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. 2021 May 25;26(1):48.
doi: 10.1186/s40001-021-00519-5.

Pulmonary sequestration with Aspergillus infection presenting as massive hemoptysis and hemothorax with highly elevated carcinoembryonic antigen in pleural effusion that mimics advanced lung malignancy

Wei Luo  1 , Tong-Chen Hu  2 , Lincheng Luo  1 , Ya-Lun Li  3
Affiliations

Pulmonary sequestration with Aspergillus infection presenting as massive hemoptysis and hemothorax with highly elevated carcinoembryonic antigen in pleural effusion that mimics advanced lung malignancy

Wei Luo et al. Eur J Med Res. .

Abstract

Background: Pulmonary sequestration (PS) associated with massive hemoptysis, hemothorax, and elevated tumor markers or even lung malignancy has been reported in several studies. These clinical features combined with lung lesions on chest imaging are sometimes hard to differentiate from lung malignancies and often complicate the diagnostic procedure.

Case presentation: A 45-year-old man with PS presented with massive hemoptysis, hemothorax, and extremely elevated carcinoembryonic antigen (CEA) in pleural effusion was initially misdiagnosed with advanced lung carcinoma, but was ultimately diagnosed with PS with Aspergillus infection.

Conclusions: PS is rarely concurrent with lung cancer; most of the time, it is misdiagnosed as a malignancy, especially when presenting with a fungal infection, which could remarkably elevate CEA in pleural effusion.

Keywords: Aspergillus infection; Carcinoembryonic antigen; Pulmonary sequestration.

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Conflict of interest statement

All authors declare no competing interest.

Figures

Fig. 1
Fig. 1
a Axial section of thoracic contrast-enhanced CT showing a heterogeneous mass at the posterior basal segment of the left lower lobes with massive pleural effusion (black arrow). b Bronchial artery angiography showing an aberrant artery arising from the descending thoracic aorta (black arrow). c Aberrant artery embolized with coils and polyvinyl alcohol. d Thoracoscopy showing a lesion on the parietal pleura, bloody effusion, and fibrous adhesions (black arrow). e CT-guided needle biopsy showing the needle in the mass. f Lobectomy showing the aberrant artery as well as the coils (black arrow and rectangle); the right upper corner shows an enlarged view of the artery and coil (green arrow). g Septate hyphae in the resected mass with a chronic inflammatory reaction (black arrow and rectangle); the right upper corner shows an enlarged view of the septate hyphae (green arrow). H&E staining, original magnification × 200. h Lobectomy showing fibrinoid necrosis with inflammatory cell infiltration. H&E staining, original magnification × 200
See this image and copyright information in PMC

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