SESSION TYPE: Airway Case Report Posters
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: Pulmonary sequestration is a rare phenomenon with complex anatomical variations (2). Sequestered areas have embryological origins and traditionally do not communicate with the lung via normal bronchogenic pathways, but rather through pores of Kohn (3). We present a case of pulmonary sequestration with histopathology demonstrating communication of sequestered segments with normal bronchioles.
CASE PRESENTATION: A 25-year-old female presented to her primary care physician secondary to persistent dry cough, low grade fevers, chills, and fatigue of two weeks duration. She was treated for an upper respiratory tract infection, but continued to deteriorate. A chest radiograph demonstrated a right lower lobe consolidation. Due to poor response to antibiotic treatment, computerized tomography of the thorax was obtained, which revealed a dense consolidation in the right base with surrounding cystic areas. The lung architecture appeared abnormal in the consolidated segments, with a distinct blood supply from a bronchial artery originating from the abdominal aorta. A diagnosis of intralobar pulmonary sequestration was made. The patient was referred for resection of the infected abnormal lung tissue. An intraoperative bronchoscopy was performed prior to surgery to assess the affected segments. Abnormal airways with purulent secretions were noted in the right lower lobe basilar segments. Thoracotomy and resection of the sequestered area was performed without complications. Post-operative recovery was uneventful, and the patient improved dramatically. Pathological analysis of the dissected specimen demonstrated multiple cystic, bronchiectatic pathways with diffuse areas of necrotizing and non-necrotizing granulomatous inflammation that appeared to communicate with normal lung. Bronchoalveolar lavage cultures from the right lower lobe grew Mycobacterium avium-intracellulare (MAI).
DISCUSSION: In this patient with pulmonary sequestration, cystic pathways identified during surgery demonstrated abnormal communication with normal bronchioles. Infection persisted in these segments despite antibiotic treatment because of poor clearance and abnormal architecture and hence necessitated surgical resection (1).
CONCLUSIONS: Anomalies secondary to pulmonary sequestration are prone to complications and require careful investigation prior to surgical resection secondary to variable anatomic properties (3).
1) Kaneko, S et. al. Pulmonary sequestration in older child and in adults. Int Surg 1992 Apr-Jun;77(2):102-7.
2) Louie, H. et. al. Pulmonary sequestration: 17-year experience at UCLA. Am Surg. 1993 Dec;59(12):801-5.
3) Sade, R. et. al. The spectrum of pulmonary sequestration Ann Thorac Surg 1974;18:644-658.
DISCLOSURE: The following authors have nothing to disclose: Aamir Gilani, Jamie Bessich, Donald Mahler
No Product/Research Disclosure InformationDartmouth-Hitchcock Medical Center, Lebanon, NH