# Infant with Intralobar and Extralobar Bilateral Pulmonary Sequestration Requiring Simultaneous Resection: A Case Report

## TL;DR

A 1-year-old boy required simultaneous removal of both intralobar and extralobar lung sequestrations due to a shared vein, preventing complications.

## Contribution

This case is the first to report simultaneous resection of bilateral sequestrations due to a shared drainage vein in infants.

## Key findings

- Coexisting intralobar and extralobar sequestrations shared a common drainage vein.
- Unilateral resection would have caused congestion in the other sequestrated lung.
- Simultaneous thoracoscopic surgery was successfully performed without complications.

## Abstract

Coexisting bilateral intralobar and extralobar pulmonary sequestration has rarely been reported, with no previous reports indicating that simultaneous resection is necessary because of a common drainage vein.

A 1-year-old boy was prenatally suspected to have right pulmonary sequestration. A preoperative contrast-enhanced CT scan revealed coexisting right intralobar and left extralobar pulmonary sequestrations. The left extralobar sequestration drained into the right inferior pulmonary vein, which was shared by the right intralobar sequestration. The patient had a history of infection with right intralobar pulmonary sequestration during infancy, so a right lower lobectomy was considered. Although an isolated right lower lobectomy would have resulted in congestion of the left sequestrated lung, simultaneous bilateral thoracoscopic surgery was performed. First, thoracoscopic resection of the left sequestrated lung and ligation of the right feeding artery of the right sequestrated lung were performed with right differential lung ventilation, followed by thoracoscopic right lower lobectomy with left differential lung ventilation after repositioning the patient. The intra- and postoperative courses were uneventful.

Simultaneous thoracoscopic surgery for bilateral pulmonary sequestration in infants with a common drainage vein is a reasonable strategy, as unilateral lesion resection may lead to postoperative complications.