Authors (including presenting author) :
Kwok FYJ, Leung TKS, Wong HYT, Thung KH, Chan S
Affiliation :
Department of Surgery, Tuen Mun Hospital
Keyword 3: :
Pulmonary Sequestration
Introduction :
Pulmonary sequestration (PS) is defined as non-functioning primitive lung tissue that lacks communication with the tracheobronchial tree and receives an anomalous systemic blood supply. It has an estimated incidence of 0.15–1.8%. Clinical manifestations include recurrent pneumonia, haemoptysis, or high-output heart failure due to systemic shunting. Traditional surgical management involves ligation of the feeding artery and pulmonary resection via thoracotomy or video-assisted thoracoscopic surgery (VATS). Recently, combined endovascular and thoracoscopic approaches have been reported for complex cases, especially those involving aneurysmal systemic arteries.
Objectives :
This report aims to illustrate the safety and feasibility of a novel staged strategy using thoracic endovascular aortic repair (TEVAR) followed by video-assisted thoracoscopic surgery (VATS) segmental resection for pulmonary sequestration complicated by an aneurysmal systemic feeding artery.
Methodology :
A single-patient case report.
Result & Outcome :
A 50-year-old man was found to have an incidental retrocardiac opacity on chest radiograph. Computed tomography angiography (CTA) demonstrated an extralobar pulmonary sequestration (PS) in the left lower lobe supplied by an anomalous artery from the descending thoracic aorta with a 15‑mm aneurysmal origin and venous drainage to the azygos vein. To reduce the risk of intraoperative haemorrhage, a two-stage strategy was adopted. Thoracic endovascular aortic repair (TEVAR) was first performed using a thoracic endograft to exclude the anomalous systemic artery, with completion angiography and early follow-up CTA confirming complete thrombosis of the aneurysmal feeder and preserved celiac perfusion. Three months later, video-assisted thoracoscopic surgery (VATS) segmental resection was undertaken. The excluded feeding artery was safely transected with an endoscopic stapler, and indocyanine green was used to demarcate the non-perfused sequestrated segment, enabling parenchyma-sparing resection. The postoperative course was complicated by a chylothorax, which resolved with conservative management, and the patient remained asymptomatic without radiological recurrence at 6‑month follow-up. Histology confirmed PS. Staged TEVAR followed by VATS segmental resection offers a safe, reproducible, minimally invasive option for PS with aneurysmal systemic feeding arteries, effectively mitigating the risk of catastrophic haemorrhage while preserving the advantages of thoracoscopic lung-sparing surgery.
