When Trauma Unmasks a Congenital Anomaly: Incidental Discovery of Bilateral Pulmonary Sequestration

Pulmonary sequestration is a rare congenital bronchopulmonary malformation in which dysplastic, non-functioning lung tissue has no or a normal connection with the tracheobronchial tree and is supplied by an aberrant systemic artery. Bilateral involvement is exceptional, and its incidental discovery during trauma imaging is rarely reported; this case, therefore, adds to the limited literature on bilateral sequestration and illustrates how an unrelated indication can unmask a long-silent congenital anomaly. A 35-year-old man with a history of unexplained chronic cough was admitted after a road traffic accident causing closed chest trauma; examination was unremarkable apart from anterior chest pain. Non-enhancing thoracic computed tomography (CT) showed a displaced sternal fracture, together with bilateral cystic and consolidative masses of the lower lobes. A contrast-enhanced CT angiography then demonstrated aberrant systemic arteries arising from the descending thoracic aorta and feeding both lesions, establishing the diagnosis of bilateral intralobar pulmonary sequestration. The sternal fracture was managed conservatively; surgical resection of the sequestration was proposed but declined by the patient, who was placed under regular clinical and radiological surveillance. The take-away lessons are that pulmonary sequestration should be considered before any atypical, bilateral basal lung lesion, that CT angiography is the key examination because it directly depicts the aberrant systemic supply, and that recognizing this entity avoids misdiagnosis as a tumor and unnecessary invasive procedures.