Abstract / Summary
Abstract Background The border between sequestered and normal lung in intralobar pulmonary sequestration (ILS) is often indistinct, complicating precise resection. Intravenous indocyanine green (ICG) can outline a perfusion-based boundary but requires prior control of the aberrant systemic artery and does not directly reflect the airway isolation that defines ILS. Case Presentation : Four adults with contrast-enhanced CT-confirmed ILS underwent video-assisted thoracoscopic surgery with intraoperative unilateral ICG inhalation. After single-lung ventilation, aerosolized ICG (2.5 mg/mL) was delivered via a nebulizer connected to the double-lumen tube for 10 to 15 minutes. Near-infrared thoracoscopy showed homogeneous fluorescence in ventilated normal lung and no fluorescence in sequestered tissue, producing a clear demarcation. Three patients underwent wedge resection; one with extensive basal segment involvement underwent lobectomy. No ICG-related adverse events occurred, and all patients recovered uneventfully. Conclusions Intraoperative aerosolized ICG inhalation safely and directly visualizes the ventilation-based boundary characteristic of adult ILS, enabling early lesion mapping and selection of the least extensive complete resection.