Intralobar pulmonary sequestration in adults: three case reports

Symptomatic right side extralobular pulmonary sequestration in a young woman: A rare case report

Pulmonary sequestration is uncommon congenital malformation. It is important to consider pulmonary sequestration even in young adults presenting with recurrent pneumonic symptoms because prompt surgical intervention is both feasible and curative. Moreover, in health settings lacking CT/MRI angiography service, pulmonary sequestration can be easily misdiagnosed as smear negative pulmonary tuberculosis. Therefore, strong clinical suspicion is required to prevent patient mismanagement.

Pulmonary Sequestration Mimicking Symptoms of Ischemic Heart Disease

Pulmonary sequestration is a rare congenital abnormality characterized by the presence of a nonfunctional lobe of the lung being separated in both blood flow and function from the rest of the lung. The condition may go unrecognized on prenatal imaging and present during adolescence and young adulthood with cough, chest pain, shortness of breath, and recurrent pneumonia. However, some patients may remain asymptomatic until later adulthood and be diagnosed based on incidental imaging findings. Surgical resection is the recommended treatment for this condition, although controversy exists regarding its use in asymptomatic patients and adults. In this case report, we present a case of a 66-year-old man who presented with progressively worsening dyspnea on exertion and atypical chest pain and underwent an ischemic workup to rule out coronary artery disease. The extensive diagnostic evaluation led to the diagnosis of nonobstructive coronary artery disease and left-sided pulmonary sequestration. The patient subsequently underwent surgical resection of the left lower pulmonary lobe, resulting in a significant improvement in symptoms.

Anomalous systemic arterial supply to the left lower lung lobe: A case report

Background

An anomalous systemic arterial supply to the lung lobes is a rare congenital pulmonary vascular malformation. Current treatments include thoracoscopic lobectomy, anatomical segmentectomy, simple ligation and arterial embolization. However, the optimal treatment remains controversial.

Case presentation

A 29-year-old man was diagnosed with anomalous systemic arterial supply to the left lower lobe through contrast-enhanced computed tomography and three-dimensional reconstruction. He underwent coil embolization of the anomalous artery and was followed up for 1 year.

Conclusions

Blockage of the blood flow of the anomalous systemic artery alone does not improve the blood supply of the pulmonary artery to lung tissue and thus cannot restore normal gas exchange through the blood-gas barrier. Coil embolization of the anomalous arterial supply can cause early postoperative pulmonary infarction.

Pulmonary Sequestration Associated with Actinomycosis: A Case Report

Background: Bronchopulmonary sequestration is a rare congenital malformation of the lower respiratory tract; it consists of a nonfunctioning mass of lung tissue that is irrigated by an anomalous systemic artery. The association with Actinomyces superinfection has not been well established. Methods: We present the case of a 35-year-old woman with a history of recurrent episodes of pneumonia. Based on radiological and histopathological examination, she was diagnosed with intralobar bronchopulmonary sequestration associated with Actinomyces infection. Promoting clinical suspicion is essential to diagnose pulmonary actinomycosis in patients with recurrent pneumonia, to improve early recognition and timely management.

Coil embolization of intralobar pulmonary sequestration - an alternative to surgery: a case report

BACKGROUND

Pulmonary sequestration is a congenital lung disease characterized by nonfunctioning pulmonary tissue that lacks normal communication with the bronchial tree and is supplied by a nonpulmonary systemic artery. Symptomatic bronchopulmonary sequestration is uncommon, seen more frequently in the pediatric population than in adults. It has traditionally been treated with surgical resection; however, a limited but growing number of cases have been treated with angiographic embolization. Given the inherent risks of cardiothoracic surgery, embolization of the anomalous vessel is an enticing alternative treatment. We present a case of a 56-year-old woman with known, symptomatic, intralobar pulmonary sequestration that was successfully treated with coil embolization.

CASE PRESENTATION

A 56-year-old Pacific Islander woman with a history of chronic myeloid leukemia was admitted to the hospital with an episode of hemoptysis. Computed tomography of the chest demonstrated left lower lobe intralobar pulmonary sequestration fed by a large tortuous vessel branching off of the descending thoracic aorta. Surgical resection of the sequestration is the current standard treatment strategy of symptomatic intralobar pulmonary sequestration. The cardiothoracic surgeon noted that given the size and location of arterial blood supply, intervention would involve thoracotomy and lobectomy. The interventional radiologist offered embolization of the lesion as an alternative to surgery. Multiple coils, 6-13 mm in size, were used to embolize the sequestration. No considerable flow distal to the coils was noted postembolization.

CONCLUSIONS

Intralobar pulmonary sequestration is a rare condition that typically requires surgical management. This case demonstrates the efficacy of coil embolization as an alternative management strategy. To date, limited case reports of adults treated with endovascular embolization exist. Treatment of symptomatic pulmonary sequestration with embolization can be considered as an alternative to surgical resection.

Case report: Pulmonary sequestration in an adult

Pulmonary sequestration is a rare congenital malformation that is uncommonly diagnosed during adulthood. Pulmonary sequestrations can manifest with variable presentations. It can remain asymptomatic or present with more severe symptoms such as hemoptysis and recurrent pneumonia. Diagnosis can be confirmed with computed tomography angiogram or angiography. Treatment with embolization of the afferent artery and surgical removal of the pulmonary sequestration generally has good outcomes. We report a case of a 43-year-old man who presented with recurrent pneumonia and left-sided back pain and was eventually diagnosed with pulmonary sequestration.

Pathologic and Radiologic Correlation of Adult Cystic Lung Disease: A Comprehensive Review

The presence of pulmonary parenchymal cysts on computed tomography (CT) imaging presents a significant diagnostic challenge. The diverse range of possible etiologies can usually be differentiated based on the clinical setting and radiologic features. In fact, the advent of high-resolution CT has facilitated making a diagnosis solely on analysis of CT image patterns, thus averting the need for a biopsy. While it is possible to make a fairly specific diagnosis during early stages of disease evolution by its characteristic radiological presentation, distinct features may progress to temporally converge into relatively nonspecific radiologic presentations sometimes necessitating histological examination to make a diagnosis. The aim of this review study is to provide both the pathologist and the radiologist with an overview of the diseases most commonly associated with cystic lung lesions primarily in adults by illustration and description of pathologic and radiologic features of each entity. Brief descriptions and characteristic radiologic features of the various disease entities are included and illustrative examples are provided for the common majority of them. In this article, we also classify pulmonary cystic disease with an emphasis on the pathophysiology behind cyst formation in an attempt to elucidate the characteristics of similar cystic appearances seen in various disease entities.

Bronchopulmonary sequestration in a 60 year old man

We report a case of bronchopulmonary sequestration (BPS) in a 60 year old man with recurrent cough. After failed antibiotic therapy for presumed left lower lobe (LLL) pneumonia seen on chest radiographs, bronchoscopy was performed revealing cryptogenic organizing pneumonia. Further work-up with thoracic imaging demonstrates a feeding artery from the thoracic aorta to the LLL consolidation indicating the presence of BPS. A brief review of the clinical and radiological features and management options of BPS are listed, with particular emphasis on the various imaging modalities and techniques in the diagnosis and pre-surgical planning of intralobar sequestration.