B60-25 Pulmonary Sequestration: A Rare Congenital Cause of Hemoptysis and Recurrent Pneumonia

Abstract Introduction Pulmonary sequestration is a rare congenital malformation of the lower respiratory tract, characterized by a nonfunctional mass of lung tissue that lacks normal communication with the tracheobronchial tree and receives its arterial blood supply from the systemic circulation (1). The condition is frequently diagnosed in childhood or adolescence, often presenting with recurrent pulmonary infections, chronic cough, or hemoptysis. We present the case of a 20-year-old male with recurrent left lower lobe pneumonia who initially presented with hemoptysis and was found to have a large left perihilar mass consistent with pulmonary sequestration. Case A 20-year-old male, never-smoker, initially presented with one day history of small volume hemoptysis. A CT angiogram (CTA) revealed a large left perihilar mass with multiple small calcifications and adjacent pulmonary opacification. The patient had experienced chronic cough and recurrent episodes of left lower lobe pneumonia since childhood. He was referred to Interventional Pulmonology for endobronchial sampling, with initial concern for endobronchial carcinoid neoplasm. However, repeat CTA demonstrated a 6.1 cm left lower lobe lesion, with aberrant vascular supply from two bronchial arteries branching off the descending thoracic aorta, consistent with sequestration. Given his symptoms, he underwent robotic left lower lobectomy for definitive management. Discussion Pulmonary sequestration is exceedingly rare, with an incidence of 0.1% in the general population. It is classified into two types: intralobar, which is located within the normal lung lobe and shares its pleural covering, and extra-lobar, which is enveloped by its own visceral pleura and thus lacks connection to the bronchial tree (2). Contrast-enhanced CT imaging is critical in demonstrating the aberrant systemic arterial supply, which is the hallmark of sequestration. Calcifications, chronic consolidation, and bronchiectasis may also be present due to repeated infections, as seen in this case. All patients with bronchopulmonary sequestration who are symptomatic should undergo surgical excision, which is curative and associated with minimal morbidity (3). Management strategies for incidentally discovered lesions continue to be debated and often consider lesion size, radiographic, and familial characteristics in determining a surgical versus conservative approach (4-6). This case highlights the importance of considering pulmonary sequestration in young patients presenting with recurrent, localized pneumonia, or hemoptysis. The rarity of pulmonary sequestration and potential for delayed diagnosis highlight the importance of individual case reports in guiding clinical recognition and management. Careful imaging review is essential to establish the diagnosis. Surgical resection remains the mainstay of treatment for symptomatic cases and provides excellent outcomes. This abstract is funded by: None