Abstract Introduction Pulmonary sequestration is a rare congenital bronchopulmonary malformation defined by nonfunctioning lung tissue with systemic arterial supply and absent normal bronchial communication. Although most cases are identified in childhood, sequestrations can remain occult and first present in adulthood, sometimes with lifethreatening infectious complications. This report emphasizes the clinical and radiographic features that should alert pulmonologists to latepresenting sequestration and highlights practical management principles when necrotizing infection and sepsis complicate the lesion. Case Description A previously active 21yearold male developed acute leftsided chest pain about one week after a viral upper respiratory illness against a background of several weeks of intermittent productive cough, exertional dyspnea, and a 30pound weight loss. Initial evaluation at an outside ED revealed fever, tachycardia, hypotension, elevated lactate, and marked leukocytosis. Chest radiography suggested left lowerlobe airspace disease with probable cavitation. CTA demonstrated an 8 × 9 cm wellcircumscribed microcystic lesion in the left lower lobe supplied by multiple systemic arteries arising from the thoracic aorta with venous drainage to the pulmonary arterial system—findings diagnostic of intralobar pulmonary sequestration. Cavitary changes were concerning for necrotizing infection. The patient was transferred for tertiary care, received broad empiric IV antibiotics targeting gramnegative organisms, anaerobes, MRSA. Recognizing that active inflammation and arterialized systemic feeders increase intraoperative bleeding and postoperative empyema risk, we elected for interval resection, medical stabilization and a 2-week preoperative antibiotic course. Cultures (blood, sputum) remained negative, underscoring that sequestered tissue may not yield reliable airway cultures. The patient clinically improved, completed oral doxycycline and amoxicillinclavulanate preoperatively, and demonstrated preserved lung function on PFTs (FEV1 118% predicted) prior to elective left thoracotomy and left lower lobectomy. Intraoperatively multiple aortic feeders were identified and ligated. Postoperative recovery was uncomplicated. Conclusion This case highlights pulmonary sequestration as an important, though uncommon, late presentation in young adults that can masquerade as cavitary lowerlobe infection. Plain radiography showing cavitation or atypical cystic airspace disease should prompt crosssectional vascular imaging because CTA delineation of systemic arterial feeders is diagnostic and directly informs surgical planning. Sequestered segments often produce nondiagnostic airway cultures, so clinicians should interpret negative cultures cautiously. Awareness of these radiographic and clinical hallmarks will help pulmonologists recognize occult sequestration earlier, streamline diagnostic pathways, and coordinate timely referral for definitive surgical management. This abstract is funded by: None
Rasul et al. (Fri,) studied this question.