C63-47 Superimposed Infection in Pulmonary Sequestration Tissue Presenting as a Lung Mass

Abstract Pulmonary sequestrations (PS) are rare congenital pulmonary anomalies where nonfunctional lung tissue lacks communication with the tracheobronchial tree and is supplied by systemic rather than pulmonary arteries. PS is classified as intralobar (ILS) within the visceral pleura or extralobar (ELS), which lies outside the lung with its own pleural covering. ILS, accounting for 75-85% of PS cases, is rarely associated with other anomalies and often shows chronic inflammation and fibrosis. ELS (15-25%) typically presents in infancy with respiratory distress and is usually associated with extrapulmonary anomalies. Blood supply typically arises from the thoracic or abdominal aorta, and most lesions occur in lower lobes. Adult PS frequently manifests as pneumonia or recurring infections but may also cause hemoptysis, lung nodules, or heart failure symptoms due to increased blood flow through the aberrant artery, or be found incidentally, as in our case. A 27-year-old female with no remarkable history presented with a productive cough with yellowish sputum for two months, associated with chest discomfort and dyspnea for two weeks. She denies recent travel, sick contacts, fever, weight loss or night sweats. Exam reveals decreased breath sounds noted at the right lung base. Chest X-ray reveals an opacity in the right lower lobe. Laboratory tests are significant for an elevated D-dimer of 884 ng/mL prompting a CT pulmonary angiography, which reveals no pulmonary embolism, but a 9x 9x 9.5 cm right lower lobe mass with vascular supply from the descending aorta, indicating pulmonary sequestration. The patient received a short course of ceftriaxone and azithromycin to treat superimposed bacterial pneumonia. A repeat CT angiogram performed 6 weeks after the initial scan to assess the need for surgical resection revealed improved aeration of the right lower lobe mass, along with residual air-filled pulmonary cysts and air-fluid levels. A systemic artery arising from the descending thoracic aorta consistent with pulmonary sequestration. Imaging is key to diagnosing PS by identifying systemic arterial supply; scintigraphy can show systemic perfusion patterns, and arteriography is now rarely needed. CT and MRI offer a precise view of sequestered tissue and feeding channels. Management involves treating infection, followed by imaging surveillance to guide surgical resection. Surgical excision has a good prognosis, and embolization may reduce intraoperative blood loss or serve as definitive treatment. Early recognition and intervention can avert complications and provide definitive treatment. This abstract is funded by: None