Congenital lung malformations encompass a spectrum of structural abnormalities, including congenital pulmonary airway malformations, in which cyst-like maldeveloped airway tissue replaces normal lung, and pulmonary sequestration, in which a piece of lung tissue lacks a normal connection to the airway and instead receives its blood supply from the systemic circulation. When these lesions occupy the posterior and lateral basal segments of the lower lung lobe, the segments labeled S9 and S10 in the standard anatomical numbering system, surgeons have traditionally faced a choice between removing the entire lobe through a lobectomy or performing a segmentectomy that isolates and removes only the affected segments. Each option carries trade-offs that matter enormously for a growing child.

Lobectomy is technically straightforward and reliably removes the malformation, which is why it has long been the default operation. But a child’s lungs continue to develop throughout childhood, and every gram of healthy parenchyma removed represents tissue that can never contribute to gas exchange. Segmentectomy, by contrast, demands meticulous dissection of the segmental blood vessels, airways, and the invisible planes between adjacent lung segments, but it preserves the superior segment, known as S6, and its vital connection to the remaining basal lung tissue. The team behind the new study, led by surgeons at the Children’s Hospital Affiliated to Shandong University and Jinan Children’s Hospital, set out to determine whether their arch-shaped modification of segmentectomy could make this lung-sparing option safer and more predictable.

The retrospective analysis reviewed the records of 77 children with congenital lung malformations who underwent thoracoscopic surgery between January 2019 and June 2023. The patients were divided into three groups according to the operation they received: 22 children underwent thoracoscopic lobectomy, 33 underwent conventional thoracoscopic S9-10 segmentectomy, and 22 underwent the new “Arch” thoracoscopic S9-10 segmentectomy. The researchers compared perioperative outcomes, postoperative findings, and radiological follow-up across the groups, and they applied the Bonferroni correction to pairwise comparisons, a statistical adjustment designed to reduce the risk of false-positive findings when multiple comparisons are made simultaneously.

The defining feature of the Arch technique lies in how the surgeon shapes the cut across the lung parenchyma. In a conventional segmentectomy, the division of the S9-10 segments can leave a broad, flat raw surface on the remaining lung, and the interface between the resected area and the preserved superior segment can be technically awkward to manage. The Arch approach instead creates an arch-like, curved resection line that follows the natural anatomical boundary between the basal segments and the superior segment. This curved geometry is intended to preserve the connection between S6 and the remaining basal parenchyma more faithfully, maintain the natural contour of the lower lobe, and reduce tension on the staple or suture lines that seal the lung after the diseased tissue is removed.

Every one of the 77 procedures in the study was completed thoracoscopically, meaning the surgeons operated through small incisions using a camera and long instruments rather than opening the chest. There were no conversions to open thoracotomy, no reoperations, no severe complications, and no residual lesion left behind in any patient. That clean safety record across all three surgical approaches is itself a notable finding, because segmentectomy in children is widely regarded as more technically demanding than lobectomy, and the study demonstrates that in experienced hands both conventional and arch-shaped segmentectomy can be completed entirely through keyhole surgery.

When the researchers examined the details of recovery, some expected patterns emerged. Lobectomy was associated with shorter operative time, shorter chest tube duration, and a shorter postoperative hospital stay than either of the segmentectomy procedures, which is consistent with the simpler nature of removing an entire lobe at once rather than dissecting individual segments. Comparing the two segmentectomy techniques directly, the Arch group showed lower mean blood loss than the conventional group, although the authors were careful to note that the absolute difference was small. The difference in operative time between the two segmentectomy groups did not remain statistically significant after adjustment for multiple comparisons, a reminder that apparent advantages seen in raw numbers can dissolve under rigorous statistical scrutiny.

Complications in the series were few and mild. Postoperative air leak, a common and usually self-limiting event in lung surgery in which air escapes from the cut lung surface into the chest drain, occurred in exactly one patient in each of the two segmentectomy groups, and both leaks resolved with drainage alone. In the Arch group, two patients developed a loculated postoperative air collection, meaning a pocket of air became walled off within the chest cavity, but these collections resolved spontaneously within three months without any surgical intervention. No major complications were observed in the Arch group, and the overall perioperative event profile was similar across all three groups in this series.

