Abstract Introduction Pulmonary sequestration (PS) is a rare congenital anomaly involving nonfunctional lung tissue lacking normal bronchial connections and supplied by aberrant extra-pulmonary vasculature. PS typically presenting as recurrent pulmonary infections in adult and typically requires lobectomy. Case Presentation Case of a 33-year-old male with a history of three months of recurrent pneumonias, presenting due to continued fever and cough, despite multiple courses of antibiotics for suspected community acquired pneumonia. On initial presentation, the patient was afebrile, hemodynamically stable, with no significant laboratory findings or leukocytosis. Plain CT imaging was consistent with left lower lobe pneumonia, 3.5 x 3.1cm adjacent rounded structure concerning for pulmonary abscess, and adjacent nodules favored to represent a mucous impaction in distal airways. Patient was empirically placed on Vancomycin and Cefepime and further investigation with CTA chest was done which revealed left lower lobe intralobar PS. Cardiothoracic surgery was consulted, and the patient was taken for a left-sided muscle-sparing mini-thoracotomy and left lower lobectomy. Intraoperatively, an intraparenchymal sequestration, roughly the size of an orange and filled with micro-pus, was identified. The aberrant blood vessels were ligated, and resection was performed with meticulous bronchial closure and hemostasis. The patient was managed post-operatively in the ICU as a persistent air leak and non-resolving pneumothorax required repositioning of chest tubes on postoperative day (POD) 5. By POD 14, the air leak resolved, chest tubes were removed and pathology confirmed PS without malignancy. The patient was discharged on levofloxacin and at two weeks continued to show improvement with no signs of recurrence or infection. Discussion PS accounts for 0.15-6.4% of congenital lung malformations and is often diagnosed in childhood or adolescence. Adult cases are uncommon and may present as recurrent pneumonia or a mass-like lesion, concerning for malignancy, such as with our patient. Our case is particularly unique due to its delayed presentation in a 33-year-old, as severe infection leading to a pus-filled sequestration, and complex postoperative course secondary to prolonged air leak. Unlike milder cases, this patient required prolonged antibiotic therapy and surgical intervention due to extensive infection. Early suspicion and evaluation for PS is crucial in adults with recurrent pneumonia unresponsive to standard antibiotic regimens. CT angiography should be used for evaluation and a multidisciplinary team involving pulmonology, infectious diseases, radiology, and cardiothoracic surgery should be recruited for a comprehensive assessment. This abstract is funded by: none
Gonzalez et al. (Fri,) studied this question.