Staged uniportal video-assisted thoracoscopic bilateral lower lobectomy for bilateral intralobar pulmonary sequestration complicated by

Background: Bilateral pulmonary sequestration (BPS) is an exceptionally rare congenital bronchopulmonary and vascular anomaly. Its complex anatomy and aberrant systemic arterial supply make diagnosis and treatment difficult, especially when severe fungal infection is present. Case presentation: A 28-year-old woman presented with a 1-year history of cough and hemoptysis and bilateral lower-lung masses. CT with 3D reconstruction showed bilateral intralobar pulmonary sequestration linked by an anomalous fistulous tract across the posterior mediastinum and supplied by multiple arteries from the descending aorta. Sputum culture and bronchoalveolar lavage next-generation sequencing confirmed Conclusion: This case delineates the clinical presentation of an extremely rare bilateral ILS connected via a posterior mediastinal fistulous tract and complicated by aspergilloma. Staged uniportal VATS, augmented by preoperative 3D reconstruction and interval pulmonary rehabilitation, represents an optimal, safe, and effective strategy for managing such intricate congenital malformations while maximizing functional preservation.