The authors are explicit that the study’s conclusions must be interpreted with appropriate caution. As a retrospective review, the analysis depends on how patients were selected for each operation in the first place, and the groups were not randomized. The small differences in perioperative outcomes between the techniques should not be overread, particularly given the statistical adjustments and the modest size of the cohorts. What the study does establish, according to its authors, is feasibility: in selected children whose congenital lung malformations are confined to the S9-10 segments, the Arch thoracoscopic segmentectomy can be performed safely, with no major complications observed, and its main potential value lies in preserving the S6-basal segment connection and normal lung parenchyma that a lobectomy would sacrifice.

That preservation may prove to be the technique’s most important legacy. For a child with decades of growth and physical activity ahead, the difference between losing an entire lower lobe and losing only its two most diseased basal segments could translate into meaningfully better lung function, exercise capacity, and quality of life over a lifetime. The research team emphasizes that prospective studies with long-term functional assessment are needed before the Arch technique can be considered a standard of care, and such studies would need to measure not just operative metrics but actual lung growth and function over years of follow-up. Until then, the study stands as an encouraging proof of concept that the geometry of a surgical resection line, shaped like an arch to respect the lung’s natural architecture, may help surgeons remove disease while giving healthy tissue every chance to thrive.

Subject of Research: Arch-shaped thoracoscopic segmentectomy for congenital lung malformations in children

Article Title: Arch-like thoracoscopic posterior and lateral basal segmentectomy for congenital lung malformations in children

Article References: Guo, R., Zhang, S., Zhai, Y., Zhao, H., Cui, R., & Li, J. (2026). Arch-like thoracoscopic posterior and lateral basal segmentectomy for congenital lung malformations in children. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07655-z

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07655-z

Keywords: congenital lung malformations, thoracoscopy, segmentectomy, pediatric surgery, minimally invasive surgery, lung-preserving surgery, lobectomy, S9-10 segments, pulmonary sequestration, CPAM, thoracic surgery, BMC Pediatrics

Congenital bronchial atresia, or CBA, is a rare developmental anomaly in which a lobar, segmental or subsegmental bronchus is focally interrupted while the distal bronchial tree remains intact. Because the airway is blocked proximally, mucus accumulates downstream, forming a mucus-filled cavity known as a bronchocele or mucocele. At the same time, air finds its way into the affected tissue through collateral ventilation channels, causing the trapped lung segment to become hyperinflated. The pairing of a bronchocele with distal hyperinflation is considered the radiological fingerprint of the condition, and in most cases computed tomography can nail the diagnosis by showing the abrupt bronchial interruption, the mucus-filled structure and the adjacent hyperlucent, emphysematous lung.

But the clinical picture becomes murkier when the anomaly sits in the lower lobes. Pulmonary sequestration, a key differential diagnosis for lower-lobe congenital lung lesions, is defined by the complete absence of normal bronchial communication and the presence of an aberrant systemic arterial supply, typically arising from the aorta. Lower-lobe CBA can also present with recurrent infection and cystic or cavitary changes, meaning the two conditions can look strikingly similar when inflammation blurs the anatomical details. That is precisely what happened in this case, and the report underscores why a systematic evaluation of both bronchial continuity and vascular supply is essential before any diagnosis of a congenital lower-lobe lesion is finalized.

The patient’s story began with annual episodes of respiratory infection, each temporarily quieted by oral antibiotics. Chest radiography revealed an abnormal shadow in the right lung field, and CT imaging demonstrated a cavitary lesion with internal fluid retention in the right lower lobe, surrounded by ground-glass opacity suggestive of active inflammation. After a course of antibiotic therapy settled the inflammation, she was referred for surgical management, still carrying the presumptive diagnosis of pulmonary sequestration.

Repeat computed tomography at the treating institution changed the picture dramatically. The scans revealed segmental emphysematous change localized mainly to Segment 7 of the right lower lobe, alongside the cavitary lesion with internal fluid retention and faint residual ground-glass opacity. Critically, the imaging identified an interruption of the right B7 bronchus — the segmental airway serving Segment 7. Just as importantly, no aberrant systemic arterial supply from the aorta was observed anywhere in the region. Instead, the pulmonary artery showed a normal branching pattern, with a normally distributed segmental artery, designated A7, supplying the lesion. Together, these findings pointed decisively away from pulmonary sequestration and toward congenital bronchial atresia, with the cavitary lesion reinterpreted as a bronchocele.

