CRA78 HIDDEN UNTIL NOW: AN EMBRYOLOGICAL ANOMALY UNVEILED IN ADULTHOOD
Pin Jin Yong1, Chong Rui Toh1, Shi Jie Chin1, Hema Yamini2
1 Hospital Labuan, Wilayah Persekutuan Labuan, Malaysia
2 Hospital Queen Elizabeth, Kota Kinabalu, Malaysia
Introduction
Pulmonary sequestration is a rare congenital anomaly characterized by non-functional lung tissue receiving aberrant systemic arterial supply. While typically diagnosed in childhood due to recurrent infections, some cases remain asymptomatic until adulthood, presenting with unexplained hemoptysis. This case highlights the diagnostic challenges and management considerations of adult-presenting pulmonary sequestration.
Case Description
A 26-year-old male, with no prior history of childhood hospitalisations or recurrent pneumonia, presented with massive hemoptysis in May 2025. Interestingly, this was his third episode of hemoptysis since 2020, with previous pulmonary tuberculosis workup yielding negative results. His prior chest radiograph was unavailable but reportedly normal.
On presentation, chest auscultation revealed left lower zone crepitations with chest radiography demonstrated a mass-like consolidation in the left lower lobe. He was treated inpatient with intravenous antibiotic, nebulized tranexamic acid, and nasal prong oxygen therapy. Sputum cultures, acid-fast bacilli (AFB) smears, and GeneXpert MTB/RIF testing were negative. A subsequent computed tomographic thorax and angiography revealed left lower lobe intralobar pulmonary sequestration, showing a well-defined soft tissue mass (64 HU, 5×7×6 cm) in the posterior-basal segment of the left lower lobe, supplied by an aberrant artery from the descending thoracic aorta with venous drainage into left inferior pulmonary vein.
Discussion
This case underscores the diagnostic complexity of adult-presenting pulmonary sequestration, given its symptoms overlap with infectious etiologies. Aberrant systemic arteries, recurrent infections, inflammation, arteriovenous shunting, and bronchial erosion may contribute to hemoptysis in pulmonary sequestration. While both lobectomy and embolization were discussed, the patient opted for surgical intervention and is awaiting cardiothoracic review.
Conclusion
Recognizing pulmonary sequestration in patients with recurrent hemoptysis and abnormal chest radiography, even in the absence of infection, can facilitate timely diagnosis and management, improving clinical outcomes.