Pulmonary sequestration with Aspergillus infection presenting as massive hemoptysis and hemothorax with highly elevated carcinoembryonic antigen in pleural effusion that mimics advanced lung malignancy

Abstract

Background Pulmonary sequestration (PS) associated with massive hemoptysis, hemothorax, and elevated tumor markers or even lung malignancy has been reported in several studies. These clinical features combined with lung lesions on chest imaging are sometimes hard to differentiate from lung malignancies and often complicate the diagnostic procedure. Case presentation A 45-year-old man with PS presented with massive hemoptysis, hemothorax, and extremely elevated carcinoembryonic antigen (CEA) in pleural effusion was initially misdiagnosed with advanced lung carcinoma, but was ultimately diagnosed with PS with Aspergillus infection. Conclusions PS is rarely concurrent with lung cancer; most of the time, it is misdiagnosed as a malignancy, especially when presenting with a fungal infection, which could remarkably elevate CEA in pleural effusion.

Factors influencing the length of stay (LOS) undergoing robot-assisted thoracoscopic lung surgery in the setting of enhanced recovery after surgery (ERAS) protocol for pediatric patients: a retrospective study

“…Patients are often not diagnosed with cystic lung disease until they display symptoms of pneumonia or an occasional chest X-ray reveals the lesion in childhood or later. Asymptomatic lung lesions can become infected, undergo malignant degeneration, or cause hemoptysis ( 15 ), pneumothorax, or hemothorax ( 16 ). In this study, two patients were pathologically diagnosed with pulmonary blastoma after surgery.…”

Intralobar Pulmonary Sequestration Presenting as Hemothorax Secondary to Spontaneous Pneumothorax: Case Report and Literature Review

“…This might be due to the invasive effect of Aspergillus infection, or changes of state in blood vessel and blood flow caused by hypertension, aneurysm, salicylic acid drugs, and mechanical compression of the pectus excavatum. An additional excel file shows the details of these cases (see Supplementary Material 1) (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24).…”

“…Hence, surgical intervention is necessary and recommended. Conversion from thoracoscopic surgery to thoracotomy may be required in complex or emergency situations ( 17 , 21 , 24 ).…”