Staged Surgical Management of Intralobar Pulmonary Sequestration with Bilateral Bronchiectasis in an Adolescent: A Rare Case Report

Staged Surgical Management of Intralobar Pulmonary Sequestration with Bilateral Bronchiectasis in an Adolescent: A Rare Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Staged Surgical Management of Intralobar Pulmonary Sequestration with Bilateral Bronchiectasis in an Adolescent: A Rare Case Report Mohammad Alaa Aldakak, Nawwar Fallouh, Raneem Ahmad, Bassel Ibrahim This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6883117/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 18 Apr, 2026 Read the published version in Journal of Cardiothoracic Surgery → Version 1 posted 14 You are reading this latest preprint version Abstract Background: Bronchopulmonary sequestration (BPS) is a rare congenital pulmonary anomaly characterized by nonfunctional lung tissue that lacks communication with the tracheobronchial tree and receives systemic arterial supply. Although BPS is typically localized and unilateral, its association with bilateral bronchiectasis is exceedingly rare. Managing such combined pathology poses significant diagnostic and therapeutic challenges. Case Presentation: We report the case of a 15-year-old Syrian female with a long history of recurrent lower respiratory tract infections and chronic productive cough. Imaging revealed bilateral bronchiectasis and an aberrant artery from the descending thoracic aorta supplying the left lower lobe, consistent with intralobar pulmonary sequestration (ILS). The patient underwent staged open thoracotomies. The first procedure involved right lower lobectomy with partial middle lobectomy and bronchial stump reinforcement using a vascularized muscle and rib flap. The second stage included left lower lobectomy with intraoperative identification and division of the aberrant artery. Histopathological analysis confirmed severe bronchiectasis, abscess formation, hemorrhage, and vascular congestion, with no evidence of malignancy or fibrosis. Discussion & Conclusion: This case highlights an uncommon coexistence of unilateral ILS with bilateral bronchiectasis, a presentation that is rarely documented in the literature. The extent of pulmonary destruction and pleural adhesions necessitated open surgical intervention. Notably, the use of bronchial stump reinforcement underscores the surgical complexity. Early recognition and multidisciplinary management are essential, especially in pediatric patients with persistent respiratory symptoms. This case adds to the limited data on complex BPS presentations and emphasizes the importance of individualized surgical planning. Bronchopulmonary sequestration Bilateral bronchiectasis Pediatric thoracic surgery Case report. Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Introduction Bronchopulmonary sequestration (BPS) is a rare congenital anomaly first described by Huber in 1777, with the term “sequestration”—meaning “to separate”—later introduced by Pryce in 1946, and is characterized by a nonfunctional mass of pulmonary tissue that lacks communication with the tracheobronchial tree and receives its arterial blood supply from the thoracic aorta or aortic arch [ 1 , 2 , 3 ]. It accounts for approximately 1.1–1.8% of all pulmonary resections and represents 0.15–6.4% of congenital pulmonary malformations and most commonly affects the lower lobe, particularly on the left side [ 1 ]. Two forms of BPS are recognized: intralobar sequestration (ILS ) , which constitutes 75–86% of cases and is most frequently located in the left lower lobe, and extralobar sequestration (ELS), which has a separate pleural covering [ 4 ]. Although BPS is benign in nature, it may remain asymptomatic or present with complications such as recurrent pulmonary infections, hemoptysis, congestive heart failure, or even tumorigenesis [ 5 ]. Symptomatic lesions are typically managed through surgical resection, ranging from sublobar to anatomical lobectomy [ 6 ]. Although bronchiectasis—a chronic condition defined by irreversible bronchial dilatation, typically evident on chest imaging as airway wall thickening and clinically manifested by persistent cough and sputum production—was once considered a rare or orphan disease, it has, over the past few decades, emerged as a globally recognized health concern, with a marked increase in both incidence and prevalence worldwide. While rare, bronchopulmonary sequestration (BPS) has been reported in association with bronchiectasis, further complicating both diagnosis and management in affected individuals [ 7 – 9 ]. Here, we report the case of a 15-year-old female from Syria diagnosed with bronchopulmonary sequestration complicated by bilateral bronchiectasis. Case Presentation A 15-year-old Arab female, non-smoker and non-alcoholic, with no prior surgical history and a documented allergy to ceftriaxone, presented with a longstanding history of recurrent lower respiratory tract infections dating back to the age of six months. Her history was notable for a chronic productive cough that required frequent courses of antibiotic therapy and was accompanied by persistent growth delay. Despite repeated medical evaluations throughout childhood, no definitive diagnosis was established. One