Pulmonary sequestration with torsion necrosis in an 11-year-old child: a case report of thoracoscopic resection and multidisciplinary management

Introduction and importance: Pulmonary sequestration (PS) with torsion necrosis is extremely uncommon in children, and little literature exists regarding its diagnostic challenges and optimal surgical approach. The present case highlights the central role of multimodal imaging and minimally invasive techniques in the treatment of this potentially fatal condition. Case presentation: An 11-year-old boy presented with acute right-sided chest pain, fever (38°C), and dyspnea. Laboratory findings were leukocytosis (WBC 21.06 × 10 9 /L, normal range: 4.3–11.3 × 10 9 /L), raised CRP (70.29 mg/L, normal range: <10 mg/L), and D-dimer (0.746 mg/L, normal range: <0.256 mg/L). Contrast CT revealed a non-enhancing triangular mass (4.3 × 1.6 × 3.6 cm) adjacent to the right diaphragm, with pleural effusion and atelectasis. Doppler ultrasound revealed a hypovascular lesion; MRI ruled out neurogenic tumors. Emergency thoracoscopic exploration showed a torsioned PS (540° vascular twist) with hemorrhagic necrosis. Hem-o-lok clips were applied to resect the lesion, and the patient made a complete recovery without complications. Clinical discussion: PS-torsion is susceptible to diagnostic pitfalls with overlapping presentations of tumors and pneumonia. Recent literature emphasizes the use of CT and MRI for diagnosing vascular anomalies and non-enhancing lesions. Unlike past reports, the present case innovatively employed single-incision thoracoscopy and ultrasound-guided localization to reduce operative risks [evidence based on case reports (Level 4)]. Early intervention prevented hemorrhagic death and sepsis, consistent with guidelines recommending immediate resection for symptomatic PS. Conclusion: This case emphasizes the role of multidisciplinary referral and high-level imaging in the diagnosis of torsioned PS. Thoracoscopic resection is safe and effective in children and warrants further validation in larger patient populations.