Intrapulmonary sequestration with destructive pneumonia and life-threatening hemoptysis in an adult patient: a case report
Authors:
J. Muri 1,2; B. Durcová 3; A. Garchar 2; P. Makovický 1; A. Vrbenská 4; V. Kamarád 1
Authors‘ workplace:
Ústav histologie a embryologie, Lékařská fakulta, Ostravská univerzita, Ostrava
1; Centrum hrudníkovej chirurgie Národný ústav tuberkulózy, pľúcnych chorôb a hrudníkovej chirurgie Vyšné Hágy, Vysoké Tatry
2; 2. Oddelenie pneumológie a ftizeológie, Národný ústav tuberkulózy, pľúcnych chorôb a hrudníkovej chirurgie, Vyšné Hágy, Vysoké Tatry
3; Oddelenie patológie, Národný ústav tuberkulózy, pľúcnych chorôb a hrudníkovej chirurgie Vyšné Hágy, Vysoké, Tatry
4
Published in:
Rozhl. Chir., 2023, roč. 102, č. 1, s. 23-27.
Category:
Case Report
doi:
https://doi.org/10.33699/PIS.2023.102.1.23–27
Overview
The article reports the case of a patient with bronchopulmonary sequestration complicated by destructive actinomycotic inflammation leading to life-threatening hemoptysis. It was an adult patient with the history of repeated right-sided pneumonia the cause of which had not been investigated in detail in the past. Only hemoptysis, which appeared as a complication, led to a closer investigation of the background of repeated right-sided pneumonia. CT scan of the chest revealed a lesion of the middle lobe of the right lung with anomalous vascularization – compatible with intralobar sequestration. Initially, conservative antibiotic treatment of pneumonia was provided at a local clinic. Embolization of the afferent vessels of the sequestrum was indicated due to persistent hemoptysis; this led to a reduction of its blood supply, proven by a follow-up CT examination of the chest. Clinically, the hemoptysis subsided. Three weeks later, the hemoptysis reocurred. The patient was acutely hospitalized at a specialized thoracic surgery department where shortly after admission, hemoptysis progressed to life-threatening hemoptea. Urgent middle lobectomy of the right lung was approached via thoracotomy to treat the source of bleeding.
The case describes unrecognized bronchopulmonary sequestration as a possible cause of recurrent ipsilateral pneumonia in adulthood; additionally, it emphasizes the possible risks associated with a pathologically altered tissue microenvironment of pulmonary sequestration, and the need for surgical removal in all indicated cases.
Keywords:
hemoptysis – pneumonia – bronchopulmonary sequestration – hemoptea
Sources
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Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2023 Issue 1
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