Pulmonary sequestration is a rare congenital bronchopulmonary malformation consisting of non-functioning lung tissue without communication with the tracheobronchial tree and supplied by an aberrant systemic artery. Intralobar pulmonary sequestration (ILS) is the most common subtype and typically presents with recurrent pulmonary infections. Although usually diagnosed in younger patients, delayed recognition may occur in adults, particularly in the elderly. We report two adult patients repeatedly treated for presumed recurrent pneumonia in whom the diagnosis of ILS was delayed. A 35-year-old patient presented with recurrent lower lobe consolidation on chest radiography and received multiple courses of antibiotic therapy. A 75-year-old patient had persistent respiratory symptoms despite unremarkable chest radiographic findings. In both cases, contrast-enhanced computed tomography of the chest demonstrated an aberrant systemic arterial supply to the lower lobe, establishing the diagnosis of intralobar pulmonary sequestration. Both patients underwent anatomical lower lobectomy (left-sided in one case, right-sided in the other). Particular attention was paid intraoperatively to identification, isolation, and secure ligation of the aberrant systemic feeding artery. The postoperative courses were uneventful. Histopathological examination confirmed the diagnosis in both cases. Intralobar pulmonary sequestration should be considered in the differential diagnosis of recurrent pneumonia, even in elderly patients. Contrast-enhanced computed tomography is essential for accurate diagnosis and operative planning. Anatomical lobectomy with safe control of the systemic arterial supply remains the definitive treatment in symptomatic adult patients.
Miklosová et al. (2026) studied this question.