CRA29 HIDDEN IN PLAIN FILM: A RARE CAUSE OF PERSISTENT CONSOLIDATION IN YOUNG ADULTS

Farina Kamal Hizat, Subramaniam Ponnuvelu, Muhammad Khairul Taufiq Rosli, Johnson Chia Chun Hien
Department of Respiratory Medicine, Hospital Tawau, Sabah, Malaysia

Introduction
Bronchopulmonary sequestration (BPS) is a rare congenital condition where lung tissue receives systemic arterial supply and lacks communication with the airways. Although usually diagnosed in childhood, it may present in adults as recurrent or persistent lung infection, often leading to misdiagnosis.

Objectives
To describe two adult cases of infected pulmonary sequestration initially mistaken for more common infections, and to highlight the value of CT angiography in confirming the diagnosis. Methodology: Two young female patients, aged 21 and 23, presented with chronic cough, weight loss, and hemoptysis. Chest imaging showed persistent cavitary lesions in the left lower lobe. One had Klebsiella pneumoniae isolated on bronchoscopy and was treated as a lung abscess. The other received empirical antibiotics for presumed necrotizing pneumonia. Both re-presented with similar symptoms. CT angiography revealed intralobar pulmonary sequestration with systemic arterial supply and distinct venous drainage. Both were referred for lobectomy.

Results
CT angiography confirmed the diagnosis in both cases. Surgical resection was completed successfully, and both patients recovered fully. Histopathology confirmed sequestrated lung tissue with chronic infection.

Conclusions
Pulmonary sequestration should be considered in young adults with non-resolving or recurrent lung lesions unresponsive to treatment. Early CT angiography helps identify abnormal vascular supply and ensures timely diagnosis and surgical referral.