A 9 month old boy had an antenatal diagnosis of a left-sided congenital lung malformation which on postnatal computed tomography scan at 6 months of age showed features of an intralobar sequestration. Appearances were unusual as there were four large feeding vessels seen to arise directly from the thoracic aorta in addition to drainage both to the pulmonary circulation and also via the hemi-azygos system.
He underwent thoracoscopic resection of the lesion with both surgeon and assistant standing in front of the patient and all ports in the anterior axillary line. This approach was chosen to allow both access to the vessels for division but also for resection of the abnormal sequestered tissue and suturing of the remaining lung to prevent air-leak.
The histology of the lesion was consistent with a hybrid lesion with both sequestration and type II congenital pulmonary airway malformation features present in addition to chronic inflammation. He made an uneventful recovery from the procedure.