Pulmonary Sequestration Masquerading as Bronchiectasis in an Adult: A Case of Diagnostic Dilemma and Literature Review.

Abstract

Aim: Pulmonary sequestration is a rare congenital anomaly of the lung characterized by nonfunctioning pulmonary tissue that lacks normal communication with the tracheobronchial tree and receives blood supply from the systemic rather than the pulmonary circulation. Many patients remain asymptomatic for years, resulting in delayed diagnosis until adulthood. We report a case of adult intralobar sequestration (ILS) in which early diagnosis was obscured by bronchiectasis. This case aims to increase clinical awareness and provide insights into clinical strategies to reduce missed diagnoses.

Case presentation: A 45-year-old woman initially presented with fever, cough, and right-sided chest pain. Chest computed tomography (CT) showed bronchiectatic changes with infection in the right lower lobe, and her symptoms improved after anti-infective treatment. However, recurrent hemoptysis developed 10 days later. Thoracic aortic computed tomography angiography (CTA) with three-dimensional reconstruction identified an aberrant systemic artery supplying the right lower lobe, confirming the diagnosis of intralobar pulmonary sequestration.

Results: The patient subsequently underwent a right lower lobectomy via video-assisted thoracoscopic surgery (VATS). During the operation, an aberrant artery originating from the aorta was successfully identified and secured with double ligation. Postoperative pathological examination confirmed pulmonary sequestration, revealing marked thickening of the alveolar walls and chronic inflammation. At the 3-month follow-up, the patient had recovered well, with no recurrence of symptoms.

Conclusions: Pulmonary sequestration should be considered in patients with recurrent localized bronchiectatic lesions, particularly when hemoptysis occurs or response to treatment is incomplete. CTA with vascular reconstruction is useful for diagnosis and preoperative evaluation.