Extralobar pulmonary sequestration manifesting as hemorrhagic infarction in a five-year-old male

•An EPS may manifest as a hemorrhagic infarction.•Detection of feeding vessels is difficult in cases of EPS with infarction.•Early surgical resection is recommended for EPS with hemorrhagic infarction.

Extralobar pulmonary sequestration (EPS) is frequently asymptomatic and detected incidentally. We herein report a pediatric case of EPS that manifested as hemorrhagic infarction. A five-year-old male with previously normal X-ray films was referred to our hospital due to acute onset of right flank pain and a non-productive cough. The initial diagnosis was infection of an EPS; however, the symptoms persisted despite the administration of antibiotics. A CT-angiogram revealed interruption of the blood flow to the sequestrum, and a definitive diagnosis as hemorrhagic infarction of a pulmonary sequestration was made. During surgery, an aberrant artery was revealed to derive from the intercostal artery and the sequestrum was resected safely. In cases of infarction of EPS, early surgical resection should be considered, because progressed adhesion can complicate dissection from surrounding organs and the detection of the feeding vessels.