An unusual presentation of recurrent pneumonia

Abstract

In October, 2010, a 20-year-old man was referred to us after having been admitted to hospital four times with community acquired pneumonia since the age of 16 years. His recurrent symptoms included a productive cough, lethargy, fever, night sweats, and rigors. Apart from child-hood asthma, he had no important medical history of respiratory illness. He was a life-long non-smoker and denied illicit drug use. Auscultation of the chest showed equal air entry to the lung fi elds with mild crepitations in the left lower zone posteriorly. Erect chest radiography showed multiple cystic lesions in the left lower lobe posteriorly with crowding of bronchovascular markings (fi gure A). CT of the chest showed a systemic artery feeding a left lower lobe pulmonary sequestration (fi gure B). The feeding artery originated from the common hepatic artery before passing through the oesophageal hiatus into the thorax. Aberrant venous drainage from the sequestration was not identifi ed and a diagnosis of intralobar pulmonary sequestration was made.Our patient had a bronchoscopy with normal fi ndings, followed by a left posterolateral thoracotomy. Intra-operatively, the pulmonary sequestration was found to be strongly adherent to the diaphragm. An aberrant systemic artery was seen rising through the oesophageal hiatus and was suture ligated and divided. No other aberrant arteries or veins were identifi ed. The sequestered lung was resected by a routine left lower lobectomy. He had an unremarkable recovery and was discharged home on the fourth day postoperatively. Macroscopic pathological