Intralobar Pulmonary Sequestration in Situs Inversus: A Rare Presentation withRecurrent Hemoptysis

Intralobar Pulmonary Sequestration in Situs Inversus: A Rare Presentation withRecurrent Hemoptysis | 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 Short Report Intralobar Pulmonary Sequestration in Situs Inversus: A Rare Presentation withRecurrent Hemoptysis Nawras Ibrahim, Rahaf Jereisat, Melissa Korb, Maher Dahdel This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7521927/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Bronchopulmonary sequestration (BPS) is a rare congenital malformation of lung tissue characterized by the absence of normal bronchial connection and systemic arterial supply (1,2). Situs inversus totalis (SIT) is an independent congenital anomaly in which thoracic and abdominal organs are reversed in mirror-image fashion (4). The coexistence of BPS and SIT is exceedingly rare (9). Case Presentation : We present a 51-year-old woman with SIT and BPS who developed massive hemoptysis. She had undergone prior embolization for intralobar sequestration (ILS) three years earlier. CT angiography revealed ILS in the medial left upper lobe (anatomic right middle lobe) with aberrant supply from the left phrenic artery. Emergent embolization achieved temporary control, but recurrent bleeding necessitated thoracotomy, wedge resection, and subsequent lobectomy. Conclusion: This case highlights the diagnostic and therapeutic challenges of ILS in SIT. Embolization provided temporary control, but definitive management was achieved with surgical resection (6,8). Bronchopulmonary sequestration Intralobar sequestration Situs inversus totalis Hemoptysis Embolization Lobectomy Thoracotomy Aberrant systemic artery Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Bronchopulmonary sequestration (BPS) represents 6.4% of congenital pulmonary malformations (1,3). Two types exist: extralobar sequestration (ELS) and intralobar sequestration (ILS) (2,7). In ILS, systemic arterial supply arises from the thoracic aorta in 74% of cases, with multiple anomalous arteries in 14.8% (1). Situs inversus totalis (SIT) occurs in approximately 1:10,000 individuals, with a male-to-female ratio of 1.5:1 (4). It is defined by mirror-image reversal of thoracic and abdominal viscera. We report a patient with SIT presenting with recurrent life-threatening hemoptysis due to ILS, managed successfully with lobectomy after failed embolization. Case Presentation A 51-year-old Hispanic female with a history of situs inversus totalis, diabetes mellitus, hypertension, and previously treated pulmonary sequestration (via endovascular embolization three years prior) presented with acute, recurrent, life-threatening hemoptysis and required intubation for airway protection, followed by bronchoscopic intervention. Diagnostic Studies Chest X-ray: Dextrocardia, right-sided aortic arch, and chronic consolidation at the medial left lung base (Figure 1). Chest CTA: Intralobar sequestration in the medial left upper lobe (anatomic right middle lobe) supplied by an aberrant artery from the left phrenic artery (Figure 2). Bronchoscopy: Localized active bleeding controlled with bronchial blocker. Angiography: Previously placed embolization pellets had migrated distally. Extravasation persisted from the left phrenic artery. Repeat embolization with glue was performed. An additional supply from the left internal mammary artery was identified and embolized (Figure 3). Histopathology: Confirmed ILS with cystic degeneration, fibrosis, and chronic inflammation (7) (Figure 4). Clinical Course Anomalous vessels were embolized emergently in the patient. However, hemoptysis recurred two days later, with a roughly 500 mL of blood loss. At re-bronchoscopy persistent bleeding was observed and a bronchial blocker was inserted. Because of continued bleeding, the decision was made to proceed with surgical intervention, and she subsequently underwent a thoracotomy with partial wedge resection of the left upper (anatomic right middle) lobe. A few days later, due to recurrent bleeding, she required a total left upper (anatomic right middle) lobectomy. Post-surgery, the patient was stabilized in the ICU and transferred to an inpatient rehabilitation facility for further recovery. Discussion Pulmonary sequestration is a non-functional lung segment supplied by systemic arteries without bronchial connection (1,2,3,5). ILS accounts for ~75% of cases and is typically located within the visceral pleura of functional lung (7). In adults, hemoptysis is the most common complication due to systemic arterial pressures (3). Preoperative imaging with CT or MR angiography is critical for diagnosis (1,5). Situs inversus complicates both anatomical assessment and surgical planning (4,9). Endovascular embolization offers temporary control in select patients but is not always definitive (8). In this case, recurrence highlighted the limitations of embolization. Surgical resection remains the gold standard, particularly in patients with life-threatening hemoptysis or failed embolization (6,8,9). Thoracotomy was chosen over VATS due to aberrant vascularity and mirror-image anatomy (6). Few cases of ILS in SIT have been reported, usually presenting with infection rather than hemoptysis (9). Our case demonstrates the unique challenges of massive hemoptysis requiring repeat embolization and lobectomy in this rare dual anomaly. Conclusion The combination of intralobar pulmonary sequestration and situs inversus totalis presents extraordinary rarity and clinical management difficulties. Several key lessons emerge from this case; Situs inversus flips out standard anatomical reference points necessitating meticulous modifications to both diagnostic and therapeutic procedures. This case highlights that endovascular embolization may not serve as an adequate permanent solution for pulmonary sequestration with large aberrant vessels or aneurysmal changes even though it is becoming a popular less invasive alternative to surgery. The treatment of rare congenital anomaly combinations requires a multidisciplinary team approach that combines skills from interventional radiology, pulmonology, thoracic surgery, and intensive care medicine Abbreviations BPS – Bronchopulmonary Sequestration CTA – Computed Tomography Angiography ELS – Extralobar Sequestration ICU – Intensive Care Unit ILS – Intralobar Sequestration SIT – Situs Inversus Totalis VATS – Video-Assisted Thoracoscopic Surgery Declarations Ethical Compliance “Written informed consent was obtained from the patient for the publication of this case report and any accompanying images” Conflict of Interest “The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.” Disclaimer/ Funding Declaration This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare-affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities. References Walker CM, Wu CC, Gilman MD, Godwin JD, Shepard JA, Abbott GF. The imaging spectrum of bronchopulmonary sequestration. Curr Probl Diagn Radiol . 2014;43(3):100–14. doi:10.1067/j.cpradiol.2014.01.005 Corbett HJ, Humphrey GM. Pulmonary sequestration. Paediatr Respir Rev . 2004;5(1):59–68. doi:10.1016/j.prrv.2003.09.009 Savic B, Birtel FJ, Tholen W, Funke HD, Knoche R. Lung sequestration: report of seven cases and review of 540 published cases. Thorax . 1979;34(1):96–101. doi:10.1136/thx.34.1.96 Eitler K, Bibok A, Telkes G. Situs inversus totalis: a clinical review. Int J Gen Med . 2022;15:2437–49. doi:10.2147/IJGM.S295444 Chakraborty RK, Modi P, Sharma S. Pulmonary sequestration. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan [updated 2023 Jul 24]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532314/ Liu C, Pu Q, Ma L, Mei J, Xiao Z, Liao H, et al. Video-assisted thoracic surgery for pulmonary sequestration compared with posterolateral thoracotomy. J Thorac Cardiovasc Surg . 2013;146(3):557–61. doi:10.1016/j.jtcvs.2013.04.027 Prasad R, Garg R, Verma SK. Intralobar sequestration of lung. Lung India . 2009;26(4):159–61. doi:10.4103/0970-2113.56357 Ellis J, Brahmbhatt S, Desmond D, et al. Coil embolisation of intralobar pulmonary sequestration: an alternative to surgery. J Med Case Rep . 2018;12:375. doi:10.1186/s13256-018-1915-5 Sankar NM, Kumar S, Natarajan S, Krishnan R, Jawale Y. Intralobar sequestration with situs inversus totalis. Asian Cardiovasc Thorac Ann . 2015;23(6):729–31. doi:10.1177/0218492314561097 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted 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. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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totalis.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7521927/v1/adee7c0882906c9ed08dce7c.png"},{"id":101827072,"identity":"a1b5df76-89b0-4ada-9053-190a073d6329","added_by":"auto","created_at":"2026-02-04 05:21:05","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":259534,"visible":true,"origin":"","legend":"\u003cp\u003eCT angiography demonstrating ILS in medial left upper lobe (anatomic right middle lobe).\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7521927/v1/edbecbfc5bba64a83d94be98.png"},{"id":101827070,"identity":"18f54fd1-565c-4b5c-a843-ad680de8a5cd","added_by":"auto","created_at":"2026-02-04 05:21:05","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":119670,"visible":true,"origin":"","legend":"\u003cp\u003eAngiography showing aberrant systemic supply from left phrenic artery before embolization.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7521927/v1/e31c66d99a829162ccc094f0.png"},{"id":101827071,"identity":"f74eec85-0ebe-45b4-8f36-65a08e523bab","added_by":"auto","created_at":"2026-02-04 05:21:05","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":860601,"visible":true,"origin":"","legend":"\u003cp\u003eHistopathology of resected specimen with cystic degeneration, fibrosis, and chronic inflammation.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7521927/v1/eda523cb350c38cd6c7dcc22.png"},{"id":101881751,"identity":"59d407df-9539-40cd-b1f1-f3c569a7eb51","added_by":"auto","created_at":"2026-02-04 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Two types exist: \u003cstrong\u003eextralobar sequestration (ELS)\u003c/strong\u003e and \u003cstrong\u003eintralobar sequestration (ILS)\u003c/strong\u003e (2,7). In ILS, systemic arterial supply arises from the thoracic aorta in 74% of cases, with multiple anomalous arteries in 14.8% (1).\u003c/p\u003e\n\u003cp\u003eSitus inversus totalis (SIT) occurs in approximately 1:10,000 individuals, with a male-to-female ratio of 1.5:1 (4). It is defined by mirror-image reversal of thoracic and abdominal viscera.