A LUNG WITHIN A LUNG? A CASE REPORT OF MASSIVE HEMOPTYSIS SECONDARY TO PULMONARY SEQUESTRATION

TOPIC: Lung Pathology TYPE: Medical Student/Resident Case Reports INTRODUCTION: Bronchopulmonary sequestration (BPS), is defined as a non-functional mass of lung tissue with systemic arterial blood supply, but without normal tracheobronchial communication. BPS often presents in adulthood recurrent pulmonary infections and even fatal hemoptysis. We present case 53-year-old African American male large volume hemoptysis while hiking upstate New York, who was found to have right lower lobe intralobar sequestration. CASE PRESENTATION: A past medical history hypertension, hyperlipidemia, diabetes mellitus presented subacute cough for one month episode hiking. Review systems negative fever, chills, chest pain, pleurisy, tuberculosis, weight loss, anticoagulation use. He admitted recreational marajuana use, denied smoking cigarettes. Initially he tachypneic, saturating 91% on room air, hemodynamically stable. Computed tomography angiography (CTA) revealed internal locules air suggesting superimposed infection. Flexible bronchoscopy fresh the mainstem lobe. Thoracotomy followed by lobectomy, which confirmed diagnosis it demonstrated an aberrant supply from descending thoracic aorta. There no envelopment pleura around fed pulsatile artery. DISCUSSION: Pulmonary airway malformations are most common type congenital abnormalities respiratory tract, diagnosed 1 10,000 35,000 live births [1]. An (IS) located extralobar (ES) outside, both having their own visceral pleura. Hybrid lesions features both. ES early associated malformations, whereas IS later [2]. can appear other pathologies CT such lesion, cyst, cavity lesion localized emphysema [3,4]. Lobectomy should be prompt prevent complications, [5]. Shorter recovery times been noted video-assisted thoracoscopic surgery (VATS) [6,7]. Postoperative complications include empyema, hemoptysis, prolonged leak, fistula formation. Berna et al described surgical approach 25 patients 2011, all were doing well at long-term follow-up [7]. CONCLUSIONS: despite its rarity innocent presentation. Radiographic ambiguity nonspecific symptoms may delay appropriate management. It imperative initial query when managing In era COVID-19, where herald deadly disease, understanding broad differential expedites REFERENCE #1: [1] Durell J, Thakkar H, Gould S, Fowler D, Lakhoo K. asymptomatic, prenatally cystic malformations. J Pediatr Surg. 2016;51(2):231-235. doi:10.1016/j.jpedsurg.2015.10.061 #2: [2] Van Raemdonck De Boeck K, Devlieger al. sequestration: comparison between pediatric adult patients. Eur Cardiothorac 2001;19(4):388-395. doi:10.1016/s1010-7940(01)00603-0 #3: [3] Wei Y, Li F. retrospective analysis 2625 cases China. 2011;40(1):e39-e42. doi:10.1016/j.ejcts.2011.01.080[4] Qi W, Zhao Shi G, Yang Intralobar displayed computed image. 2017;12(1):83. Published 2017 Sep 8. doi:10.1186/s13019-017-0646-9[5] Rubin EM, Garcia Horowitz MD, Guerra JJ Jr. Fatal massive secondary Chest. 1994 Sep;106(3):954-5. doi: 10.1378/chest.106.3.954. PMID: 8082388.[6] Sun X, Xiao Y. patients: study. 2015;48(2):279-282. doi:10.1093/ejcts/ezu397[7] Polaczek, M., Baranska, I., Szolkowska, Zych, J., Rudzinski, P., Szopinski, Orlowski, T., & Roszkowski-Sliz, (2017). Clinical presentation characteristics Journal 9(3), 762–767. https://doi.org/10.21037/jtd.2017.03.107 DISCLOSURES: No relevant relationships Christian Castaneda, source=Web Response disclosure file Rammohan Gumpeni; Sophia Ji, Parmjyot Singh, Anthony Smith,