Pulmonary sequestrations comprise a spectrum of congenital lung malformations, with abnormal lung tissue lacking connection with the tracheobronchial tree, supplied by an aberrant systemic artery. Until a few years ago, lobectomy was considered the standard treatment for intralobar pulmonary sequestration. However, minimally invasive sublobar resection gained a place as an interesting alternative therapeutic approach, guided by indocyanine green and computed tomography-based 3-dimensional anatomical models. Like pulmonary sequestrations, pulmonary pseudosequestrations are a congenital lung malformation, but characterized by a normal lung tissue fed by systemic arterial branches. To the best of our knowledge, there are no published cases of pulmonary pseudosequestration combined with sequestration. We present a case of an intralobar pulmonary sequestration coupled with an adjacent pseudosequestration, resected using thoracoscopic surgery with the aid of a 3-dimensional anatomical model and indocyanine green.
In our experience, when facing an intralobar pulmonary sequestration, the guidance of a CT-based 3D anatomical model is crucial to define the surgical strategy and achieve lung-sparing resections. In this setting, the application of ICG ensures accurate identification of the resection plane, regardless of whether a wedge resection or anatomical segmentectomy is performed.