year prior to presentation, the patient underwent comprehensive investigations at a pediatric center, where both cystic fibrosis and primary ciliary dyskinesia, including Kartagener syndrome, were ruled out. At the time of admission, the patient complained of a persistent productive cough with copious sputum but denied dyspnea, hemoptysis, fever, or weight loss. Systemic review was otherwise unremarkable. Clinical examination of the chest revealed bilateral fine inspiratory crackles predominantly at the lung bases. Vital signs were stable, with oxygen saturation at 95% on room air. Laboratory workup, including complete blood count, immunological profile, and inflammatory markers, was within normal limits. Sputum culture was sterile. Serologic testing for transglutaminase antibodies and thyroid function tests were negative. Chest radiography showed right lower zone opacities with silhouetting of the right cardiac border ( Fig. 1 ) . Computed tomography (CT) of the chest demonstrated areas of increased density involving both lower lobes, particularly at the lung bases, as well as a distinct opacity in the medial segment of the right middle lobe, suggestive of localized chronic inflammatory infiltration ( Fig. 2 ) . Notably, a contrast-enhanced CT scan showed an aberrant systemic artery originating from the descending thoracic aorta, supplying the left lower lobe, consistent with intralobar pulmonary sequestration ( Fig. 3 ) . No sequestration or aberrant supply was identified on the right side. A separate vascular variant was noted as an aberrant right subclavian artery arising anomalously from the aortic arch, a purely anatomical observation without pathological relevance ( Fig. 4 ) . Pulmonary function testing was not performed preoperatively due to multiple limiting factors, including the patient’s poor cooperation, and the high burden of mucus production. Additionally, given that both lower lobes were radiologically confirmed to be structurally destroyed and functionally non-contributory, surgical resection was deemed feasible and justified without the need for formal spirometric assessment. The patient underwent staged surgical management due to the severity and bilaterality of the disease. In the first procedure, a right posterolateral thoracotomy was performed with resection of the severely damaged right lower lobe and a wedge resection of the middle lobe ( Fig. 5 , Fig. 6 ) . Due to extensive inflammation and fragility of the bronchial stump, reinforcement was achieved by applying a vascularized muscle and rib flap, preserving the pedicle and rotating it over the bronchial closure to minimize the risk of bronchopleural fistula formation ( Fig. 7 ) . Histopathological examination of the resected lung confirmed bronchiectasis with mixed acute and chronic inflammation, lymphoid aggregates, hemorrhage, and abscess formation. Following a stable recovery period, a second-stage left thoracotomy was performed. Intraoperatively, an aberrant artery from the descending thoracic aorta was isolated, ligated, and divided, confirming the diagnosis of intralobar pulmonary sequestration of the left lower lobe ( Fig. 8 ) . The affected lobe was markedly consolidated and resected en bloc ( Fig. 9 ) . Gross examination revealed two well-demarcated infarcted zones within the lobe. Histological analysis showed extensive hemorrhage, marked perivascular inflammatory infiltrates, and vascular congestion, without evidence of malignancy or fibrosis ( Fig. 10 ) . Postoperatively, the patient showed marked clinical improvement with complete resolution of productive cough and stabilization of pulmonary function. Discussion Many studies have suggested that intralobar sequestration may develop as an acquired condition, potentially secondary to chronic local infections such as bronchiectasis [ 10 , 11 ]. On the other hand, the most widely accepted theory suggests that pulmonary sequestration arises from an accessory lung bud that develops posterior to the primary bronchopulmonary buds during the pseudoglandular stage of lung development (5–17 weeks of gestation), a period that precedes the separation of the aortic and pulmonary circulations. This embryologic timing may account for the spectrum of bronchopulmonary foregut malformations associated with these anomalies [ 12 , 13 ]. The clinical presentation of pulmonary sequestration varies, with intralobar sequestration (ILS) commonly manifesting as fever, purulent sputum, and cough that may rapidly progress to lung infections, whereas extralobar sequestration (ELS) is often asymptomatic or incidentally discovered and frequently misdiagnosed as lung cancer, pulmonary cysts, or mediastinal tumors [ 14 ]. While our patient exhibited common features of intralobar sequestration (ILS), such as productive cough and recurrent infections, the chronic onset since infancy combined with bilateral bronchiectasis suggests a more advanced and progressive disease course than typically observed. Although ILS usually presents as a localized lesion confined to a single lobe, its association with bilateral bronchiectasis is exceptionally rare. Most reported cases involve unilateral disease, making the coexistence of ILS with widespread bilateral bronchiectasis, as seen in our patient, both