CRA89 BRONCHOPULMONARY SEQUESTRATION AS SHE LIVES AND BREATHES - A CASE REPORT

Ag Zarif Aminuddin BIN AG DAMIT¹, Rong Lih HO ¹, Larry Ellee NYANTI ², Tharmaraj KUNARAJ¹, Hema RAMAMURTY¹, Shan Min LO¹, Nai-Chien HUAN¹, Kunji Kannan SIVARAMAN¹

¹ Respiratory Department, Queen Elizabeth Hospital, Sabah, Malaysia.
² Medical Department, Faculty of Medicine and Health Sciences, University Malaysia Sabah.

Introduction
Bronchopulmonary sequestration (BPS) ; a rare congenital abnormality manifesting as a mass of lung tissue that lacks the communication of the tracheobronchial tree yet receives systemic arterial supply. BPS can be detected as early as pre-natal sonography for Extralobar-BPS or present as recurrent lung infection in cases of Intralobar-BPS.

Case
A 21-year-old lady presented to us with five-days history of greenish productive cough, associated with left lower pleuritic chest pain, fever and dyspnoea. Without hemoptysis or constitutional symptoms.

Chest radiography revealed left middle zone air-fluid level. Combined with high inflammatory markers prompted a CECT Thorax exhibited left lower lobe heterogeneous mass with arterial supply from lower thoracic aorta but no communication with airway suggestive of BPS. Multiple hypodense lobules with air-fluid levels and adjacent ground glass density likely complicated with abscess formation. Cultures and tuberculous work-up deemed negative. Draining of the abscess carries 90% risk of bronchopulmonary fistula. She is scheduled for lobectomy after CECT Thorax reassessment following completion of 4-weeks of parenteral then oral antibiotics.

Discussion
BPS subtypes are classified anatomically; Intralobar sequestration (ILS), Extralobular (ELS), Hybrid/Congenital Pulmonary Malformation, Bronchopulmonary foregut malformation. 

ILS-located within a normal lobe and lacks its own visceral pleura, accounts for approximately 75% of all cases.

BPS that causes any respiratory symptoms are treated with surgical resection - curative.
Surgical resection is encouraged for asymptomatic patients of any age with characteristics suggestive of high risk for developing complications.

Conclusion
Symptomatic BPS requires surgical resection which prevents the occurrence of repeated complications which may cause long term morbidity.