Extralobar pulmonary sequestration with a transdiaphragmatic gastric attachment: a case report

Extralobar pulmonary sequestration (EPS) has been reported in intradiaphragmatic or intraabdominal locations, but simultaneous involvement of multiple compartments is exceedingly rare. This is the first reported case to our knowledge with simultaneous intrathoracic, transdiaphragmatic, and gastric involvement. A 21-month-old male was prenatally diagnosed with a left lung lesion via ultrasound. A computed tomography (CT) scan with contrast performed at 3 months of age at an outside center was consistent with a left lower lobe hybrid lesion. The family did not wish to undergo surgery at that time. A repeat CT scan with contrast was performed at 15 months of age for better visualization of the anatomy. The patient underwent video-assisted thoracoscopic surgery, which revealed an extrapulmonary mass with feeding vessels from the aorta and a fibrous transdiaphragmatic connection to the stomach. Intraoperative upper endoscopy confirmed no esophageal or gastric luminal involvement. The lesion was resected, and the diaphragm was primarily closed thoracoscopically. Pathology demonstrated extrapulmonary sequestration with type 2 congenital pulmonary airway malformation (CPAM)-like features. The patient recovered well and was discharged on postoperative day two. Congenital lung lesions may have transdiaphragmatic extensions to the digestive tract not detectable by preoperative imaging studies.