unusual and clinically significant [ 15 , 16 ]. However, Bronchiectasis is a chronic respiratory disorder defined by irreversible bronchial dilatation on chest computed tomography (CT), accompanied clinically by persistent cough, daily sputum production, and recurrent pulmonary exacerbations [ 17 ]. Initial evaluation of bronchopulmonary sequestration (BPS) typically involves chest radiography, which may show a homogeneous mass—often in the left lower lobe—with cystic changes or air-fluid levels from secondary infection [ 18 ]. When suspicion arises, contrast-enhanced CT or MRI is recommended to characterize the lesion and identify systemic arterial supply [ 18 , 19 ]. Angiography may be required in select cases for definitive vascular mapping, especially when an aortic branch is involved [ 18 ]. Other cases reported that diagnosis of ILS is frequently delayed, often into adolescence or adulthood, even when symptoms begin early in life. Similarly, our patient exhibited chronic symptoms since infancy, yet definitive diagnosis and surgical treatment were only established during adolescence. This diagnostic delay, combined with bilateral progression and extensive parenchymal injury, highlights the importance of early imaging and multidisciplinary evaluation in pediatric patients with recurrent respiratory infections [ 15 , 20 ] Surgical resection remains the mainstay of treatment for bronchopulmonary sequestration, though selective embolization of the feeding artery has been proposed as a less invasive alternative in selected cases [ 21 , 22 ]. Surgical resection is recommended for patients with respiratory symptoms, recurrent infections, or when imaging demonstrates a lesion occupying more than 20% of the hemithorax [ 23 ]. However, The management of bronchiectasis is particularly challenging due to its clinical and etiological heterogeneity, as it may arise primarily or as a consequence of various infectious, genetic, autoimmune, or allergic disorders [ 9 , 24 ]. Conventional antibiotic therapy often proves insufficient, requiring prolonged use with limited outcomes, as the disease is typically progressive, incurable, and associated with significant morbidity and early mortality [ 25 ]. In addition, minimally invasive approaches such as VATS lobectomy and arterial embolization have been successfully employed in cases of pulmonary sequestration with limited inflammation, as reported by Tayama et al. and Tunsupon et al. [ 26 , 27 ]. In our case, although sequestration was confined to the left lower lobe, the patient presented with bilateral bronchiectasis and severe parenchymal destruction. This necessitated an open surgical approach with staged thoracotomies, as the disease involved dense pleural adhesions and nonfunctional lung segments, thereby exceeding the threshold for minimally invasive or conservative interventions and reflecting a more advanced and destructive clinical course. Notably, bronchial stump reinforcement using a vascularized muscle and rib flap was performed in the first stage—an approach not described in the reviewed literature—highlighting the technical complexity and severity of pathology encountered in this case. Conclusion This case illustrates a rare and complex presentation of intralobar pulmonary sequestration associated with bilateral bronchiectasis in an adolescent patient. The extent of parenchymal destruction and bilateral disease necessitated a staged open surgical approach, highlighting the importance of individualized treatment planning. Early recognition, thorough imaging evaluation, and multidisciplinary management are essential to optimizing outcomes in patients with atypical or progressive forms of BPS. This case underscores the need to consider congenital anomalies in the differential diagnosis of chronic respiratory symptoms, even when they present beyond early childhood. Declarations Conflict of interest statement: The authors declared no potential conflicts of interest concerning the research, authorship, and/or publication of this article. Ethical Approval: Institutional Review Board (IRB) approval is not required for de-identified single case reports or case histories, in accordance with institutional policies. Patient consent: Written informed consent was obtained from the patient for publication and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Author Contribution M.A.A. conceived the study, collected clinical data, performed the literature review, and drafted the manuscript. N.F. contributed to manuscript editing, radiological interpretation, and image preparation. R.A. and B.I. performed the surgical procedures, contributed intraoperative data, and critically revised the surgical aspects of the manuscript. All authors reviewed and approved the final version of the manuscript. References Sun X, Xiao Y. Pulmonary sequestration in adult patients: a retrospective study. Eur J Cardiothorac Surg. 2015;48(2):279–82. 10.1093/ejcts/ezu397 . Caradonna P, Bellia M, Cannizzaro F, Regio S, Midiri M, Bellia V. Non-invasive diagnosis in a case of bronchopulmonary sequestration and proposal of diagnostic algorithm. Monaldi Arch Chest Dis. 2008;69(3):137–41. 10.4081/monaldi.2008.392 . Pryce DM. Lower accessory pulmonary artery with intralobar sequestration of lung; a report of seven cases. J Pathol Bacteriol. 