Minimally-invasive surgery for concurrent intralobar pulmonary sequestration and bronchogenic cyst in an adult: a case report

Background: Congenital pulmonary anomalies (CPA) are rare diseases of the lung and the mediastinum appearing as undetermined cystic lesions. While most of CPA are identified during prenatal evaluation, some cases are identified occasionally in the adult age in asymptomatic patients or after the onset of non-specific symptoms. Among CPA, intralobar pulmonary sequestration (PS) and bronchogenic cyst (BC) have been described in a significant number of patients, however their synchronous presentation is very rare. Case Description: We present here the case of a 29-year-old woman who was admitted because of the occasional discovery of a posterior mediastinal cystic lesion associated with an area of hypovascularized pulmonary parenchyma in the left lower lobe. Moreover, contrast-enhanced computed tomography (CT) scan showed the presence of two aberrant arteries originating respectively from the descending thoracic aorta and the subphrenic abdominal aorta. The differential diagnosis included a pulmonary sequestration and an intraparenchymal arteriovenous fistula. A surgical treatment by means of video-Assisted thoracic surgery (VATS) was planned with a standard Copenhagen triportal approach. First, the aberrant arteries were stapled and the dysfunctional lung tissue was excised from the normal parenchyma by a wedge resection. The mediastinal cystic lesion was dissected from the aortic wall and removed. The intraoperative and postoperative course were regular without complications. The final pathological diagnosis was an intralobar PS of the left lower lobe associated with a BC. Conclusions: The combination of preoperative evaluation with angio-CT scan and operative VATS technique allowed the proper diagnostic and therapeutic management in this case of rare association of intralobar PS and BC.