B80-1-25 Recognizing Pulmonary Sequestration: A Rare Congenital Pulmonary Anomaly

Abstract Introduction Pulmonary sequestration is a rare anomaly accounting for less than 6% of congenital lung malformations. It refers to lung tissue that does not communicate with the tracheobronchial tree and has separate blood supply. Two main variants exist: extralobar (25%) or intralobar (75%). Extralobular typically manifests in infancy with severe pulmonary symptoms, while intralobular is asymptomatic and incidentally found after recurrent bouts of pneumonia. Often pulmonary sequestration can be misdiagnosed as lung cancer, pulmonary cysts, and mediastinal tumors. More research on clinical characteristics should be carried out to improve the diagnosis rate and decrease unnecessary invasive testing. Failure of early diagnosis will lead to recurrent pulmonary infections, multiple hospital admissions, and morbidity. We present a case of intralobular pulmonary sequestration diagnosed in a young female. Case presentation Our patient is a 27-year-old female who presented to the hospital with new onset right sided pleuritic chest pain radiating to the back, worsening with inspiration. Her history is unremarkable; lifelong non-smoker, no history of asbestos exposure, malignancy, trauma, fevers, sick contacts, or weight loss. On presentation her vitals were unremarkable. Her labs were significant for leukocytosis of 13.9. CT of the chest, abdomen, and pelvis with IV contrast noted a medial right posterior pleural mass measuring 5.6 by 2.2 by 6.1 cm with calcification and right pleural effusion without mediastinal lymphadenopathy. MRI demonstrated a 2.2 by 5.0 by 0.9cm pleural-based structure in the right paraspinal region at T9 vertebral body level with a suggestion of an artery arising from the aorta extended towards the structure, indicating pulmonary sequestration. She subsequently developed elevated temperatures and initiated antibiotics. Upon outpatient follow up, repeat CT scan redemonstrated findings of the consolidation with arterial supply from the aorta and venous drainage to the azygous vein with improvement of the effusion and resolution of the chest pain. Discussion This patient’s CT scan was only conducted due to unexplained chest pain, which was likely in the setting of her parapneumonic effusion. Definitive diagnosis requires the establishment of a systemic arterial and venous supply of sequestered tissue which was evident on further imaging. Conventionally, digital subtraction angiography is the study of choice. However, multi-planar CT with 3D reconstruction has taken over as a better noninvasive diagnostic tool with MR angiography as an alternative. Pulmonary lobectomy is recommended even in asymptomatic patients to avoid infection and progressive inflammation, done by open thoracotomy or video-assisted thorascopic surgery (VATS) with uniportal VATS technique. This abstract is funded by: None