1946;58(3):457–67. Sarkar S, Girija A, Shirgaonkar R, Mohapatra PR. Intralobar pulmonary sequestration. QJM. 2024;117(5):366–7. 10.1093/qjmed/hcad286 . Zeng Z, Zhu Y, Liu C, Lin F. Pulmonary sequestration. QJM. 2022;114(12):898–9. 10.1093/qjmed/hcab265 . 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Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 18 Apr, 2026 Read the published version in Journal of Cardiothoracic Surgery → Version 1 posted Editorial decision: Revision requested 22 Dec, 2025 Reviews received at journal 31 Aug, 2025 Reviews received at journal 29 Aug, 2025 Reviewers agreed at journal 20 Aug, 2025 Reviews received at journal 14 Aug, 2025 Reviewers agreed at journal 14 Aug, 2025 Reviewers agreed at journal 12 Aug, 2025 Reviews received at journal 12 Aug, 2025 Reviewers agreed at journal 11 Aug, 2025 Reviewers agreed at journal 11 Aug, 2025 Reviewers invited by journal 11 Aug, 2025 Editor assigned by journal 13 Jun, 2025 Submission checks completed at journal 13 Jun, 2025 First submitted to journal 12 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6883117","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":500442170,"identity":"62109f60-113e-4236-b957-50b1d5b2ea04","order_by":0,"name":"Mohammad Alaa 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consolidation.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6883117/v1/1a73b31b6b9072ae841a1e9c.jpg"},{"id":89394909,"identity":"13523fd0-5c6d-4b65-8f4c-c1ba12b19260","added_by":"auto","created_at":"2025-08-19 13:36:48","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":36891,"visible":true,"origin":"","legend":"\u003cp\u003eAxial CT scan of the chest shows areas of increased density in both lower lobes, particularly at the lung bases, as well as focal opacity in the medial segment of the right middle lobe.\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6883117/v1/7344329375eac50350d56e78.jpg"},{"id":89394908,"identity":"dc0f76ec-90ba-4abd-8b55-6a5bf3e30477","added_by":"auto","created_at":"2025-08-19 13:36:48","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":99288,"visible":true,"origin":"","legend":"\u003cp\u003eContrast-enhanced coronal CT scan of the chest demonstrates an aberrant systemic artery arising from the descending thoracic aorta and supplying the diseased left lower lobe, consistent with intralobar pulmonary sequestration.\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6883117/v1/918cc276972bf98bc3398d33.jpg"},{"id":89400355,"identity":"91812676-1236-4d8f-b600-bd7f4f914ad1","added_by":"auto","created_at":"2025-08-19 14:08:48","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":127904,"visible":true,"origin":"","legend":"\u003cp\u003e3D volume-rendered reconstruction of the aortic arch demonstrates an aberrant origin of the right subclavian artery (arteria lusoria) arising from the arch.\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-6883117/v1/e560f1f659674a77fb7535b7.png"},{"id":89398039,"identity":"39177506-0b17-4d5f-99ed-5f49882da0e8","added_by":"auto","created_at":"2025-08-19 13:52:48","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":97466,"visible":true,"origin":"","legend":"\u003cp\u003eIntraoperative view showing the destroyed right lower lobe.\u003c/p\u003e","description":"","filename":"Figure5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6883117/v1/b4eb717c64f50a0a762d7f3b.jpg"},{"id":89396982,"identity":"4167de56-edb1-4b11-9bef-94759199b214","added_by":"auto","created_at":"2025-08-19 13:44:48","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":117140,"visible":true,"origin":"","legend":"\u003cp\u003eGross specimen of the resected right lower lobe.\u003c/p\u003e","description":"","filename":"Figure6.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6883117/v1/c75febe8c484288946e5b062.jpg"},{"id":89394927,"identity":"735c3d6d-a1dc-49fe-8a46-deca2c1805f2","added_by":"auto","created_at":"2025-08-19 13:36:48","extension":"jpg","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":80918,"visible":true,"origin":"","legend":"\u003cp\u003eIntraoperative image showing a vascularized muscle and rib flap being rotated to cover the bronchial stump.\u003c/p\u003e","description":"","filename":"Figure7.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6883117/v1/42be918bc22d4db63bc92fa4.jpg"},{"id":89398043,"identity":"d7932a92-dd19-4308-9c0c-b7426087ef53","added_by":"auto","created_at":"2025-08-19 13:52:48","extension":"jpg","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":26071,"visible":true,"origin":"","legend":"\u003cp\u003eIntraoperative image showing the aberrant systemic artery which is arising from the descending thoracic aorta and supplying the sequestered left lower lobe, confirming the diagnosis of intralobar pulmonary sequestration.\u003c/p\u003e","description":"","filename":"Figure8.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6883117/v1/d1d1067f3a9bbe7366bf55b8.jpg"},{"id":89399240,"identity":"24a79250-4024-4542-a686-4130e8a090e5","added_by":"auto","created_at":"2025-08-19 14:00:48","extension":"jpg","order_by":9,"title":"Figure 9","display":"","copyAsset":false,"role":"figure","size":36380,"visible":true,"origin":"","legend":"\u003cp\u003eIntraoperative image of the left lower lobe, showing gross distortion due to advanced bronchiectasis and intralobar pulmonary sequestration.