Intralobar Pulmonary Sequestration in Situs Inversus: A Rare Presentation with Recurrent Hemoptysis

Bronchopulmonary sequestration (BPS) is a rare congenital malformation of lung tissue characterized by the absence of normal bronchial connection and systemic arterial supply [1,2]. Situs inversus totalis (SIT) is an independent congenital anomaly in which thoracic and abdominal organs are reversed in mirror-image fashion [4]. The coexistence of BPS and SIT is exceedingly rare [9]. We present a 51-year-old woman with SIT and BPS who developed massive hemoptysis. She had undergone prior embolization for intralobar sequestration (ILS) three years earlier. CT angiography revealed ILS in the medial left upper lobe (anatomic right middle lobe) with aberrant supply from the left phrenic artery. Emergent embolization achieved temporary control, but recurrent bleeding necessitated thoracotomy, wedge resection, and subsequent lobectomy. This case highlights the diagnostic and therapeutic challenges of ILS in SIT. Embolization provided temporary control, but definitive management was achieved with surgical resection [6,8]. Clinicians should be aware of the potential for recurrent hemoptysis in ILS with complex vascular anatomy, especially in patients with SIT.