Thoracoscopic management of easily neglected extralobar pulmonary sequestration presenting with torsion and infarction in children: three case reports and literature review.

BACKGROUND

Extralobar pulmonary sequestration (ELS) is a rare congenital pulmonary malformation, and reports of ELS complicated by torsion and infarction are exceedingly uncommon. Here, we report three pediatric cases of ELS complicated by torsion and infarction, aiming to enhance clinical awareness and understanding of this condition.

METHODS

Using the keywords "extralobar pulmonary sequestration, torsion, infarction, thoracoscopic, chest pain, abdominal pain, children", we conducted a comprehensive literature review of all studies related to ELS with torsion in children from database inception to December 2025. We identified 16 articles describing ELS with torsion, comprising a total of 24 reported pediatric cases of pulmonary sequestration complicated by torsion.

RESULTS

Between May 2022 and November 2025, three children with ELS complicated by torsion and infarction were treated at Shanghai Children's Hospital. Two patients presented primarily with abdominal pain and chest pain, while one patient presented with abdominal pain alone. Contrast-enhanced chest computed tomography (CT) was performed in all cases: two patients were suspected of having intrathoracic soft-tissue masses, and one patient was diagnosed with pulmonary sequestration. All patients subsequently underwent thoracoscopic resection of the pulmonary sequestration. Postoperative pathological examination confirmed pulmonary sequestration with hemorrhagic necrosis in all three cases.

CONCLUSIONS

Pulmonary sequestration with torsion should be considered in the differential diagnosis of patients presenting with chest/abdominal pain accompanied by an intrathoracic soft-tissue mass. With the continuous advancement of minimally invasive techniques, thoracoscopic surgery offers a favorable prognosis for pediatric patients with pulmonary sequestration complicated by torsion and infarction.