\u003c/p\u003e","description":"","filename":"Figure9.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6883117/v1/16f5dfb49f49215ebdf17b80.jpg"},{"id":89396986,"identity":"b12d70b7-bcaf-4fa0-ad5d-5314380e6fe3","added_by":"auto","created_at":"2025-08-19 13:44:48","extension":"jpg","order_by":10,"title":"Figure 10","display":"","copyAsset":false,"role":"figure","size":60686,"visible":true,"origin":"","legend":"\u003cp\u003eHistological section of the resected left lower lobe (H\u0026amp;E stain, high power view), demonstrating a dilated bronchial lumen lined by pseudostratified columnar epithelium, surrounded by dense inflammatory infiltrates, vascular congestion, and areas of parenchymal hemorrhage. No evidence of malignancy or fibrosis is seen.\u003c/p\u003e","description":"","filename":"Figure10.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6883117/v1/2273629c99cfb5566a98bfa1.jpg"},{"id":107350875,"identity":"33b0ed65-ecaa-4839-a92f-945c6d90d4f8","added_by":"auto","created_at":"2026-04-20 16:06:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":922927,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6883117/v1/ad6530e7-2c97-49e8-9244-260f3ff87e6a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Staged Surgical Management of Intralobar Pulmonary Sequestration with Bilateral Bronchiectasis in an Adolescent: A Rare Case Report","fulltext":[{"header":"Introduction","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eBronchopulmonary sequestration (BPS) is a rare congenital anomaly first described by Huber in 1777, with the term \u0026ldquo;sequestration\u0026rdquo;\u0026mdash;meaning \u0026ldquo;to separate\u0026rdquo;\u0026mdash;later introduced by Pryce in 1946, and is characterized by a nonfunctional mass of pulmonary tissue that lacks communication with the tracheobronchial tree and receives its arterial blood supply from the thoracic aorta or aortic arch [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. It accounts for approximately 1.1\u0026ndash;1.8% of all pulmonary resections and represents 0.15\u0026ndash;6.4% of congenital pulmonary malformations and most commonly affects the lower lobe, particularly on the left side [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Two forms of BPS are recognized: intralobar sequestration (ILS\u003cb\u003e)\u003c/b\u003e, which constitutes 75\u0026ndash;86% of cases and is most frequently located in the left lower lobe, and extralobar sequestration (ELS), which has a separate pleural covering [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Although BPS is benign in nature, it may remain asymptomatic or present with complications such as recurrent pulmonary infections, hemoptysis, congestive heart failure, or even tumorigenesis [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Symptomatic lesions are typically managed through surgical resection, ranging from sublobar to anatomical lobectomy [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Although bronchiectasis\u0026mdash;a chronic condition defined by irreversible bronchial dilatation, typically evident on chest imaging as airway wall thickening and clinically manifested by persistent cough and sputum production\u0026mdash;was once considered a rare or orphan disease, it has, over the past few decades, emerged as a globally recognized health concern, with a marked increase in both incidence and prevalence worldwide. While rare, bronchopulmonary sequestration (BPS) has been reported in association with bronchiectasis, further complicating both diagnosis and management in affected individuals [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eHere, we report the case of a 15-year-old female from Syria diagnosed with bronchopulmonary sequestration complicated by bilateral bronchiectasis.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 15-year-old Arab female, non-smoker and non-alcoholic, with no prior surgical history and a documented allergy to ceftriaxone, presented with a longstanding history of recurrent lower respiratory tract infections dating back to the age of six months. Her history was notable for a chronic productive cough that required frequent courses of antibiotic therapy and was accompanied by persistent growth delay. Despite repeated medical evaluations throughout childhood, no definitive diagnosis was established.\u003c/p\u003e\u003cp\u003eOne year prior to presentation, the patient underwent comprehensive investigations at a pediatric center, where both cystic fibrosis and primary ciliary dyskinesia, including Kartagener syndrome, were ruled out.\u003c/p\u003e\u003cp\u003eAt the time of admission, the patient complained of a persistent productive cough with copious sputum but denied dyspnea, hemoptysis, fever, or weight loss. Systemic review was otherwise unremarkable. Clinical examination of the chest revealed bilateral fine inspiratory crackles predominantly at the lung bases. Vital signs were stable, with oxygen saturation at 95% on room air. Laboratory workup, including complete blood count, immunological profile, and inflammatory markers, was within normal limits. Sputum culture was sterile. Serologic testing for transglutaminase antibodies and thyroid function tests were negative.