Objective:

To enhance clinical awareness and understanding of extralobar pulmonary sequestration (ELS) complicated by torsion and infarction through the presentation of three pediatric cases.

Approach:

• Literature Review: A comprehensive literature review was conducted using specific keywords related to ELS with torsion in children, identifying 16 articles and 24 pediatric cases.
• Case Presentation: Three pediatric cases treated at Shanghai Children's Hospital between May 2022 and November 2025 were reported, detailing symptoms, imaging findings, surgical procedures, and postoperative outcomes.

Key Findings:

• Two patients presented with abdominal and chest pain, while one presented with abdominal pain alone.
• Contrast-enhanced CT revealed intrathoracic soft-tissue masses in two patients and confirmed pulmonary sequestration in one.
• All patients underwent thoracoscopic resection, with postoperative pathology confirming pulmonary sequestration with hemorrhagic necrosis.

Interpretation:

Pulmonary sequestration with torsion should be considered in differential diagnoses for patients with chest/abdominal pain and intrathoracic soft-tissue masses.

Limitations:

• The study is based on a small number of cases (three) from a single institution, which may limit the generalizability of the findings.
• The literature review may not encompass all relevant cases due to publication bias or incomplete reporting.

Conclusion:

Thoracoscopic surgery is a viable option for pediatric patients with pulmonary sequestration complicated by torsion and infarction.