A Case of Extralobar Pulmonary Sequestration Presenting With Torsion: The Optimal Timing of Surgery

Abstract

An 8-year-old girl was referred to our hospital because of fever of unknown origin, and pain in her right abdomen, left shoulder, left chest, and left lower back. She presented with knock pain of the left lower back and right abdominal tenderness without rebound tenderness or defense. CT revealed a 36 × 35 × 20-mm-sized solitary mass without enhancement in the left pleural space. On the basis of the clinical course and CT findings, the torsion of an extralobar pulmonary sequestration was suspected; however, no feeding artery was identified and pleural effusion was confirmed the next day by dynamic CT. She underwent thoracotomy on the fourth day of hospitalization. The peduncle of the mass was found to be twisted, and the sequestrum was resected. The initial diagnosis (torsion of an extralobar pulmonary sequestration) was confirmed pathologically. She successfully recovered after the operation, and left the hospital on the fourth day after surgery. Although most cases of extralobar pulmonary sequestration are asymptomatic and are detected incidentally, in rare cases, it presents with abdominal pain and chest pain due to the torsion of its vascular pedicles. It is usually difficult to make a preoperative diagnosis on the basis of imaging findings, and strong pleural adhesion develops over time. It is therefore preferable to perform the operation within 7 days of when the onset of the torsion of the sequestrum was suspected to have occurred.