\u003c/p\u003e\u003cp\u003eChest radiography showed right lower zone opacities with silhouetting of the right cardiac border \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. Computed tomography (CT) of the chest demonstrated areas of increased density involving both lower lobes, particularly at the lung bases, as well as a distinct opacity in the medial segment of the right middle lobe, suggestive of localized chronic inflammatory infiltration \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eNotably, a contrast-enhanced CT scan showed an aberrant systemic artery originating from the descending thoracic aorta, supplying the left lower lobe, consistent with intralobar pulmonary sequestration \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. No sequestration or aberrant supply was identified on the right side. A separate vascular variant was noted as an aberrant right subclavian artery arising anomalously from the aortic arch, a purely anatomical observation without pathological relevance \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003ePulmonary function testing was not performed preoperatively due to multiple limiting factors, including the patient\u0026rsquo;s poor cooperation, and the high burden of mucus production. Additionally, given that both lower lobes were radiologically confirmed to be structurally destroyed and functionally non-contributory, surgical resection was deemed feasible and justified without the need for formal spirometric assessment.\u003c/p\u003e\u003cp\u003eThe patient underwent staged surgical management due to the severity and bilaterality of the disease. In the first procedure, a right posterolateral thoracotomy was performed with resection of the severely damaged right lower lobe and a wedge resection of the middle lobe \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. Due to extensive inflammation and fragility of the bronchial stump, reinforcement was achieved by applying a vascularized muscle and rib flap, preserving the pedicle and rotating it over the bronchial closure to minimize the risk of bronchopleural fistula formation \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. Histopathological examination of the resected lung confirmed bronchiectasis with mixed acute and chronic inflammation, lymphoid aggregates, hemorrhage, and abscess formation.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFollowing a stable recovery period, a second-stage left thoracotomy was performed. Intraoperatively, an aberrant artery from the descending thoracic aorta was isolated, ligated, and divided, confirming the diagnosis of intralobar pulmonary sequestration of the left lower lobe \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. The affected lobe was markedly consolidated and resected en bloc \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig9\" class=\"InternalRef\"\u003e9\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. Gross examination revealed two well-demarcated infarcted zones within the lobe. Histological analysis showed extensive hemorrhage, marked perivascular inflammatory infiltrates, and vascular congestion, without evidence of malignancy or fibrosis \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig10\" class=\"InternalRef\"\u003e10\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. Postoperatively, the patient showed marked clinical improvement with complete resolution of productive cough and stabilization of pulmonary function.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eMany studies have suggested that intralobar sequestration may develop as an acquired condition, potentially secondary to chronic local infections such as bronchiectasis [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. On the other hand, the most widely accepted theory suggests that pulmonary sequestration arises from an accessory lung bud that develops posterior to the primary bronchopulmonary buds during the pseudoglandular stage of lung development (5\u0026ndash;17 weeks of gestation), a period that precedes the separation of the aortic and pulmonary circulations. This embryologic timing may account for the spectrum of bronchopulmonary foregut malformations associated with these anomalies [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The clinical presentation of pulmonary sequestration varies, with intralobar sequestration (ILS) commonly manifesting as fever, purulent sputum, and cough that may rapidly progress to lung infections, whereas extralobar sequestration (ELS) is often asymptomatic or incidentally discovered and frequently misdiagnosed as lung cancer, pulmonary cysts, or mediastinal tumors [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. While our patient exhibited common features of intralobar sequestration (ILS), such as productive cough and recurrent infections, the chronic onset since infancy combined with bilateral bronchiectasis suggests a more advanced and progressive disease course than typically observed. Although ILS usually presents as a localized lesion confined to a single lobe, its association with bilateral bronchiectasis is exceptionally rare. Most reported cases involve unilateral