Posterior mediastinal masses have widely variant presentations and a broad differential diagnosis. We describe an adolescent boy presenting with a posterior mediastinal mass, associated with abdominal pain and pleural effusion. Radiologic, operative, and pathologic findings are reviewed. This patient was found to have torsion of an extralobar pulmonary sequestration, of which only 2 other cases have been reported in the literature. Although radiologic findings of a systemic arterial supply to the mass may be absent, with patients presenting with this constellation of symptoms, a high index of suspicion of a sequestration should be maintained.
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