Three-dimensional CT reconstruction sealed the diagnosis. The technique clearly demonstrated the interruption of the B7 bronchus and the normal distribution of the A7 segmental artery, while the pulmonary venous anatomy was confirmed to be unremarkable. This imaging approach, the report notes, is particularly valuable when sublobar resection is being considered, because precise anatomical understanding of the bronchovascular architecture is required for safe and appropriate surgery. In this patient, however, the geometry of the disease made lung-sparing surgery impractical: although the lesion was centered in Segment 7, the hyperinflation extended close to the basal bronchial bifurcation, and inflammatory changes on earlier scans had involved the adjacent segments. Complete resection by segmentectomy was therefore judged too difficult, and the surgical team opted for a thoracoscopic right lower lobectomy.

The operation itself went smoothly. Pulmonary function testing before surgery had been within normal limits, and laboratory findings showed only mild inflammatory change. Intraoperative bronchoscopy confirmed the imaging findings, demonstrating no identifiable orifice of the B7 bronchus at the level of the right intermediate bronchus, while the orifices of B6 and the remaining basal bronchi, B8 through B10, were clearly visible. The procedure took 123 minutes with minimal blood loss, the postoperative course was uneventful, and the patient was discharged on the eighth day after surgery.

Histopathological examination of the resected tissue provided the final confirmation. The cavitary lesion was composed of bronchial structures filled with retained mucus and showed no communication with the central airway — exactly the architecture expected of a bronchocele associated with congenital bronchial atresia. Based on the combined radiological, bronchoscopic and histopathological findings, the team established the final diagnosis of CBA, closing a diagnostic journey that had begun with a completely different suspected condition.

The case carries several important lessons for clinicians and radiologists. Although the combination of a bronchocele and distal hyperinflation is characteristic of CBA, a lower-lobe location, recurrent infection and a cavitary appearance can cause the anomaly to radiologically resemble pulmonary sequestration. The distinction matters enormously: pulmonary sequestration accounts for approximately 0.15 percent to 6.4 percent of congenital pulmonary malformations and is defined by its aberrant systemic blood supply, whereas CBA preserves normal pulmonary arterial supply despite its proximal bronchial interruption. In CBA, the bronchus is interrupted proximally while the distal airway is preserved and filled with mucus; in sequestration, there is no normal bronchial communication at all, and the tissue is fed by a systemic artery, typically from the aorta.

Rarity compounds the diagnostic difficulty. CBA is less frequently encountered in clinical practice than sequestration and is most commonly detected incidentally, with a strong predilection for the upper lobes — particularly the left upper lobe. Lower-lobe involvement is uncommon in adult radiologic series, and segmental bronchial atresia confined to a single basal segment such as S7 is extremely rare. In such cases, recurrent infection and cystic or cavitary changes can closely resemble intralobar pulmonary sequestration, making accurate differentiation genuinely challenging even for experienced teams. The authors emphasize that systematic evaluation of both bronchial continuity and vascular supply is the key to getting it right, and that three-dimensional CT reconstruction may prove useful not only for diagnosis but also for guiding surgical decision-making, from choosing between segmentectomy and lobectomy to mapping the precise anatomy the surgeon will encounter.

Subject of Research: Congenital bronchial atresia of the right lower lobe mimicking pulmonary sequestration

Article Title: Congenital Bronchial Atresia Mimicking Pulmonary Sequestration in the Lower Lobe: A Case Report

Article References: Mitsumata, S., Midorikawa, K., Wakamatsu, K., Kaneda, S., Futamata, T., Iwanaka, T., Ueda, Y., Miyahara, S., Masuda, Y., Nakashima, H., & Sato, T. (2026). Congenital Bronchial Atresia Mimicking Pulmonary Sequestration in the Lower Lobe: A Case Report. Respirology Case Reports, 14(9), Article e70712. https://doi.org/10.1002/rcr2.70712

Image Credits: AI Generated

DOI: 10.1002/rcr2.70712

Keywords: congenital bronchial atresia, pulmonary sequestration, bronchocele, three-dimensional CT reconstruction, thoracoscopic lobectomy, segment 7 right lower lobe, recurrent lung infection, bronchial interruption, segmental emphysema, congenital pulmonary malformation, surgical planning, case report