\u003c/p\u003e\n\u003cp\u003eWe report a patient with SIT presenting with recurrent life-threatening hemoptysis due to ILS, managed successfully with lobectomy after failed embolization.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 51-year-old Hispanic female with a history of situs inversus totalis, diabetes mellitus, hypertension, and previously treated pulmonary sequestration (via endovascular embolization three years prior) presented with acute, recurrent, life-threatening hemoptysis and required intubation for airway protection, followed by bronchoscopic intervention.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eDiagnostic Studies\u003c/strong\u003e\u003c/h3\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eChest X-ray:\u003c/strong\u003e Dextrocardia, right-sided aortic arch, and chronic consolidation at the medial left lung base (Figure 1).\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eChest CTA:\u003c/strong\u003e Intralobar sequestration in the medial left upper lobe (anatomic right middle lobe) supplied by an aberrant artery from the left phrenic artery (Figure 2).\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eBronchoscopy:\u003c/strong\u003e Localized active bleeding controlled with bronchial blocker.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAngiography:\u003c/strong\u003e Previously placed embolization pellets had migrated distally. Extravasation persisted from the left phrenic artery. Repeat embolization with glue was performed. An additional supply from the left internal mammary artery was identified and embolized (Figure 3).\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eHistopathology:\u003c/strong\u003e Confirmed ILS with cystic degeneration, fibrosis, and chronic inflammation (7) (Figure 4).\u003c/li\u003e\n\u003c/ul\u003e\n\u003ch3\u003e\u003cstrong\u003eClinical Course\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eAnomalous vessels were embolized emergently in the patient. However, hemoptysis recurred two days later, with a roughly 500 mL of blood loss. At re-bronchoscopy persistent bleeding was observed and a bronchial blocker was inserted.\u003c/p\u003e\n\u003cp\u003eBecause of continued bleeding, the decision was made to proceed with surgical intervention, and she subsequently underwent a thoracotomy with partial wedge resection of the left upper (anatomic right middle) lobe. A few days later, due to recurrent bleeding, she required a total left upper (anatomic right middle) lobectomy.\u003c/p\u003e\n\u003cp\u003ePost-surgery, the patient was stabilized in the ICU and transferred to an inpatient rehabilitation facility for further recovery.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePulmonary sequestration is a non-functional lung segment supplied by systemic arteries without bronchial connection (1,2,3,5). ILS accounts for ~75% of cases and is typically located within the visceral pleura of functional lung (7).\u003c/p\u003e\n\u003cp\u003eIn adults, hemoptysis is the most common complication due to systemic arterial pressures (3). Preoperative imaging with CT or MR angiography is critical for diagnosis (1,5). Situs inversus complicates both anatomical assessment and surgical planning (4,9).\u003c/p\u003e\n\u003cp\u003eEndovascular embolization offers temporary control in select patients but is not always definitive (8). In this case, recurrence highlighted the limitations of embolization. Surgical resection remains the gold standard, particularly in patients with life-threatening hemoptysis or failed embolization (6,8,9). Thoracotomy was chosen over VATS due to aberrant vascularity and mirror-image anatomy (6).\u003c/p\u003e\n\u003cp\u003eFew cases of ILS in SIT have been reported, usually presenting with infection rather than hemoptysis (9). Our case demonstrates the unique challenges of massive hemoptysis requiring repeat embolization and lobectomy in this rare dual anomaly.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe combination of intralobar pulmonary sequestration and situs inversus totalis presents extraordinary rarity and clinical management difficulties. Several key lessons emerge from this case; Situs inversus flips out standard anatomical reference points necessitating meticulous modifications to both diagnostic and therapeutic procedures. This case highlights that endovascular embolization may not serve as an adequate permanent solution for pulmonary sequestration with large aberrant vessels or aneurysmal changes even though it is becoming a popular less invasive alternative to surgery. The treatment of rare congenital anomaly combinations requires a multidisciplinary team approach that combines skills from interventional radiology, pulmonology, thoracic surgery, and intensive care medicine\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eBPS\u003c/strong\u003e – Bronchopulmonary Sequestration\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eCTA\u003c/strong\u003e – Computed Tomography Angiography\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eELS\u003c/strong\u003e – Extralobar Sequestration\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eICU\u003c/strong\u003e – Intensive Care Unit\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eILS\u003c/strong\u003e – Intralobar Sequestration\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSIT\u003c/strong\u003e – Situs Inversus Totalis\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eVATS\u003c/strong\u003e – Video-Assisted Thoracoscopic Surgery\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthical Compliance\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e“Written informed consent was obtained from the patient for the publication of this case report and any accompanying images”\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConflict of Interest\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e“The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.”