Pathologic quiz case: a 30-year-old man with recurrent pneumonia. Intralobar bronchopulmonary sequestration.

Abstract

30-year-old African American man presented to the hospital with a 2-week history of a productive cough, shortness of breath, chills, hemoptysis, and pleuritic chest pain in the left posterior chest. His past medical history was significant for moderate alcohol consumption, recurrent pneumonias, smoking one-half pack of cigarettes per day for 15 years, and Mycobacterium tuberculosis exposure with positive purified protein derivative. Physical examination revealed an area of dullness to percussion in the left lower lung field with diminished breath sounds. No wheezes, rales, or rhonchi were noted. Laboratory workup, including complete blood count and electrolyte levels, was within normal limits. Pulmonary function testing showed severe restriction of forced and slow vital capacities with superimposed airflow obstruction. Chest radiographs were obtained that revealed near complete whiteout of the left lower lung field. Contrast-enhanced computed tomographic scan of the chest revealed an enhancing, inhomogeneous lesion, 7.5 3 6 cm in size, in the left lower lobe (Figure 1, white arrow) with what appeared to be a branch of the aorta penetrating the mass (Figure 1,