A case of extralobar pulmonary sequestration torsion with epigastric pain

Abstract

A 33-year-old woman visited a former hospital with sudden onset of intermittent and severe epigastric pain. The cause of the abdominal pain was examined in the hospital. Although pulmonary sequestration was noted in the left thoracic cavity, there was no abnormality in the abdomen, and the cause could not be identified. The epigastric pain disappeared, but back pain appeared from the left side of the chest. On the 5th day of hospitalization, increases in inflammatory response in blood samples and left pleural effusion were observed considered to be due to extralobar pulmonary sequestration, and she was transferred to our hospital. Bloody pleural effusion was observed by thoracic drainage, and the preoperative diagnosis was extralobar pulmonary fractional torsion. A 7-cm pulmonary sequestration turned black on the diaphragm in contact with the aorta using thoracoscopic. For safety, thoracotomy was performed, and the inflow and circulating vessels were confirmed and ligated and separated. The pulmonary sequestration was detached and removed. The patient was discharged from the hospital on the 8th day after surgery. No recurrence of symptoms has occurred in the 1 year and 3 months since surgery. Extrapulmonary lobar pulmonary fractionation is often asymptomatic and discovered incidentally during chest CT, chest surgery, or autopsy, but in the case of extralobar pulmonary sequestration torsion, the patient may present with sudden and severe abdominal pain, which can be a differential diagnosis for acute abdominal syndrome. Extralobar pulmonary sequestration torsion may cause sudden and severe abdominal pain, which might be a differential diagnosis for acute abdominal syndrome.