disease, making the coexistence of ILS with widespread bilateral bronchiectasis, as seen in our patient, both unusual and clinically significant [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHowever, Bronchiectasis is a chronic respiratory disorder defined by irreversible bronchial dilatation on chest computed tomography (CT), accompanied clinically by persistent cough, daily sputum production, and recurrent pulmonary exacerbations [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Initial evaluation of bronchopulmonary sequestration (BPS) typically involves chest radiography, which may show a homogeneous mass\u0026mdash;often in the left lower lobe\u0026mdash;with cystic changes or air-fluid levels from secondary infection [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. When suspicion arises, contrast-enhanced CT or MRI is recommended to characterize the lesion and identify systemic arterial supply [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Angiography may be required in select cases for definitive vascular mapping, especially when an aortic branch is involved [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Other cases reported that diagnosis of ILS is frequently delayed, often into adolescence or adulthood, even when symptoms begin early in life. Similarly, our patient exhibited chronic symptoms since infancy, yet definitive diagnosis and surgical treatment were only established during adolescence. This diagnostic delay, combined with bilateral progression and extensive parenchymal injury, highlights the importance of early imaging and multidisciplinary evaluation in pediatric patients with recurrent respiratory infections [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eSurgical resection remains the mainstay of treatment for bronchopulmonary sequestration, though selective embolization of the feeding artery has been proposed as a less invasive alternative in selected cases [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Surgical resection is recommended for patients with respiratory symptoms, recurrent infections, or when imaging demonstrates a lesion occupying more than 20% of the hemithorax [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. However, The management of bronchiectasis is particularly challenging due to its clinical and etiological heterogeneity, as it may arise primarily or as a consequence of various infectious, genetic, autoimmune, or allergic disorders [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Conventional antibiotic therapy often proves insufficient, requiring prolonged use with limited outcomes, as the disease is typically progressive, incurable, and associated with significant morbidity and early mortality [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In addition, minimally invasive approaches such as VATS lobectomy and arterial embolization have been successfully employed in cases of pulmonary sequestration with limited inflammation, as reported by Tayama et al. and Tunsupon et al. [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. In our case, although sequestration was confined to the left lower lobe, the patient presented with bilateral bronchiectasis and severe parenchymal destruction. This necessitated an open surgical approach with staged thoracotomies, as the disease involved dense pleural adhesions and nonfunctional lung segments, thereby exceeding the threshold for minimally invasive or conservative interventions and reflecting a more advanced and destructive clinical course. Notably, bronchial stump reinforcement using a vascularized muscle and rib flap was performed in the first stage\u0026mdash;an approach not described in the reviewed literature\u0026mdash;highlighting the technical complexity and severity of pathology encountered in this case.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis case illustrates a rare and complex presentation of intralobar pulmonary sequestration associated with bilateral bronchiectasis in an adolescent patient. The extent of parenchymal destruction and bilateral disease necessitated a staged open surgical approach, highlighting the importance of individualized treatment planning. Early recognition, thorough imaging evaluation, and multidisciplinary management are essential to optimizing outcomes in patients with atypical or progressive forms of BPS. This case underscores the need to consider congenital anomalies in the differential diagnosis of chronic respiratory symptoms, even when they present beyond early childhood.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eConflict of interest statement:\u003c/h2\u003e\u003cp\u003eThe authors declared no potential conflicts of interest concerning the research, authorship, and/or publication of this article.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eEthical Approval:\u003c/h2\u003e\u003cp\u003eInstitutional Review Board (IRB) approval is not required for de-identified single case reports or case histories, in accordance with institutional policies.