aorta. Although typically diagnosed in childhood, PS may occasionally be discovered in adults, often incidentally or during evaluation for recurrent respiratory symptoms. Radiologic imaging, particularly contrast-enhanced computed tomography (CT), is essential for diagnosis and surgical planning. We report a case series of five adult patients with pulmonary sequestration.

We present a case of a young adult patient with haemoptysis and back pain following 2 days of worsening cough. CT imaging revealed an intralobar pulmonary sequestration of the left lower lobe with an anomalous arterial supply from the thoracic aorta and a large associated haemothorax. The patient developed haemodynamic instability and was taken emergently to the operating room for left thoracotomy. Intraoperatively, active haemorrhage from the aberrant systemic vessel was identified, controlled and ligated. A left lower lobectomy was performed, and the patient made an excellent recovery.Pulmonary sequestration is a rare congenital anomaly of non-functioning lung parenchyma with systemic arterial supply, typically presenting in childhood with recurrent infections. Rarely, as in this case, it presents in adulthood with life-threatening haemorrhage. This case underscores the importance of early recognition and prompt surgical management in adult presentations of pulmonary sequestration with haemorrhagic complications.

Feasibility and Safety of Nonintubated Anesthesia in Pediatric Video-assisted Thoracoscopic Surgery: A Preliminary Report.

Staged Hybrid Treatment of a Large Aneurysmal Pulmonary Sequestration With Thoracic Endovascular Aortic Repair Followed by Lobectomy

BackgroundAccurately delineating the intricate vascular and bronchial anatomy of sequestered lung tissue poses significant challenges in pulmonary sequestration (PS) resection. Although conventional two-dimensional (2D) imaging remains indispensable, its limitations in spatial resolution are frequently associated with intraoperative uncertainties. This study investigates the clinical applicability of three-dimensional computed tomography bronchography and angiography (3D-CTBA) for preoperative planning and intraoperative guidance in PS surgery.MethodsIn this retrospective cohort study conducted at a single tertiary center, we enrolled 22 consecutive intralobar PS patients scheduled for surgical resection between January 2021 and October 2024. All study participants underwent preoperative 3D-CTBA reconstruction to formulate individualized surgical strategies. Anatomical accuracy of the three-dimensional (3D) models was rigorously validated against intraoperative observations, while procedural safety was assessed by recording intraoperative complications, including iatrogenic injury to aberrant artery and adjacent tissue.ResultsThe surgical team conducted preoperative planning for all patients using 3D reconstruction models. Ultimately, five patients (22.7%) underwent sublobar resection, while the remaining 17 patients (77.3%) underwent lobectomy. Two cases involving arteries originating from uncommon sites were undetected in computed tomography (CT) imaging, and one patient with three thoracic aortic arteries was misclassified as having only a single aberrant artery. However, the 3D-CTBA models demonstrated complete consistency with intraoperative findings. The surgical team confirmed complete concordance (100%) between the 3D reconstructions and intraoperative anatomical findings, with all procedures resulting in no iatrogenic injuries to aberrant arteries or adjacent tissues.ConclusionsOur findings preliminarily establish 3D-CTBA as a reliable strategy for PS surgery, effectively addressing the dual challenges of aberrant vessel identification and parenchymal preservation, particularly in complex cases (e.g., patients with arteries originating from rare systemic arterial circulation or having multiple aberrant arteries). We believe that 3D-CTBA technology holds significant promise for the surgery of PS, and we anticipate its widespread use in patients with complex pulmonary malformations in the future. Further large-scale, multicenter, prospective studies are required to further confirm our findings.

