INTRAPULMONARY SEQUESTRATION IN AN ADULT

Abstract

SESSION TITLE: Tuesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: An intrapulmonary sequestration is defined as nonfunctioning lung tissue that is not in normal continuity with the tracheobronchial tree and derives its blood supply from systemic vessels[1]. Pulmonary sequestration is considered a childhood disease; however, the condition can continue into adolescence and sometimes adulthood[2]. Here, we present a middle-aged female presenting with pneumonia, found to have intrapulmonary sequestration and underwent lobectomy. CASE PRESENTATION: 43-year-old female with past surgical history of diaphragmatic hernia repair in childhood presented with persistent cough of two weeks duration with clear rhinorrhea and sharp left lower chest pain. Chest radiography revealed a left lower lobe consolidation suspicious for pneumonia. Patient was admitted for suspected pneumonia, and initial vital signs showed temperature 99F, heart rate 134, respiratory rate 25, blood pressure 97/75, and oxygen saturation of 99% on room air. Laboratory studies were significant for WBC count of 9.60, Hgb 10.5, and platelet count 69,000, with a d-dimer of 722. A CT angiogram to rule out a pulmonary embolism displayed a complete collapse of the left lower lobe with abnormal systemic arterial branch extending to the left lower lobe consistent with sequestration. Subsequently, patient underwent bronchoscopy that was noted to be normal with negative cultures and washings. The patient signed out against medical advice after the procedure, but returned to the hospital five days later with non-resolution of her cough and left sided chest pain. Chest radiograph and CT angiography performed showed unchanged findings of left lower lung infiltrate and suspected sequestration. Cardiothoracic surgery was consulted and patient was taken for a left lower lobectomy. The procedure and pathology confirmed the diagnosis of intrapulmonary sequestration. The patients’ symptoms resolved after surgery and she was discharged home in stable condition. DISCUSSION: Pulmonary sequestration, a disease of childhood, most commonly presents as pneumonia but may also present with chest pain, cough, shortness of breath and hemoptysis [3,4]. The condition may also be found incidentally in asymptomatic adults. Most pulmonary sequestrations arise in the left lung with two-thirds arising in the lower left lung lobe with the blood supply coming from systemic circulation, usually the thoracic or abdominal aorta. The treatment for a pulmonary sequestration involves surgical resection of the effected lung lobe to avoid infection and damage to the lung parenchyma. Our case is made unique by the advanced age of our patient with no prior history of recurrent infections or underlying respiratory symptoms prior to this presentation[5]. CONCLUSIONS: Pulmonary sequestration should be in the differential even in advanced age without prior history of underlying respiratory symptoms or recurrent infections. Reference #1: 1. "Congenital Malformations and Genetic Disorders of the Respiratory Tract.” American Review of Respiratory Disease, 120(1), pp. 151–185 Reference #2: 2. Petty, L., Joseph, A., & Sanchez, J. (2018). Case report: Pulmonary sequestration in an adult. Radiology Case Reports,13(1), 21-23. https://doi.org/10.1016/j.radcr.2017.09.029 Reference #3: 3. Frazier, A. A., Christenson, M. L., Stocker, J. T., & Templeton, P. A. (1997). Intralobar sequestration: Radiologic-pathologic correlation. RadioGraphics, 17(3), 725-745. https://doi.org/10.1148/radiographics.17.3.9153708 4. Hertzenberg, Casey & Daon, Emmanuel & Kramer, Jeffrey. (2012). Intralobar pulmonary sequestration in adults: Three case reports. Journal of thoracic disease. 4. 516-9. 10.3978/j.issn.2072-1439.2012.06.07. 5. Alsumrain, M., & Ryu, J. H. (2018). Pulmonary sequestration in adults: A retrospective review of resected and unresected cases. BMC Pulmonary Medicine, 18(1) DISCLOSURES: No relevant relationships by Anas Al-khateeb, source=Web Response No relevant relationships by Sharath Bellary, source=Web Response No relevant relationships by Michael Ellis, source=Web Response No relevant relationships by Muqueet Kadri, source=Web Response No relevant relationships by William Meng, source=Web Response No relevant relationships by Richard Miller, source=Web Response No relevant relationships by Rutwik Patel, source=Web Response No relevant relationships by Hari Sharma, source=Web Response No relevant relationships by Euclid St.Hill, source=Web Response