B47-37 Bronchopulmonary Sequestration in Adulthood: A Hidden Diagnosis

Introduction Bronchopulmonary sequestration (BPS) is a rare congenital malformation characterized by nonfunctioning lung tissue that lacks communication with the tracheobronchial tree and receives systemic arterial blood supply, most often from the thoracic or abdominal aorta. BPS is classified as intralobar or extralobar depending on whether it shares the visceral pleura with adjacent lung tissue. While commonly diagnosed in childhood due to recurrent infections or respiratory symptoms, it may remain asymptomatic and be discovered incidentally in adulthood. We present a case of incidentally detected intralobar BPS in a 67-year-old man evaluated for an inguinal hernia. Case Presentation A 67-year-old man with hypertension and a large right inguinal hernia presented to an outside hospital with groin pain. CT of the abdomen and pelvis confirmed a large hernia containing ileum, cecum, and ascending colon, and incidentally revealed a 3.6 × 3.5 cm left lower-lobe pulmonary nodule. A dedicated CT chest with contrast confirmed the nodule and demonstrated air trapping and cystic changes in the left lower lobe. He was referred to our pulmonary clinic for further evaluation. The patient reported dyspnea only with severe exertion and denied chest pain, cough, hemoptysis, fever, or weight loss. He had no smoking history. Physical exam and pulmonary function testing were unremarkable, with normal spirometry, lung volumes, and diffusion capacity. Cardiac evaluation including EKG, echocardiogram, and stress testing was normal. Review of imaging revealed features consistent with intralobar BPS supplied by an aberrant systemic artery from the descending thoracic aorta. Given the absence of significant symptoms and patient preference, surgical intervention was deferred, and conservative management with observation was recommended. Discussion BPS accounts for 0.15-6.4% of congenital pulmonary malformations. The intralobar type is more common and typically drains into the pulmonary veins, whereas the extralobar type drains into systemic veins and is often identified earlier in life. In adults, BPS is frequently found incidentally on imaging performed for other indications. Symptomatic cases may present with recurrent infections, chronic cough, or hemoptysis. CT angiography is the diagnostic gold standard, enabling visualization of the aberrant systemic arterial supply and distinction from bronchogenic cysts or neoplasms. Surgical resection is recommended for symptomatic or complicated lesions, while asymptomatic patients may be managed conservatively with radiologic surveillance. This case highlights the importance of considering BPS in the differential diagnosis of atypical pulmonary findings, even in older adults, to ensure appropriate counseling and individualized management. This abstract is funded by: None