Maeda Ryo, Inomata Mayu, Nakada Hiroshi, Yamada Ryusei
Department of Thoracic and Breast Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
Department of Thoracic and Breast Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
Int J Surg Case Rep. 2025 Aug;133:111683. doi: 10.1016/j.ijscr.2025.111683. Epub 2025 Jul 15.
Extralobar pulmonary sequestration with torsion is an exceptionally rare condition, especially in adults, and can present with nonspecific symptoms such as abdominal pain, making diagnosis challenging. Timely recognition is critical, as delayed treatment may lead to infarction and serious complications. This report describes the case of a patient with extralobar pulmonary sequestration who presented with abdominal pain.
An 83-year-old healthy female presented with increasing severe abdominal pain and mild fever that had developed for the past three weeks. Chest and abdominal computed tomography revealed a non-enhancing mass in the right posterior paravertebral area, with mild pleural effusion. Video-assisted thoracoscopic surgery to establish a definitive diagnosis revealed a yellow-whitish ovoid mass with congestion and necrosis, accompanied by bloody pleural effusion. The mass was connected to the mediastinum via a twisted feeding vessel. The final diagnosis was consistent with extralobar pulmonary sequestration with torsion and infarction. The patient's symptoms were relieved immediately after surgery.
Extralobar pulmonary sequestration with torsion is rare in adults. Abdominal pain is the hallmark symptom of this condition. The lack of contrast enhancement in the lesion with no visible feeding vascular pedicle or pleural effusion is imaging signs of pulmonary sequestration torsion, and surgical resection is the standard treatment.
This case highlights the importance of considering pulmonary sequestration in the differential diagnosis of unexplained abdominal pain with posterior mediastinal masses, underscoring the value of surgical exploration for diagnosis and treatment.
肺叶外型肺隔离症合并扭转是一种极为罕见的病症，尤其是在成年人中，可能表现为腹痛等非特异性症状，这使得诊断颇具挑战性。及时识别至关重要，因为延迟治疗可能导致梗死及严重并发症。本报告描述了一例以腹痛为表现的肺叶外型肺隔离症患者的病例。
一名83岁健康女性，出现逐渐加重的严重腹痛及过去三周内出现的低热。胸部及腹部计算机断层扫描显示右后椎旁区域有一不强化的肿块，伴有少量胸腔积液。通过电视辅助胸腔镜手术以明确诊断，发现一个黄白色卵圆形肿块，伴有充血和坏死，并有血性胸腔积液。该肿块通过一条扭曲的供血血管与纵隔相连。最终诊断为肺叶外型肺隔离症合并扭转及梗死。患者术后症状立即缓解。
肺叶外型肺隔离症合并扭转在成年人中罕见。腹痛是这种病症的标志性症状。病变缺乏对比增强且无可见的供血血管蒂或胸腔积液是肺隔离症扭转的影像学表现，手术切除是标准治疗方法。
本病例强调了在不明原因腹痛伴后纵隔肿块的鉴别诊断中考虑肺隔离症的重要性，突出了手术探查对于诊断和治疗的价值。
