VATS Resection for Extralobar Pulmonary Sequestration With a Large Aberrant Artery After Endoluminal Stenting and Plug Occlusion

Objectives

Pulmonary sequestration is a rare congenital lung malformation that more commonly occurs in the left lung, mainly near the lower mediastinum. It is rarely observed in adult patients. The authors present the case of a 57-year old man with a pulmonary sequestration with an abnormal large artery situated in the inferior pulmonary ligament. Twenty-four hours before the resection, this patient had endoluminal stenting (TEVAR) and plug occlusion to decompress the large aberrant artery.

Methods

This patient is a 57-year-old man and a former 25 pack year smoker, with a previous medical history of left bundle branch block and hypertension and a left lower lobe pulmonary mass found incidentally in 2008, who presented evaluation of lung mass. In 2008, when the left lower lobe mass was discovered, the patient underwent computed tomography (CT) guided biopsy, which returned negative for malignancy. This patient was followed for a few years with routine CT scans. Recently, he presented with a cough, intermittent fevers, and night sweats. He underwent a CT angiogram (CTA), which showed that the mass had increased in size and was supplied by an abnormally large artery branching from the descending thoracic aorta.

Results

In anticipation of the planned resection, this patient had distal plug occlusion of the aberrant artery and endoluminal stenting of the thoracic aorta to decompress the vessel. The next day, he underwent a video-assisted thoracoscopic resection of the sequestration along with the aberrant artery as narrated in this video. The resection and postoperative course of this patient was uncomplicated.

Conclusion

The use of endoluminal stents and plug occlusion is helpful in decompressing aberrant vessels, allowing for safe resection. Pulmonary sequestration is a rare disease, and missed diagnosis and misdiagnosis are very common in these patients. CTA, 3D reconstruction, and other angiography techniques should be used when there is suspicion of such a condition.

This educational video was originally presented during the STSA 65th Annual Meeting. This content is published with the permission of the STSA. For more information on the STSA and its next Annual Meeting, please click here.