\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDisclaimer/ Funding Declaration\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare-affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eWalker CM, Wu CC, Gilman MD, Godwin JD, Shepard JA, Abbott GF. The imaging spectrum of bronchopulmonary sequestration. \u003cem\u003eCurr Probl Diagn Radiol\u003c/em\u003e. 2014;43(3):100\u0026ndash;14. doi:10.1067/j.cpradiol.2014.01.005\u003c/li\u003e\n \u003cli\u003eCorbett HJ, Humphrey GM. Pulmonary sequestration. \u003cem\u003ePaediatr Respir Rev\u003c/em\u003e. 2004;5(1):59\u0026ndash;68. doi:10.1016/j.prrv.2003.09.009\u003c/li\u003e\n \u003cli\u003eSavic B, Birtel FJ, Tholen W, Funke HD, Knoche R. Lung sequestration: report of seven cases and review of 540 published cases. \u003cem\u003eThorax\u003c/em\u003e. 1979;34(1):96\u0026ndash;101. doi:10.1136/thx.34.1.96\u003c/li\u003e\n \u003cli\u003eEitler K, Bibok A, Telkes G. Situs inversus totalis: a clinical review. \u003cem\u003eInt J Gen Med\u003c/em\u003e. 2022;15:2437\u0026ndash;49. doi:10.2147/IJGM.S295444\u003c/li\u003e\n \u003cli\u003eChakraborty RK, Modi P, Sharma S. Pulmonary sequestration. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan [updated 2023 Jul 24]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532314/\u003c/li\u003e\n \u003cli\u003eLiu C, Pu Q, Ma L, Mei J, Xiao Z, Liao H, et al. Video-assisted thoracic surgery for pulmonary sequestration compared with posterolateral thoracotomy. \u003cem\u003eJ Thorac Cardiovasc Surg\u003c/em\u003e. 2013;146(3):557\u0026ndash;61. doi:10.1016/j.jtcvs.2013.04.027\u003c/li\u003e\n \u003cli\u003ePrasad R, Garg R, Verma SK. Intralobar sequestration of lung. \u003cem\u003eLung India\u003c/em\u003e. 2009;26(4):159\u0026ndash;61. doi:10.4103/0970-2113.56357\u003c/li\u003e\n \u003cli\u003eEllis J, Brahmbhatt S, Desmond D, et al. Coil embolisation of intralobar pulmonary sequestration: an alternative to surgery. \u003cem\u003eJ Med Case Rep\u003c/em\u003e. 2018;12:375. doi:10.1186/s13256-018-1915-5\u003c/li\u003e\n \u003cli\u003eSankar NM, Kumar S, Natarajan S, Krishnan R, Jawale Y. Intralobar sequestration with situs inversus totalis. \u003cem\u003eAsian Cardiovasc Thorac Ann\u003c/em\u003e. 2015;23(6):729\u0026ndash;31. doi:10.1177/0218492314561097\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Bronchopulmonary sequestration, Intralobar sequestration, Situs inversus totalis, Hemoptysis; Embolization, Lobectomy, Thoracotomy, Aberrant systemic artery","lastPublishedDoi":"10.21203/rs.3.rs-7521927/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7521927/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Bronchopulmonary sequestration (BPS) is a rare congenital malformation of lung tissue characterized by the absence of normal bronchial connection and systemic arterial supply (1,2). Situs inversus totalis (SIT) is an independent congenital anomaly in which thoracic and abdominal organs are reversed in mirror-image fashion (4). The coexistence of BPS and SIT is exceedingly rare (9).\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase Presentation\u003c/strong\u003e: We present a 51-year-old woman with SIT and BPS who developed massive hemoptysis. She had undergone prior embolization for intralobar sequestration (ILS) three years earlier. CT angiography revealed ILS in the medial left upper lobe (anatomic right middle lobe) with aberrant supply from the left phrenic artery. Emergent embolization achieved temporary control, but recurrent bleeding necessitated thoracotomy, wedge resection, and subsequent lobectomy.\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e This case highlights the diagnostic and therapeutic challenges of ILS in SIT. Embolization provided temporary control, but definitive management was achieved with surgical resection (6,8).\u0026nbsp;\u003c/p\u003e","manuscriptTitle":"Intralobar Pulmonary Sequestration in Situs Inversus: A Rare Presentation withRecurrent Hemoptysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-04 05:20:56","doi":"10.21203/rs.3.rs-7521927/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2f43777f-0663-4676-b3be-2ec106c79693","owner":[],"postedDate":"February 4th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-04T05:20:57+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-04 05:20:56","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7521927","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7521927","identity":"rs-7521927","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}