A RARE CONGENITAL PULMONARY MALFORMATION – PULMONARY SEQUESTRATION: A CASE REPORT

Abstract

PURPOSE: To show a rare case of congenital pulmonary malformation - pulmonary sequestration. METHODS: Medical record review. RESULTS: A 36-year-old man presented to outpatient clinic with severe cough for one month. Chest x-ray revealed airspace opacities in the right lower lung, suggestive of pneumonia. Antibiotics with ampicillin/sulbactam one week was used but his cough persisted. Laboratory examination revealed a low titer of anti-mycoplasma pneumonia IgG reactivity (12.3 AU/mL). And antibiotics was changed to levofloxacin. After two more weeks antibiotics treatment, his symptoms improved. But the follow-up chest x-ray only showed partial clearing of the previous opacity. Triangular shape opacity was still be found in right lower lung field. Chest CT scan was arranged for further survey. A blood vessel arising from aorta and to the right lower lung mass lesion were found. The image and the pulmonary structure are compatible with pulmonary sequestration. This patient had abdominal pain over the right upper quadrant about 20 months later. Abdominal CT showed the same picture in right lower lung without interval change. CONCLUSIONS: Pulmonary sequestration is a relatively rare congenital pulmonary malformation. There are various manifestations, from asymptomatic to pulmonary infections or hemoptysis. Usually, chest x-ray with patients’ presentation may lead to the possible diagnosis of infection or neoplasm. However, our point is that chest CT scan is the most helpful and gold standard to make a definite diagnosis. CLINICAL IMPLICATIONS: Chest CT scan is the most helpful tool to identify the vascular anatomy and make the diagnosis of pulmonary sequestration.