Intralobar and Extralobar Bronchopulmonary Sequestration Complicated by Nocardia asteroides Infection

Abstract

Pulmonary sequestration is a rare congenital or acquired pulmonary anomaly. Pulmonary sequestration may be classified as intralobar, located within normal lung, or extralobar, in which it is separated by pleura. The coexistence of both forms is extremely rare. Infection, mainly bacterial, is a major complication of sequestration. We report the case of a young man in whom a sequestration with both intralobar and extralobar components was complicated by Nocardia asteroides infection.

Recurrence of right lower lobe pneumonia 3 years after the first episode in an otherwise healthy 13-year-old girl

“…However, incomplete embolization and incomplete or null regression of the sequestered tissue are reported in 25-47% of pediatric cases [12,16]. Some authors advocate conservative antibiotic treatment with surgical intervention only in cases of repeated infections; however, this strategy is rarely used because of the potential of bleeding complications from repeated infections [15].…”

“…The most common complication of intralobar sequestrations is infection by bacteria migrating through the pores of Kohn or by other routes, if the sequestration is incomplete. The standard treatment is resection of the segment or lobe that contains the sequestered tissue [14,15]. Resection of intralobar sequestrations almost always involves a lobectomy, whilst segmental resections are usually only possible in lesions detected before the onset of infection.…”

A rare case of coexistent intralobar and extralobar pulmonary sequestration

“…Pulmonary sequestration is a rare congenital bronchopulmonary-vascular malformation, which represents about 0.15 to 6.4% of all the anomalies of respiratory tract [1][2][3][4][5][6][7]. Pathomorphological, it is a non-functional lung tissue that has no communication with traheobronchial tree.…”

“…Generally, they are more frequently encountered to the left, rarely to be bilaterally localized. ELS may be located outside the thorax, in 80% of the cases encountered in men and is usually diagnosed in infancy [2,[4][5][6][7]9].…”

“…Pulmonary sequestration was first described in detail by Pryce in the 1946 when intralobar (ILS) and extralobar form (ELS) of sequestration were precisely defined [3]. In the last 50 years some 900 separate publications have been presented with both forms of lung anomalies, while the simultaneous existence of the ILS and ELS has so far been presented only in 8 publications [4,5].…”