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003ePatient consent:\u003c/h2\u003e\u003cp\u003eWritten informed consent was obtained from the patient for publication and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eM.A.A. conceived the study, collected clinical data, performed the literature review, and drafted the manuscript. N.F. contributed to manuscript editing, radiological interpretation, and image preparation. R.A. and B.I. performed the surgical procedures, contributed intraoperative data, and critically revised the surgical aspects of the manuscript. All authors reviewed and approved the final version of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSun X, Xiao Y. Pulmonary sequestration in adult patients: a retrospective study. 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Ochsner J. 2017;17(3):288\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Bronchopulmonary sequestration, Bilateral bronchiectasis, Pediatric thoracic surgery, Case report.","lastPublishedDoi":"10.21203/rs.3.rs-6883117/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6883117/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eBronchopulmonary sequestration (BPS) is a rare congenital pulmonary anomaly characterized by nonfunctional lung tissue that lacks communication with the tracheobronchial tree and receives systemic arterial supply. Although BPS is typically localized and unilateral, its association with bilateral bronchiectasis is exceedingly rare. Managing such combined pathology poses significant diagnostic and therapeutic challenges.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase Presentation: \u003c/strong\u003eWe report the case of a 15-year-old Syrian female with a long history of recurrent lower respiratory tract infections and chronic productive cough. Imaging revealed bilateral bronchiectasis and an aberrant artery from the descending thoracic aorta supplying the left lower lobe, consistent with intralobar pulmonary sequestration (ILS). The patient underwent staged open thoracotomies. The first procedure involved right lower lobectomy with partial middle lobectomy and bronchial stump reinforcement using a vascularized muscle and rib flap. The second stage included left lower lobectomy with intraoperative identification and division of the aberrant artery. Histopathological analysis confirmed severe bronchiectasis, abscess formation, hemorrhage, and vascular congestion, with no evidence of malignancy or fibrosis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion \u0026amp; Conclusion: \u003c/strong\u003eThis case highlights an uncommon coexistence of unilateral ILS with bilateral bronchiectasis, a presentation that is rarely documented in the literature. The extent of pulmonary destruction and pleural adhesions necessitated open surgical intervention. Notably, the use of bronchial stump reinforcement underscores the surgical complexity. Early recognition and multidisciplinary management are essential, especially in pediatric patients with persistent respiratory symptoms. This case adds to the limited data on complex BPS presentations and emphasizes the importance of individualized surgical planning.\u003c/p\u003e","manuscriptTitle":"Staged Surgical Management of Intralobar Pulmonary Sequestration with Bilateral Bronchiectasis in an Adolescent: A Rare Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-19 13:36:43","doi":"10.21203/rs.3.rs-6883117/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-22T19:17:59+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-31T04:11:35+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-29T17:49:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"204472508908699575380306876363303484271","date":"2025-08-20T17:34:07+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-14T09:48:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"99706547144492448686739951382581230540","date":"2025-08-14T08:56:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"324022425717454079514486182130258199221","date":"2025-08-12T09:34:26+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-12T05:49:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"178252863913279966766122657920063492568","date":"2025-08-11T17:43:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"105834629682239277721157049491810485250","date":"2025-08-11T16:30:54+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-11T16:20:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-13T05:53:37+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-13T05:51:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Cardiothoracic Surgery","date":"2025-06-12T20:43:51+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6a590e85-87a2-4b2b-874f-40c52eca9bef","owner":[],"postedDate":"August 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-20T16:03:29+00:00","versionOfRecord":{"articleIdentity":"rs-6883117","link":"https://doi.org/10.1186/s13019-026-03988-z","journal":{"identity":"journal-of-cardiothoracic-surgery","isVorOnly":false,"title":"Journal of Cardiothoracic Surgery"},"publishedOn":"2026-04-18 15:59:55","publishedOnDateReadable":"April 18th, 2026"},"versionCreatedAt":"2025-08-19 13:36:43","video":"","vorDoi":"10.1186/s13019-026-03988-z","vorDoiUrl":"https://doi.org/10.1186/s13019-026-03988-z","workflowStages":[]},"version":"v1","identity":"rs-6883117","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6883117","identity":"rs-6883117","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}