PMC9354599_01
The enhanced chest CT of the case before surgery. (A) CT images in the AP showed two areas with different enhancement degrees in one mass, and the upper pole of the mass was adjacent to the inferior lobe of the left lung. (B) CT images in the AP showed that the largest cross-section of the mass was close to the upper pole of the spleen. (C) CT images in the AP showed the origin of the upper group of anomalous vessels (referring back to this image postoperatively, we found that it showed the origin of the anomalous supplying arteries and a draining vein of the upper ELS). (D) CT images in the AP showed the origin of the inferior group of anomalous vessels (referring back to this image postoperatively, we found that it showed the origin of an anomalous supplying artery of the inferior ELS). The draining vein of the inferior lesion cannot be distinguished. CT, computed tomography; AP, arterial phase; ELS, extralobar sequestration.  : upper ELS;  : inferior ELS;  : spleen;  : draining vein of the upper ELS;  : the origin of anomalous supplying arteries of the upper ELS;  : anomalous vessels in the left diaphragm connecting to the inferior ELS;  : the origin of an anomalous supplying artery of the inferior ELS.
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F1
After admission, an enhanced chest CT revealed a clearly defined mass below the inferior lobe of the left lung with a size of 3.8 cm x 3.5 cm x 2.8 cm (Figures 1A,B). In addition, an anomalous vessel was seen to connect to the azygos vein at the same CT level in the upper group of anomalous arteries (Figures 1C,D).
Intraoperative findings. (A) The inferior ELS was adjacent to the left diaphragm, and the base of the inferior ELS was closely related to the left diaphragm. (B) The inferior ELS was resected after double ligation of the anomalous vessels using two absorbable vessel clamps. (C) The upper ELS was adjacent to the left lower pulmonary ligament. Four anomalous vessels connecting to the upper ELS could be seen. (D) The upper ELS was resected after double ligation of the anomalous vessels using two absorbable vessel clamps. ELS, extralobar sequestration.
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F2
The base of the inferior ELS was closely related to the left diaphragm (Figure 2A). The inferior ELS was resected after double ligation of the anomalous vessels using two absorbable vessel clamps (Figure 2B). The three upper anomalous vessels originated from a common vessel trunk (Figure 2C). The upper ELS was resected using the same method as the inferior ELS (Figure 2D).
Resected pathological tissue. The pink tissue on the left of the image is the inferior ELS, which was approximately 3.7 cm x 2.7 cm x 2 cm, and the dark red tissue on the right of the image is the upper ELS, which was approximately 3.8 cm x 2.9 cm x 2.5 cm. ELS, extralobar sequestration.
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F3
The two resected lesions were completely removed from the thoracic cavity and were diagnosed as PS through pathological examination (Figures 3, 4).
Histopathological findings. (A) Histopathological imaging of the inferior ELS. The tissue is mainly composed of abnormal airway epithelium, which contains fewer arterial and venous components with smaller diameters (hematoxylin and eosin stain, x 10). (B) Histopathological imaging of the upper ELS. The tissue is characterized by numerous arterial and venous components with larger diameters (hematoxylin and eosin stain, x 10).
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F4
The two resected lesions were completely removed from the thoracic cavity and were diagnosed as PS through pathological examination (Figures 3, 4).