BackgroundCongenital cystic lung malformations (CCLM) increasingly require parenchyma-sparing resections. While thoracoscopic segmentectomy offers tissue preservation benefits, its complexity demands advanced preoperative visualization. This study evaluates head-mounted display virtual reality (HMD-VR) for surgical planning in pediatric segmentectomies.MethodsNineteen children (4 to 148 months) underwent VR-assisted thoracoscopic segmentectomy. Patient-specific three-dimensional (3D) models were generated using Medicalholodeck® software, integrating contrast-enhanced CT DICOM data. Surgeons performed immersive rehearsals via HMD, evaluating anatomical relationships and simulating dissection planes. Primary outcomes included technical feasibility, perioperative metrics (operative time, blood loss, complications), and anatomical accuracy validation by independent surgeons.ResultsAll procedures (100%) were completed thoracoscopically without conversion. Mean operative time was 116.3 ± 45.5 min with blood loss of 29.5 ± 20.6 ml. Pathologies comprised congenital pulmonary airway malformation (78.9%, CPAM) and others (21.1%, bronchial atresia, pulmonary sequestration, and lobar emphysema). 26.3% of cases required combined segmentectomy due to lesions spanning ≥ 2 segments. For these patients, hospital stay, intraoperative blood loss, operative time, and duration of chest tube drainage were significantly higher than for single segmentectomies (P < 0.01), although there was no significant difference in postoperative complications. Postoperative follow-up at 1, 3, and 6 months demonstrated satisfactory recovery in all patients, with no respiratory symptoms, recurrence, or mortality.ConclusionsHMD-VR enables precise spatial mapping of complex pediatric pulmonary anatomy, facilitating safe thoracoscopic segmentectomies even for multi-segmental lesions. Its immersive planning optimizes surgical trajectories and mitigates intraoperative risks, demonstrating transformative potential for parenchymal preservation in CCLM management.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12887-025-06259-3.

While meso/dextrocardia, a cardiac axis abnormality, is associated with various complications and a poor prognosis, few studies have been reported. We aimed to identify and review patients at our hospital who had been diagnosed with fetal meso/dextrocardia. The medical records of 29 patients diagnosed with fetal meso/dextrocardia between April 1, 2014 and March 31, 2024 were reviewed. We identified eight cases of mesocardia and 21 cases of dextrocardia (17 dextropositions and four dextroversions). Right lung hypoplasia (including 3q trisomy, esophageal bronchopleural fistula, and left pulmonary artery sling) was identified in three cases. Five cases of persistent left superior vena cava (PLSVC) were identified [isolated PLSVC (n = 2), VACTERL association (n = 1), trisomy 13 (n = 2)]. Dextroposition was linked to congenital pulmonary airway malformation (eight cases), left pulmonary sequestration (one case), congenital diaphragmatic hernia (six cases), right lung hypoplasia (one case), and VACTERL association with right lung aplasia and esophageal atresia (one case). Dextroversion was associated with asplenia syndrome (two cases), single-ventricle (one case), and Temple syndrome with PLSVC and bilateral hypoplastic pulmonary arteries (one case). Among 29 newborns, six (20.7%) died during the early neonatal period and seven (24.1%) required postnatal multidisciplinary treatment, highlighting a poor prognosis in many cases. While some patients, such as those with isolated PLSVC, had favorable outcomes, several cases involved severe complications requiring intensive perinatal management. When fetal meso/dextrocardia is detected, it is critical to evaluate fetal anomalies comprehensively and not limit assessment to the heart and lungs.

Bronchopulmonary sequestrations (BPS) are rare congenital anomalies resulting in formation of non-functioning lung tissue separate from the rest of the tracheobronchial tree. A defining feature of BPS is their arterial supply from an anomalous systemic vessel. Depending on pleural envelopment and venous drainage, they are categorized into intra-lobar BPS and extra-lobar BPS. In rare cases, they may be associated with other congenital pulmonary airway malformations and hiatal hernias. BPS are usually identified on CT angiography and may be missed on non-contrast imaging. Definitive treatment typically involves embolization followed by surgical resection. We present a rare case of intra-lobar pulmonary sequestration associated with a hiatal hernia.

Congenital Lung Malformations: A Comprehensive Overview of Current Knowledge-Narrative Review.