Pulmonary sequestration is a rare congenital malformation of the lower respiratory tract, characterized by nonfunctioning lung tissue without tracheobronchial communication and receiving its blood supply from the systemic circulation. It can present as either intralobar or extralobar sequestration, with intralobar being more common. Surgical resection remains the treatment of choice, although preoperative strategies such as endovascular occlusion can reduce the risk of intraoperative complications. We report the case of a 52-year-old woman with a history of recurrent pulmonary infections who was referred for evaluation of an incidentally discovered cystic lesion in the left lower lobe following a transient episode of amaurosis fugax. Chest CT revealed a 5.3 cm pulmonary sequestration supplied by a large aberrant artery (AA) originating from the descending aorta. A two-stage hybrid procedure was performed, starting with thoracic endovascular aortic repair (TEVAR) to exclude the AA, followed by video-assisted thoracoscopic surgery (VATS) left lower lobectomy. The patient had an uneventful recovery and was discharged postoperatively. TEVAR was employed as a preoperative strategy to minimize the bleeding risks associated with the large AA during minimally invasive lobectomy. A hybrid two-stage approach using TEVAR followed by VATS is a safe and effective method for managing intralobar pulmonary sequestration with large aberrant vessels. Careful preoperative planning and a multidisciplinary approach are essential for optimal outcomes.

Horner's syndrome, characterized by ptosis, miosis, and anhidrosis, results from oculosympathetic complex injury, often due to trauma affecting the superior cervical ganglion. Although rare following carotid surgery, we present a case of Horner's syndrome after elective carotid endarterectomy (CEA). This report explores potential mechanism, including prolonged surgical retraction and hematoma formation, while reviewing similar cases in the literature. A 45-year-old woman presented with recurrent dizziness and progressive left-sided hearing impairment over 5 years. She also reported neck discomfort and experienced five episodes of amaurosis fugax in her left eye within 1 week. Computed tomography revealed occlusion of the right common and internal carotid artery (ICA), along with a 90% stenosis at the left common carotid bifurcation extending into the left ICA. Subsequently, an elective left CEA was performed. Within 24 hours postoperatively, she developed clinical signs of Horner's syndrome, including left-sided ptosis, miosis, anhidrosis, and concurrent facial nerve palsy. Notably, there was no evidence of hematoma formation or sensorimotor deficits. This case highlights the rare occurrence of Horner's syndrome as a postoperative complication of CEA. Surgeons should be mindful of anatomical variations and potential intraoperative mechanisms contributing to this complication to enhance prevention strategies. Recognizing this risk is essential for optimizing postoperative care and patient counseling.