Pulmonary sequestration: an unlikely diagnosis

Abstract

Introduction: Pulmonary sequestration is a rare congenital abnormality. It can be defined as an embrionary mass of lung tissue composed of the airway and alveolar elements, and it can be classified as pulmonary intrabolar sequestration (ILS) or extralobar sequestration (ELS). ILS is the most common, and males and females are equally affected. ILS is presented later in human life with infections, hemoptysis, and dyspnea. ELS is less prevalent, it presents a male predominance, and normally it is diagnosed early. The main treatment is sequestered lung resection, with a good prognosis.

Case description: Woman, 39-year-old, Caucasian who worked as a plastic artist. She had a personal background of rosacea and pulmonary tuberculosis, without medication or allergies. She was a social smoker and drinker. She went to the family’s doctor on 30^th November 2020, D15, due to a dry cough and vespertine fever. She was ordered to do posteroanterior thorax radiography and blood tests. She went to the emergency room (ER), D43, due to the prevalence of the symptoms, where she was prescribed azithromycin 500mgs id, 3 days, desloratadine 5mgs id, 20 days, and prednisolone 5mgs, bid, 4 days. The patient returned to the family’s doctor, after going again to ER, due to the lack of improvement. The patient was referred to pneumology by the family’s doctor and was diagnosed with pulmonary sequestration. She was sent for thoracic surgery and was submitted for lobectomy.  Now, the patient maintains follow-up after surgery, without symptoms, and with a good prognosis.

Commentary: The etiologic investigation led to an unlikely diagnosis of pulmonary sequestration. This case highlights the relevance of complementary diagnostic methods in this kind of pathology and shows the importance of a good articulation between primary and secondary health care, leading to an advantageous diagnosis and treatment.