Pulmonary sequestration is defined as a portion of abnormal lung tissue that does not communicate with the tracheobronchial tree through a normally located bronchus and has an abnormal vascular supply [1]. It was first described by Rektorzik in 1861, but the term "sequestration" was introduced by Pryce in 1946 in a 7-case report [2,3]. This extremely rare disorder accounts for 0.16% to 6.4% of all pulmonary congenital malformations [3]. Depending on its location, pulmonary sequestration is generally subdivided into intralobar and extralobar sequestration [4]. Extralobar pulmonary sequestration accounts for 14%-25% of cases [2]. It is most frequently diagnosed in the first 6 months of life, but is seen incidentally, though rarely, in older children and adults [5]. We present an adult case with extralobar pulmonary sequestration.
Case ReportA 36-year-old Turkish female, a non-smoker, was admitted to our department with complaints of chest and back pain for five years. Her past history was unremarkable. A chest X-ray (CxR) showed an area of opacity behind the cardiac silhouette in the lower area of the left hemithorax (figure 1). On admission, her resting pulse rate was 86 beats per min., blood pressure 100/70 mmHg, and respiratory rate 18 breaths per min. Her respiratory system and general examinations revealed no significant abnormalities. Full blood count and biochemical tests were normal. Erythrocyte sedimentation rate was 20 mm/h. During hospital stay, the patient was given a course of antibiotics, but opacity in the left lower area persisted. A Computed Tomography (CT) scan of the thorax with intravenous contrast showed a 9 x 7 cm in size ovoid mass with necrosis in the lower left lobe. It revealed two aortic branches directed toward the pulmonary opacity (figure 2), which is consistent with a suspicion of pulmonary sequestration. Bronchoscopic examination revealed a normal endobronchial appearance. Bronchial lavage examination was negative for acid-fast bacilli. Her thoracic Magnetic Resonance (MR) angiography showed an arterial supply from descending thoracic aorta. Pulmonary functional tests were within normal limits. The patient was referred to surgery, and a left-sided thoracotomy was performed. The lesion was located within the pleural space between the diaphragm and the lower lobe. Four arteries arising from the descending aorta were identified. The anomalous pulmonary tissue was removed by mass excision. Pathologic examination of surgical material obtained diagnosis of extralobar pulmonary sequestration. The patient still remains in excellent condition after nearly two years from the operation. We described the case of a 36-year-old Turkish female with an extralobar pulmonary sequestration who suffered from chest and back pain for five years without any evidence of pulmonary infection. A chest X-ray showed an area of opacity behind the cardiac silhouette in the lower area of the left hemithorax. A CT scan of the thorax with intravenous contrast showed a 9 x 7 cm in size ovoid mass with necrosis in the...
