Intralobar pulmonary sequestration in an adult: a case report

Abstract

Background: Pulmonary sequestration is a rare congenital lung anomaly, presenting mostly in childhood and adolescence.

Case presentation: We report the case of a 26-year-old male patient presenting with pleuritic left sided chest pain and haemoptysis. Computed tomography of the chest showed features of intralobar pulmonary sequestration involving the left lower lobe, with arterial supply arising from the descending thoracic aorta above the diaphragm and normal venous drainage. Video assisted thoracic surgery was planned to perform a left lower lobectomy. Considering the risk of bleeding from the large artery supplying the sequestered segment, a posterolateral thoracotomy incision was made and left lower lobectomy was completed, with successful division of the arterial feeder. The patient was discharged home without complications. Pathologic examination of the specimen grossly revealed partial division of the lobe by two fissures with extensive adhesions into an upper and lower portion with no clear demarcation and a large vessel which enters the lower portion at the posterior inferior aspect, separate from the hilum with a diameter 10 mm. Microscopically, both portions of the lobe showed normally alveolated lung tissue with patchy recent intra-alveolar haemorrhage and evidence of chronic inflammation in the sequestered segment. There was no evidence of malignancy.

Conclusion: This case highlights the rare presentation of pulmonary sequestration in adulthood and the importance of imaging to identify anomalous arterial supply to the sequestered segment in the left lower lobe of the lung. The use of safe surgical techniques to control the anomalous systemic arterial feeding vessel cannot be overemphasized.

Keywords: Bronchopulmonary; Congenital lung anomaly; Intralobar; Pulmonary sequestration.

Fig. 1

A, B CT scan showing aberrant formation of segmental lung tissue within the left lower lobe

Fig. 2

A, B Coronal CT views showing systemic arterial supply taking origin from the DTA

Fig. 3

A, B Intra-operative photographs of the large anomalous artery arising from the DTA which was subsequently stapled and divided